By Amy Silverman
By Olivia LaVecchia
By Monica Alonzo and Stephen Lemons
By Chris Parker
By Michael Lacey
By Weston Phippen
"But obviously, [Malone] made his plans apparent to me, and unfortunately for someone, I don't know who--me, the patients, Maricopa County--there was a change," Casano says.
Dr. Ames "Berne" Yee, now in his own practice, recalls that the kick out the door was swift. "We used to do some volunteer attending work with the residents, and we were told, basically, 'You're not needed anymore,'" he says. "We were sent a letter. There was no 'thanks for helping'--it was just sort of a 'get lost' letter."
For doctors like Yee, who had done his residency at Maricopa, the separation was abrupt and painful. Doctors from Phoenix used to be invited to meet and discuss cases regularly with students at the hospital. Malone let it be known that they weren't welcome anymore, Yee says.
"My general impression was that he didn't want the general community knowing what was going on at the hospital, that he ran the place his way," Yee recalls.
Yee believes that was a loss for the hospital. "[The residents] got a lot of good, practical, hands-on experience [from the doctors]," Yee says. "Malone kind of changed how things worked, so I thought the residents didn't get as good an education as they did in the past."
In 1992, Malone's surgeons group merged with the other doctors at the hospital and, in 1993, entered into one contract for all services under the name of the Maricopa Faculty Association, later changed to MedPro. Under the arrangement, the county negotiates with one provider for all the hospital's health care, instead of dealing with each individual specialty. This group also teaches medical students who do their residency at Maricopa County's hospital. In addition to being president of the physicians' group, Malone is also responsible for the surgical-residency program--a position he's held for most of the past decade.
After finishing four years of medical school, med students are required to complete a residency at a teaching hospital before they can become fully accredited doctors. In exchange for the experience, they're expected to provide long hours of cheap labor. A medical residency is often the most grueling three to six years of a doctor's life.
Dr. Deborah White, a resident at Maricopa Medical Center from 1989 to 1992, says there's no doubt that the surgical program is tough. A lot of that just has to do with the realities of surgeons and surgery, she says.
"You kind of have to have this ego and bravado to do this, so you get a bunch of cowboys," she says. "You'd be up two days straight, go home late at night and have to be up at 4 in the morning. And you do that for weeks and weeks, and you get this real battlefield mentality. Even though you're supposed to have four weeks off a year, people rarely took them, because if you took them, that was a sign of weakness . . . and they would think of you as a weenie. And the last thing you want, especially as a female surgeon, is to be thought of as a weenie."
Adding to the pressure is the knowledge that you can be fired at any time, for almost any reason, White says.
"Not only are you doing a job where you never feel like you know enough, you're terrified of killing somebody," she explains. "You're afraid that each mistake you make might cost you your job and you might never find another one, and all those years will have gone to waste."
However, the surgical-residency program at the Maricopa Medical Center might have crossed the line from demanding to simply punitive.
Dr. Magda Cynkutis-Simon and her husband, Robert Simon, a civil rights attorney, contend that MedPro has gone after Magda to get even for her report of sexual discrimination, and that the Maricopa County government is now adding to the damage to her career by defending MedPro.
Cynkutis-Simon says she was doing fine in the program until her second year. Then a number of problems started, she says.
Malone, whom she says never worked with her on a procedure, gave her low marks on a faculty evaluation in September of last year. Malone wouldn't grade other surgeons he hadn't worked with, she says. "He didn't do that for me, even though he did that for others. He decided to trash me."
Cynkutis-Simon also ran into problems with two rotations of her program: at the Barrow Neurological Institute and at the Mayo Clinic. Her evaluators cited concerns about Cynkutis-Simon's attitude, her inability to work with others and her surgical skills.
On March 19, Malone wrote a memo to Cynkutis-Simon requiring her to seek counseling.
"Your preceptor . . . has informed members of the committees that your interpersonal skills may be to blame for your poor scores, and that some of your grievances regarding your . . . rotations may be justified," Malone wrote. "Therefore, the Governance Committee has agreed to permit you to seek counseling, rather than place you on probation."
In April, the faculty committee sent another memo to Cynkutis-Simon, spelling out in more detail and stronger language its problems with her performance.
"There is not one service on which you rotated this year where you did not receive unsatisfactory and/or unacceptable performance grades by one or more of your evaluators," Dr. Peter Ferrara, the committee's chair, wrote.