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#childsafety | Former doctor for John Muir Health claims hospitals put money ahead of patient safety, cites child’s death



A former doctor at John Muir Health alleges in a lawsuit that the nonprofit group, which operates hospitals in Walnut Creek and Concord, put money ahead of patient safety and ignored her warnings of surgical dangers which led to illnesses and deaths.

Hospital officials denied the allegations made by Dr. Alicia Kalamas in a lawsuit filed Wednesday in Contra Costa County Superior Court.

Kalamas, who worked at John Muir Health for eight years, said she repeatedly raised red flags to executives about improper surgical practices, only to be ignored because she was viewed as a woman with “sharp elbows” or because officials worried changes would signal that past practices were dangerous.

In one example, she said she warned officials not to approve a complicated surgery on a child, and told them that other regional hospitals were better prepared to perform the operation. But because the hospital group’s executives wanted to build a pediatric brand they disregarded her concerns, she alleges in the suit. Surgeons at John Muir Health performed the surgery, and the child died.

In their response to that claim, John Muir Health officials said Kalamas was not directly involved in the case and could not evaluate the “significant risks” of either proceeding with or forgoing the surgery.

Kalamas, 50, of Piedmont, sued the nonprofit and its two top executives, John Muir Health CEO Cal Knight and John Muir Medical Group President and CEO Taejoon Ahn, alleging the group breached her contract and forced her out of her position after labeling her a troublemaker.

“The people at the top running the organization have lost their way,” Kalamas told The Chronicle. “They are more interested in the bottom line than patient safety.”

John Muir Medical Center on Wednesday, Jan. 12, 2022, in Walnut Creek, Calif.

Santiago Mejia / The Chronicle

Dr. Russell Rodriguez, chief medical officer at John Muir Health, said all employee feedback is valued, and that before executives chose not to renew Kalamas’ contract they had decided to restructure the program she managed to “better meet contemporary patient needs.”

“The fact the clinical consensus might differ from those views of a single physician does not mean he or she was ignored,” Rodriguez said in a statement to The Chronicle. “Despite efforts to provide coaching and other assistance, this was a reality with Dr. Kalamas and something she had difficulty understanding and accepting.”

He said senior leaders make patient safety their top priority and noted all of the money John Muir Health makes is reinvested into the health system.

Kalamas specializes in anesthesiology with a focus on perioperative medicine, which ensures the many factors that influence surgical success — before, during and after an operation — are properly managed. In 2013, Kalamas was recruited from UCSF to John Muir Health as medical director of the perioperative medicine program.

She quickly sought to address the hospitals’ readmission rate for its highest volume surgeries, which was higher than the region’s rate of 6.9%, according to the lawsuit.

Her research found a simple problem, she claims. When prescribing opiates as pain killers after surgeries, particularly for knee and hip replacements, there was no protocol to educate and provide medication to prevent constipation, which led to patients having to return to the hospital for a variety of issues.

“Millions of dollars were paid to JMH for their failure to provide their patients a fifty-cent over the counter stool softener, a glass of water, and some basic advice,” Kalamas alleges in her lawsuit.

After her changes were administered, the hospital had a 27% drop in joint-replacement readmissions, reducing the cost to medical providers and taxpayers, she says.

Kalamas moved on to address surgical site infections. Patients who developed such infections are 60% more likely to be admitted to the ICU and five times more likely to be readmitted, according to research. Annually, such problems cost the U.S. healthcare system $3.5 billion to $10 billion.

In the past, John Muir Health earned revenue from such complications, charging patients for the extra treatment, the lawsuit alleges. However, the federal government began forcing the hospital to pay millions of dollars in penalties, Kalamas says, eventually forcing it to improve. Still, Kalamas claims that executives and others ignored numerous emails she sent alerting them that lack of monitors for blood sugar levels before and after surgery were harming and killing patients.

The lawsuit gives an example of a diabetic patient who had to have a second surgery following an infection. His heart was not strong enough and he had a massive heart attack in front of his wife on his first day home and later died, according to the suit. Another young patient with kidney failure and diabetes did not have her blood sugar checked and died shortly after receiving anesthesia; her blood sugar was at a high rate when she coded, Kalamas says.

Rodriguez, John Muir’s chief medical officer, said eliminating surgical site infections is a “critical focus,” and that restructuring the perioperative program will further reduce the infections.

“Perioperative services needed to be made available to a greater portion of those undergoing surgery, and care needed to be extended beyond the clinic setting,” he said.

Kalamas said that as a woman, her whistleblowing and critiques were seen as disruptive or, as one supervisor told her, she had developed a reputation for “sharp elbows.”

“I’ve been at other institutions … and I never felt dismissed,” Kalamas told The Chronicle. “I felt like at John Muir Health I was warning of very serious health and safety concerns and nobody was paying attention.”

When she learned of the young child’s planned surgery, it fell outside her area in the hospital, but she felt obligated to speak up, she says. Due to medical privacy laws, neither Kalamas nor her attorney Dan Horowitz could provide specifics about the child and the procedure.

“The case should have been referred to a qualified medical center which is what Dr. Kalamas strongly encouraged them to do,” the lawsuit alleges. “Specifically, Dr. Kalamas explained to medical leadership that she had extensive experience with similar cases at UCSF and that JMH was massively under prepared.”

She said she told John Muir Health executives if they did the surgery it would be a “clean kill.”

After the child died, Kalamas requested the case be reviewed by the Medical Executive Committee, which could result in discipline for those involved, disclosure to the parents, and other safeguards being put in place. In a 2021 email, shared with The Chronicle, Kalamas was informed the case never went to the committee.

She memorialized her previous apprehension about the surgery in an email, explaining how experts in liver transplantation and anesthesia had agreed with her reservations.

“I was livid that JMH misrepresented their clinicians’ skill set and the institutions ability to provide safe care to the parents (redacted) given UCSF, Stanford and Oakland Childrens’ are all much better equipped to handle cases of this complexity,” she wrote, adding she was told John Muir Health officials wanted their new pediatric center and needed to avoid disruptions.

Horowitz said that to this day the parents of the child do not know about Kalamas’ concerns.

In response to the pediatric fatality, Rodriguez said some cases have “extremely advanced life-threatening conditions for which any intervention is high risk and forgoing intervention is likewise high risk.” He said all options were discussed with the family before the surgery and that because Kalamas was not on the treatment team, she would not be aware of all the details.

He said a post-case review was done through the peer review process, but Kalamas would not be aware of any assessment because it is confidential.

By May 31, 2021, Kalamas said her contract was allowed to expire. She has not returned to a hospital since.


Matthias Gafni is a San Francisco Chronicle staff writer. Email: matthias.gafni@sfchronicle.com Twitter: @mgafni





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