Editors’ note: This article has been updated to clarify Vierra’s quote at the end of the article.
Dr. Benny Benzeevi took the stand today in a case brought by a group of doctors against Tulare Regional Medical Center (TRMC).
The case, which centers around the January 2016 removal of the hospital’s old Medical Executive Committee (MEC) and medical staff, concluded for the month.
Benzeevi, the CEO of Healthcare Conglomerate Associates (HCCA) the company which runs TRMC, testified that he, and others with the hospital, believed the removal was necessary and required to be done as fast as possible, based upon statements made by an inspector representing the Centers for Medicare and Medicaid Services (CMS).
Lawyers for the deposed MEC contend that the hospital’s administration and board did not give them a chance to remedy those concerns — or even involve them in the process leading up to their ouster — and that the removal was against state law and the hospital’s bylaws.
“Living Under A Rock”
Dr. Everett Davis was the CMS inspector who led hospital officials to believe that without immediate, sweeping action, the hospital’s future would be at risk, Benzeevi said.
Davis had called an impromptu exit interview on January 7, 2016, Benzeevi told the court, and at that point he gave a scathing assessment of the hospital’s medical staff.
“He said ‘[This] is a completely dysfunctional medical staff, and if this persists, the hospital will be no more,’” Benzeevi stated.
No one from the former Medical Executive Committee was in the room, all sides agree, when the CMS inspector, “angry [and] disgusted,” gave his view of the state of affairs at the hospital.
Benzeevi’s characterization of Davis mirrors that made by Dr. Parmod Kumar, a long-time hospital board member who was also present at the interview.
“What he told me, when he was insulting me as a board of director, he’s so disgusted, he was going to leave,” Kumar testified. “He was supposed to be here for two more days and complete the survey, and things are so bad here, he’s leaving.”
The hospital’s CEO said that he did not make an effort to invite any members of the former MEC to the interview with Davis.
“You don’t go to the problem to solve the problem,” Benzeevi told Michael Amir, a lawyer representing the former MEC.
After being questioned by Amir, Benzeevi clarified that while there was no clear indication that Davis would find any faults with the medical staff or MEC, he knew that Davis was regularly spending time in the medical office.
That led him to believe that Davis would likely find issue with medical staff or the MEC.
While Benzeevi did not offer for Davis to meet with the MEC during his time in Tulare, he claimed that Davis was a demanding figure — not open to discussion.
“Dr. Davis demanded things and wouldn’t allow you to speak,” he said.
After the impromptu exit interview, Benzeevi agreed that he had not informed the prior MEC of the upcoming January 26 vote or Davis’ statements – and that he was not aware of anyone who had informed them.
“You’d have to be living under a rock,” to not realize that the medical staff and MEC would not be involved somehow, Benzeevi said. “It was pretty obvious [Davis] was angry. It would be impossible to miss it.”
The Follow-Up
Benzeevi was asked about a follow-up survey from CMS in March, after the ouster of the former MEC — with Davis again emerging as a key figure.
“Literally, [he was] screaming and yelling like we were little children,” Benzeevi said. “He said we made it worse, not better.”
The day after the survey, HCCA officials wrote a letter responding to Davis’ statements, with Benzeevi’s signature attached.
Amir asked why the hospital hadn’t written a similar letter to CMS after its initial survey in January.
“The findings the first time were things we knew to be the case,” Benzeevi said.
Amir produced a copy of the letter, which claimed that Davis “did not care that [Judge Mathias] had found the disassociation was not a violation of applicable law or bylaws.”
At the time the letter was written, Mathias had only denied a request from the former MEC for a temporary restraining order preventing the new medical staff from being installed.
Records “Languishing”
Benzeevi noted that some of the medical staff’s peer review files were “languishing,” going unresolved for “years to months.”
Peer review is a process that ensures quality care is being provided by physicians to patients at the hospital.
As a member of the hospital’s administration, he stated that he received reports that tracked how long peer review cases had been open, and if they had been closed or not.
