Distaff Is Restless

A resident gets cut from Maricopa Medical Center's surgical training program. She says it's discrimination. It's just the latest problem facing the center's taxpayer-funded contractor, Medpro.

Dr. Magda Cynkutis-Simon immigrated to the United States from Poland when it was still under a Communist regime. She knows better than most the frustrations of dealing with the arcane rules of bureaucracy, unresponsive officials and violations of her dignity.

She just never expected to face those problems while a resident at Maricopa Medical Center.

Cynkutis-Simon was placed on administrative leave--in effect, fired--from her position as a doctor at the county-owned hospital on October 1. She and her attorney, Jim Vaughan, went from office to office trying to find someone who would offer her a reason.

The only response she got: Call the County Attorney's Office.
When Vaughan asked Dr. Beverly Rowley, who runs the Office of Academic Affairs at the hospital, the reason for the firing, Rowley replied, "No reason is needed."

Vaughan demanded, "Is she a threat to patients?"
"I'm not going to respond to you," Rowley said.
Why? Vaughan asked.
"Because I don't have to," Rowley said.

Cynkutis-Simon thinks she knows why, however. She says that her firing is retaliation for reporting sexual discrimination in the surgical-residency program at the county hospital. She intends to file for an injunction against the county, asking a judge to overturn the dismissal.

She's not the only one who's complained of sexual discrimination. Two other residents made the same allegations before Cynkutis-Simon did.

Cynkutis-Simon's charges are the latest problem for the private contractor which runs the training program for medical students at the hospital, Medical Professional Associates Inc., also known as MedPro.

In the past year, surgical students' test scores have fallen. The director of the surgical-residency program has been fired, and the doctor who took his place is no longer board-certified, as required by accreditation councils.

All this is worrisome, partly because MedPro's doctors and residents at Maricopa Medical Center deliver the majority of care to patients there, especially in emergency medicine. MedPro is also using county, state and federal dollars to train medical students. And Maricopa County taxpayers cover the costs of defending malpractice suits against MedPro's doctors.

Taxpayers will also be picking up MedPro's tab for Cynkutis-Simon's discrimination lawsuit.

But despite the massive public investment in MedPro, the county government hasn't taken much of an interest in public oversight. Maricopa County's Board of Supervisors and administrators have demanded little accountability. Instead, with few exceptions, they seem content to let private contractors like MedPro run the day-to-day operations of the hospital.

Since 1996, MedPro's contract has dropped by $10 million after county negotiators began questioning MedPro's charges. But even MedPro's most recent contract was passed quickly and without much scrutiny or public comment.

County officials and representatives of MedPro declined comment for this article.

But MedPro still has a bright future with the county. The Board of Supervisors is now considering a variety of options to privatize the hospital, something it's been trying to do since 1994. MedPro figures prominently in almost all of the plans.

While the county struggles to find a way to divest itself of the financially troubled hospital, one thing seems certain: The doctor bills will continue to be delivered to the public--and right now, county administrators keep paying them, no questions asked.

MedPro--formerly known as the Maricopa Faculty Association--is one of the most powerful players in the local health-care industry, despite its low profile.

It is the second-largest physicians' group in Phoenix, and trains 237 medical residents in a variety of medical specialties, including surgery. It currently pulls in more than $32 million from the county for its services at the publicly owned Maricopa Medical Center, plus more from private billings generated by its doctors for work done at the hospital. MedPro's doctors--students and teachers--are responsible for almost all the care delivered in the most critical areas of the county hospital: trauma (emergency), general surgery and the burn unit.

MedPro is controlled by Dr. James Malone. As president, CEO and chairman of the board of MedPro, Malone has the power to fire other doctors in the corporation immediately, with 10 days' pay, according to the corporate bylaws. Malone has also negotiated with the county for MedPro's contract. And, in the attempt to privatize the hospital, he has served as the corporation's spokesman and is chair of the hospital's department of surgery.

Malone didn't return phone calls for this article. But those who know him describe his powerful intellect and his controlling personality.

Malone took over surgical operations at the county hospital in the mid-1980s in the manner of a surgeon: swiftly, decisively and sharply. Previously, doctors had more or less donated their time as teachers, getting only a small stipend and hospital privileges. They taught the medical residents at MMC while keeping their own outside practices. Malone changed that--he didn't want doctors to have practices outside their duties to the hospital and to the contracted physicians' group. In the process, several doctors were told their services were no longer needed.

"The scenario previously was that we could maintain private practice and still donate time to the medical center--but Jim Malone wanted full-time faculty, which is pretty common," Dr. Salvatore "Sam" Casano says. Casano covered one or two trauma rotations a month under the previous arrangement.

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