In January, Sonali Patel, an emergency department doctor at a big Houston hospital, became ill while on duty. After testing positive for Covid, she said she told her boss she had the coronavirus and was going home.
“He insisted I stay and finish the shift,” she recalled in an interview with NBC News and in a recent lawsuit. “I told him it’s not the safe thing to do. We have a ton of immunocompromised patients and we were putting them at risk.”
By requesting time off from work while sick with Covid, Patel breached an unofficial policy promoted by officials at the hospital staffing company she works for — American Physician Partners — according to the lawsuit filed against the company by her and seven physician colleagues.
Those doctors say American Physician Partners' officials pressed them to work while ill, even if they contracted Covid and could spread it to patients and colleagues, according to the suit filed in Harris County, Texas, district court in March. Physicians who worked while sick were celebrated, while those who stayed home with Covid had their pay docked, the lawsuit says.
One American Physician Partners medical director had a name for the unwritten policy about working while having Covid symptoms, the lawsuit says. It was “the 4 M’s,” which stood for “Motrin, mask, man-up and must not test.” When a physician raised concerns about this practice, he was told by a superior that “that’s just the culture” at the company, according to the suit.
American Physician Partners, founded in 2015 and based in Brentwood, Tennessee, provides emergency department staffing in more than 150 facilities in 18 states, its website says. Eighteen are hospitals in the Houston Methodist system, according to the doctors’ lawsuit. The company is backed by BBH Capital Partners, the private equity unit of Brown Brothers Harriman, a New York investment firm.
An American Physician Partners spokeswoman said it is the company’s policy not to discuss pending litigation. A BBH Capital Partners spokeswoman said the company does not comment on pending litigation at its portfolio companies.
Pressing doctors to work when they have Covid could result when an emergency department is intentionally understaffed to save money, said Dr. Mitchell Louis Judge Li, founder of Take Medicine Back, a movement to eliminate corporate control from health care. Regardless of the motivation, he said, understaffing an ER is dangerous.
“Short-staffing or inappropriate staffing chosen by a corporation does not allow physicians enough time to be effective with their patients,” he said. “That is a clear public health risk.”
NBC News has not confirmed whether short-staffing was an issue at the hospital.
A spokeswoman for the Houston Methodist hospital system, which is not a party to the suit, said in a statement the litigation was an internal dispute that had nothing to do with the care provided by the hospital system.
“We are unaware of any ER doctor who came to work after testing positive for Covid-19,” the statement provided by Stefanie Asin said. “Our hospital system’s quarantine and isolation policy aligns with CDC guidance, which means employees and physicians are instructed to stay home from work if they test positive for Covid-19 for the required quarantine period. Our emergency rooms saw at least 50 percent increases in patients during the worst of the pandemic, and all of our ER physicians performed heroically and took great care of our patients when they needed it the most.”
Private equity firms have taken over a broad swath of health care entities in recent years. They use large amounts of debt to acquire companies, aiming to increase profits quickly so they can resell for gains a few years later.
Their forays into emergency medicine are transforming the field, analysts and health care experts say. Today, an estimated 40-plus percent of the country’s hospital emergency departments are overseen by for-profit health care staffing companies owned by private equity firms, academic research, regulatory filings and internal documents show.
Concerned about the potential peril these takeovers have on patient care, legislators in some states are proposing bills to rein in health care acquisitions by for-profit and private equity entities. On June 16, Pennsylvania state Sen. Tim Kearney, a Democrat, and several of his colleagues in the Legislature announced a package of bills to “safeguard the integrity of local health care systems and protect patients from suffering the repercussions of greedy and irresponsible hospital schemes carried out by private equity firms.”
One bill would establish a two-year moratorium on the transfer of ownership of any hospital or health system in Pennsylvania involving a for-profit entity; another would prohibit for-profit entities from owning or managing hospitals in the state.
“All this stuff happens in the quiet, it never happens where people can see it and understand it,” Kearney said in an interview. “We hope to shine a light on this practice, let people understand what’s happening to their health care and why it’s happening.”
American Physician Partners is smaller than its two top competitors in emergency department staffing — Envision Healthcare and TeamHealth, both of which are also backed by private equity firms. In a November 2021 investor presentation reviewed by NBC News, American Physician Partners said it is “the industry’s low-cost provider” and described emergency department staffing as a $17 billion market. “As elderly become larger proportion of the population, demand for critical care in the ED increases,” the presentation noted.
The lawsuit against American Physician Partners is a sign of growing discontent among front-line health care workers with the impact they say profit-oriented owners are having on patient care and hospital work environments. Another came earlier this month, when most of the emergency department and anesthesia professionals at two Southern California hospitals, Corona Regional Medical Center and Temecula Valley Hospital, threatened to resign if plans to hand control of hospital services to Envision Healthcare go through.
An Envision spokeswoman declined to comment.
The Houston area doctors are seeking $1 million in damages in their suit and allege that because of its practices, American Physician Partners failed to pay them as promised. In addition to docking pay for days missed because of Covid, the doctors contend, the company deducted costs from their pay for services that were not provided and did not compensate them for treating patients who decided to leave the hospital against medical advice, an occurrence the physicians couldn’t control.
American Physician Partners has “been attempting to artificially inflate its books to appeal to investors and avoid insolvency by maintaining cash flow at the direct expense of the doctors,” the suit alleges.
Dr. Prasanth Boyareddigari is one of the doctors suing American Physician Partners. He is the educational director of the Houston Methodist Emergency Department and an assistant clinical professor of emergency medicine at Weill Cornell Medical College and the Texas A&M School of Medicine.
American Physician Partners' practice of requiring physicians to work when sick is a result of trying to save money by inadequately staffing facilities, Boyareddigari said in an interview. “If they lose one or two physicians to illness, they are in a bind,” he said. “They are utilizing whatever measures they can to be financially efficient and saving costs regardless of outcomes or the effect on patient care, which is quite the opposite of what we would do as physicians.” His views on this are also reflected in the lawsuit.
Dr. Robert McNamara is professor and the chair of emergency medicine at Temple University's Lewis Katz School of Medicine and a vocal critic of corporations practicing medicine, which he says can lead to putting profits ahead of patients. More than 30 states, including Texas, have laws against the corporate practice of medicine.
“The fundamental code of medicine is to first do no harm,” he said. By asking doctors to work when they have Covid, “you’re asking somebody to break that oath.”
Late last year, American Physician Partners warned investors that its revenues might be hurt by the “No Surprises Act,” recently passed by Congress to curb high cost, out-of-network medical bills patients can receive when they are treated at hospital emergency departments. In the November presentation, it cited “numerous cost-saving initiatives underway as part of the company’s continual focus on cost optimization” to maintain its earnings “if the ‘No Surprises Act’ results in downward pressure on rates.”
The new legislation could cut $11 million or roughly 9 percent from American Physician Partners' most recent 12-month operating income, the document said. But cost-saving efforts, such as reducing staffing hours and shifting the staffing between higher-cost doctors and lower-cost mid-level practitioners “to align with volume trends,” should neutralize the impact, the company said.
The American Physician Partners spokeswoman declined to say whether the “No Surprises Act” had hurt the company’s results.