He could not provide a specific number of cases that had not been closed in a timely manner, instead only stating that there were “a handful,” occupying “a half of a page” of paper.
Amir asked whether the physicians whose’ files were languishing were Dr. Rebecca Zulim, Kumar, or himself — and if they were languishing due to a lack of cooperation.
Benzeevi stated that he had never “[had] an instance of noncooperation,” and stated that the files left open did not involve Kumar, Zulim, or himself.
Benzeevi had been subject to the peer review process in 2013 while running the hospital’s emergency department, a court filing shows, when Dr. Anil Patel, the former Chief of Staff of the old MEC, received a letter claiming that Benzeevi created a hostile work environment.
The document was filed in a separate lawsuit by Benzeevi against Dr. Abraham Betre, the last Chief of Staff of the former MEC.
“On or about March 13, 2013, while still in charge of running the Hospital’s Emergency Department, I was informed by Dr. Anil Patel, who was the current Chief of Staff of the Tulare Regional Medical Center Medical Staff (the ‘Former Medical Staff’),” Benzeevi’s declaration read, “that an anonymous letter accused me of creating a ‘hostile work environment.’ The letter was ‘signed’ Staff but otherwise provided no indication of who sent the letter or whether it was even sent by an actual member of the Hospital staff.”
An ‘ad hoc’ committee was created to investigate the letter further, and the matter was later sent to the Institute for Medical Quality, which found that the allegations were largely baseless.
“On November 27, 2013, the IMQ issued its peer review report regarding the allegations against me. With a single exception, the IMQ found that the various accusations against me were ‘unsubstantiated,’ and in some instances were contrary to the actual evidence,” Benzeevi’s declaration read.
“Additionally, IMQ criticized management and the Former Medical Staff for failing to ‘work as a cohesive team’ and stated that the ‘[Former] Medical staff peer review processes must be improved.’ Finally, the IMQ made some suggestions regarding how managers, including myself, could improve interpersonal relations with the nursing staff.”
The same document quotes a declaration by Kumar regarding his peer review process.
“I received a letter from Dr. Betre […] informing me that the [former] MEC was investigating me for using foul language in front of a subordinate on one occasion,” Kumar’s declaration read, “and for ‘backdating’ chart notes in three cases.”
“[…] the ‘backdating’ accusation was made after I had inadvertently listed the dates of my dictation as the dates of three patients’ physical examinations, at a time when I had performed approximately 150 procedures [in] 18 month[s].”
Dr. Anthony Vierra, an anesthesiologist based in Tulare, took the stand after Benzeevi.
Vierra was a member of the former MEC, he said, and a member of the credentialing and bylaws committees.
He stated that he while he was not directly involved in the former MEC’s peer review committee, he received reports from them due to his position on the MEC.
The MEC’s stand-alone peer review committee, Vierra explained, handles peer review cases for “high-profile physicians” and department chiefs — other peer review cases are handled by physicians’ own specialty departments.
Vierra gave insight into Kumar’s April 5 testimony regarding his peer review case.
Kumar claimed that he was not given due process, but Vierra claims that the MEC gave Kumar approximately a year to perform his required training.
“He did not do it time and time again,” Vierra said.
Kumar was given a final deadline, Vierra said, of approximately one to two days before the January 26, 2016, vote to disassociate from the old MEC.
“[It was] necessary for him to keep his privileges. If he didn’t do it,” Vierra said, contradicting Kumar’s prior testimony, “he would not have privileges [at TRMC.]”
The Medical Staff Clause
Jason Baim, a lawyer representing the old MEC, shifted gears to a controversial portion of HCCA’s Management Services Agreement, the contract governing the relationship between HCCA and the Tulare Local Healthcare District, the legal entity which owns TRMC.
The document allows HCCA to submit amendments to medical staff bylaws unless the individual recommendation is voted down by the hospital’s board of directors with a 4/5ths majority. The agreement also requires the board to provide a written notice “with good cause” after giving HCCA a “reasonable opportunity” to explain or justify the recommendation.
The agreement created “uneasiness among employees,” according to Vierra’s recollection of one MEC meeting.
At the same meeting, Tony Jones, a former CEO/Chief Restructuring Officer for HCCA, made a striking admission according to Vierra.
“He told of he was aware of the clause in there that said they were going to essentially disband the current MEC and appoint one,” Vierra said. “He was aware of that one and said that’s not my clause, not my contract, but I’m aware of it.”
The trial will resume on May 22 at 9:30am in Department 2 of the Tulare County Superior Court.
Here’s a video from today’s hearing with Dr. B on the stand:
Who had the handful of marbles, Kumar or Benzeevi???
The community is right, you people are pathetic. Citizens for Hospital Accountabily-Your Lies are disgusting and disgraceful. In my opinion your whole group is just very angry that somebody has finally came in to repair the damage from the past individuals whom now run the Citizens Site.
As for Dr Kumar he’s done more positive things for the Community of Tulare then any of your so called doctors combined.
Kim–
It’s legitimate that you disagree with the Citizens for Hospital Accountability group. But calling their assertions “lies” does get a bit tired. You’re better than this. They are merely expressing what their position is. As do you. We here at the paper merely express the facts as they present themselves. No one is impugning the quality of your nursing. Nobody wants to see the hospital fold. And the process–the trial and the recall of Dr. Kumar, and whatever will come next–will unfold as it all must do. So–How about we tone down this shooting from the hip and each of us focus on whatever our individual task at hand is? They’ll protest, you’ll nurse, and we’ll run a newspaper. That way, when it’s all said and done, we’ll each be able to continue. You do a great disservice to yourself and your cause by using words such as “lies” and “disgusting” and “disgraceful.” Calling doctors “so called” doesn’t further your cause, either. You’re going to have to work with someone in the aftermath of all this–think about that. And we’ll still be here to report it. How about we all work together to make this a good–or at least non–story?
Didn’t you know what was in the contract?
Truth is finally coming out.
The Loan they are seeking also has strings attached to the Management Service Agreement.
If the original Bond of $15 million (which is now $13+ is paid off HCCA gets to profit share at 95% and 5% to the district) Betcha didn’t know about that one either…….
I have some old notes that show the hospital had $41 million to start the tower, Cash. Where’s the accounting? Added to the $85 that makes $125 already……if they get an additional $76 million, our hospital will be over $200 million dollars! That adds up to over $1600 bucks a square foot! Highest ever paid on a hospital facility!
I thought HCCA’s plan was to get the new ER open and work on the upper floors with profits….oh wait, HCCA doesn’t want to be responsible for anything. As a matter of fact they wanted everything they put into that tower in the interim paid back!
I don’t think Benzeevi could manage his way out of a paper bag!
Joseph everyone disagrees is either Kim or Teresa. Prior to that I was Samantha Blans assistant not to mention Kathleen Johnson. A real paper would never disregard the opinion of others as this one does.
Joseph I encourage you to go through your paper/comments and start calling out people who have disrespected Dr Kumar ,
Dr Benzeevi Sherri Bell , Laura Gadke and Richard Torres , or is that acceptable because those people are on the Citizens Site.
Kassandra
Let’s look at some of the Language by Valley Voice and Citizens for Hosputal Accountability that is allowed to linger On the pages for continuous viewing, yet most who disagree are deleted.
MURDER
BENSLEZZI
NO COMMON SENSE
OPPORTUNIST
SERIAL KILLER
TOWER OF SHAME
THIEF
LIES
LIARS
CROOKS
ADULTEROUS
LOVE CHILD
DECEITFUL
DISGARCEFUL
DISGUSTING
This is the format in which you have encouraged your readers to communicate and it’s very sad.
The Voice has never used any of those words except for “Tower of Shame,” which is the title of a Tulare County Grand Jury report. The Tulare County Grand Jury is an arm of the State and the County.
No commenter has ever used the word “murder” in relation to the hospital or its officials.
Please feel free to send any comments my way that you find to be objectionable. If they do not meet our standards, I will take them down. [email protected]
Socrates once said
” The secret of change is to focus all of your energy, not on fighting the old, but on building the new”
With 100% certainty this is not happening.
Joseph Oldenbourg do tell all! This is as juicy as a Heidi Fleiss black book moment.
Since your trying to figure out and reveal people I have a few I’d love to know. Oh and one other thought, how do you choose who you will Bully? If their on your side you leave them alone and if they’re on the opposition side you Bully them?
My List
“Concerned citizen”
“Still mad”
“Barbara”
” Educated citizen”
” Poor Geammer”
“S.Smith”
“CB”
“Prom Loviss”
“Alicia”
“JoanB”
“ASing”
“Overwhelmed”
“Tom”
“M Garcia”
“Tate Simmons”
“Tulare Tax payer”
” Rnwithavoice”
“Lisa”
“Truthbtold”
“Jack”
“Dave”
“Tularestrong”
“ThisISay”
“Tulare True”
“Myopinioncounts2”
“CMiller”
“Truth16”
“Appalledcitizen”
“SamMyG”
“ICAREFORTULARE”
“Dan”
“Mark R”
“Fed up with HCCA”
“Enough is enough”
“HCCA Sucks”
We can go in for days….Valley Voice your despicable.
Glad to see that I am keeping good company……thanks!
What lies? I read a lot of opinions, and discussions about events at a government operated hospital. I see lots of people being critical of politicians, government employees, and contractors. Tossing around the word “bullying” doesn’t make it true. And if the politicians who run TRMC/HCCA don’t like the heat, well to paraphrase Harry Truman, get out of the kitchen,.
The other observation is that “Kassandra” appears to be arguing that all speech with which she disagrees should be censored by the newspaper. Perhaps she should open her own paper, and then she can censor all the opinions that she doesn’t like. (I suppose I”m assuming her gender, but oh well).
“Clay” I think you missed the point.
Kassandra…….he got the point alright……he was right on about you. You come across as someone who strives to shoot the messenger if she/he didn’t like the message.
Clay you are right on the point. They call us bullies. I have attended a few meetings and I have personally seen HCCA’s Dr. B and lawyer Greene attack members of the committee for ACCOUNTABILITY whether with slide shows or snide comments. I have been outside after meetings and personally heard a gal named Theresa slander and verbally attack a committee member. So Kassandra don’t act like “woe is me we are being attacked and not treated fairly.”
IF YOU SPEAK IT, YOU HAD BETTER BE READY TO HEAR IT. Why can’t we all agree to disagree and fix this mess.Oh yeah I am a real person, not a made up one.
You keep talking about “fixing this thing”. What iis it that you want to fix? A profitable hospital, a functioning medical staff, multiple pay raises to the employees,finishing the outside of the tower even after the bond ran out? If “fixing” for you guys means going back to the days of old where you were in charge, where waste, dysfunction, and incompetence ruled, then NO THANKS
Stay tuned……..
“Stay Tuned”. For wha? The Citizens for Hospital Accountability to try and take down our only Hospital in Tulare. Stand up people and fight for your hospital don’t let these people come back to finish off the job. NO THANKS CITIZENS FOR HOSPTIAL NOT ACCOUNTABILITY!!
When a company is profitable do they have to take out 800000 line of credit to pay off past due bills piling up for a year. And then lie about it publicly like Mr Kumar did. DO you remember that? NO THANKS lieing to the public. NO THANKS running up bills you cant pay.
Not a lot of businesses wish they were that type of profitable but maybe you’re OK with that since you still get your direct deposit
Do they have you monitor the comments on your days off. “Work from home.”
Maybe the pay is worth selling out your co-workers and youre community.
Di Di Di your hilarious. I don’t work for any hospital nor do I get any direct deposit. You know what the say when you assume. Sorry you don’t like my thoughts maybe you should not read them.
If you talk like an insider, sound like an insider, you present yourself as an insider. I think that Di is quite reasonable to “assume” that you ARE! Oh yeah……if Di and the rest of us didn’t read your thoughts you would be “failing” at your assigned task. Wouldn’t want that to happen now would we! lol
” The rest of us” Citizens for NO Accountability. Might this be the
” US” you refer to. You people are a hindrance to the process of this company getting our hospital finish, sothe fine Citizens of Tulare can have a hospital.
The hospital will most certainly close if our community allows people like you to continue spinning false facts and outright lies. If our building does not get completed, our hospital will close. If you don’t understand that, then you’re uneducated.. Thank God that HCCA has managed to find a way to finish that tower in spite of the self destructive bent of some in our community. The fact that our hospital is still open is a testament to HCCA’s amazing abilities.
Citizens for NO Accountability basically Don’t want a Bond Don’t want a Loan And want everyone removed so they can take over and finish off the job of closing our only hospital. Be careful what you wish for people.
Deanne do you really expect the people who are reading this to believe that the census is low because of HCCA . When in reality the census is low because doctors,including mine are telling people to go to other facility’s because they’er mad about being released from thier position (MEC) They were not properly performing their duties so why would anyone have them continue ?
Good job on misleading the Citizens. Do yourself a favor get out a pen and paper and write down all the doctors on the Prior MEC and look at who’s not admitting. I bet your list goes like this.
Dr Betre- Don’t Admit
Dr Patel- Don’t admit
Dr Kamboj-Don’t admit
Dr Kamboj-Don’t admit
Dr Smith-Don’t admit
Dr Orth-Don’t admit
Oh Kassandra,
I am not misleading anyone. Just look at the numbers prior to HCCA taking over and then every year thereafter. The numbers have done nothing but decline under their management. Unless of course the reporting isn’t factual.
First pediatric admits make-up very little of TRMC census and it hasn’t for many years. As well as ENT. I am well aware that Dr. Smith continued to do many surgeries at TRMC until the unprecedented move was made to replace the MEC just over a year ago. That further plummeted the census and that move, which was very calculated, was under the direction and leadership of HCCA.
But the continued blame of others for the lack of their managerial expertise is not surprising. A successful hospital must recognize the importance of one of their key internal customers, the physicians, without them success will be hard to achieve. Since December 2012 the lack of respect has been evident, which started out by not recognizing Dr. Patel as the elected Chief of Staff. It wasn’t until you dig deeper in reading Sherrie Bell’s deposition that you discover that Dr. Benzeevi was trying to get elected to the MEC and was unsuccessful. So the board took a stance against the MEC back then over Benzeevi’s sour grapes. Then look closely at the meeting minutes from when HCCA was selected to be the alignment partner, you could see again that your most valuable internal customer was again slighted. Nothing is ringing more true than Dr. Sunlap’s question “is the hospital going to be aligned with an institution that will strip of us our assets?”
Oh Deanne
It’s clear again that the Citizens for Hospital UNaccountability are continuing with their work of fiction. There were no legitimate offers available that geared toward saving our hospital. HCCA was the only one and most importantly HCCA delivered stellar results. You can keep fantasizing and making false claims. You’re pretty good at it considering that one of your leaders was thrown off the board for participating in approving illegal physician contracts. Your “group” represent no one here except those failed leaders of the past who have failed our hospital and our community. It is YOU who should Go.
Oh Kim or Kassandra where do you get your facts. Who was thrown off the board?
I have been witness to the constant change of “facts”. Love the one that HCCA was the only legitimate offer. They were so legitimate that they didn’t even exist until after they were selected and they were allowed in as a legitimate option after the RFP closed.
I am afraid you wouldn’t recognize facts that were right in front of you.
Deanne you’re misleading yourself and the community. Prime example of trying to make people believe I’m someone else. Stop the Anger and focus on what’s positive. You’re a day late and a dollar short.
No answer to your basic statement – who was thrown off the board? Or this is the more alternative facts to deceive the public?
Ya Deanne you’ve caused enough trouble for this community move on!!
Citizens for Hospital Accountabilty is destroying this community. HCCA has resurrected our Hospital and brought it back to life. The falsehoods you are spewing about the audit are just that…… FALSE!!!
Thank you HCCA.