Yves here. While whistleblower Dr. Ming Lin has secured employment while pursuing damage claims against the hospital system and his immediate private equity employer, TeamHealth, for terminating him for speaking out against poor Covid procedures, it’s the medical version of exile to Siberia. Lin is now working in Rosebud, South Dakota for the Lakota, at least an 18 hours drive from his home. Even though Native American nations deserve first class care, the reality is that reservations by design are isolated and usually poor, and therefore have difficulty attracting and keeping qualified professionals. Dr. Lin has likely left his family behind.
By Lynn Parramore, a Senior Research Analyst at the Institute for New Economic Thinking. Originally published at the Institute for New Economic Thinking website
When the pandemic unleashed its deadly havoc on the world, Dr. Ming Lin was an emergency physician at PeaceHealth St. Joseph Medical Center in Bellingham, Washington — a frontline hero in the battle against coronavirus. But soon he saw that safety measures were not enough to keep either his patients orthe hospital staff safe.
In March, Lin went public with his concerns on Facebook. Soon after, in a move that has been widely condemned, he was terminated from a position he had held for 17 years. The signalto frontline health workers across America was unmistakable: Speak out about safety and you risk your job.
TeamHealth, a corporation owned by the private equity company the Blackstone Group, which contracts with hospitals to staff emergency rooms, offered to find Lin a new position in another state, or lower-paid, part-time work as a floating ER physician at other Washington hospitals. Unwilling to accept these conditions or uproot his family, including three smallchildren, Lin did not accept these offers. Instead, he is fighting back: The American Civil Liberties Union of Washington is representing him in a lawsuit against both PeaceHealth and TeamHealth.
Lynn Parramore: Let’s start out with a bit about your background. Why did you decide to become an ER doctor?
Ming Lin: I grew in Galveston, Texas, which was a pretty racially and economically diverse community, mostly consisting of Blacks, Hispanics and whites ranging from poor to upper middle class at best. Considering its diversity, it was integrated as best as one could expect. There was only one high school and it seemed everybody who grew up there spoke with the same Tex-Mex , Black American dialect.
My interest and desire to become an ER doctor really did not start until I did my first rotation in the emergency room at the University of Texas at San Antonio. It was, at the time, a relatively new specialty striving for respect, but there were many elements which I loved. For one thing you got to see cool things. And you never had to be on call and never took your work home with you. I also loved that every patient to me was like a complex social, emotional physical puzzle. And I love puzzles.
But what I truly loved about emergency medicine is the diversity of the patient population and that despite their racial or economic background, everybody was treated the same based on their symptoms and severity of illness. Rarely was there such a thing as a VIP patient, unless it was one of our own staff members, and never did the financial aspect cloud our judgement. This diversity also extended to the staff who worked in the Emergency Department. People who work in the ED come from all walks of life, very much like the population we serve, and we all bond as a team to give the best care we can. It is like a second family to me.
LP: You were dealing with the Covid crisis early on. How do you judge the U.S. response?
ML: Seeing what was happening in Asia and Europe as the pandemic took off was extremely concerning. It was obvious to me that a storm was headed our way, I just was not sure how it was going to play out. But I knew we were in for a long ride. It was a bit frustrating to see that we had stumbled in our ability to obtain rapid testing and that we were not advocating for masks early on. Those measures were, after all, effective in slowing the past Spanish flu pandemic in 1918. Instead of implementing preventative measures to limit transmission, we were more focused on ventilators, which carried an extremely high mortality rate. This is not including the disability you would suffer if you survived 30 days on the ventilator.
LP: What were those early days like in Washington state, in terms of the safety of patients and occupational health issues?
ML: Being only 75 minutes from the initial epicenter, Seattle, it did feel a little like we were sitting ducks waiting for a disaster to happen. I could see that other hospitals were doing more to protect their staff, patients, and community from infection, and many of us were resigned to the fact that we did not have adequate protective equipment to safely manage a massive flow of sick Covid patients.
What I found most frustrating was the lack of adequate measures to limit transmission of the virus to protect our patients and medical staff, such as temperature screening and social distancing, among other things. At the time, healthcare workers probably made up the largest proportion of those testing positive for Covid, and yet we were doing the minimum to prevent the transmission to our patients and each other. Advocating for clean hands while our mouth and nose were exposed to this airborne organism did not seem to make sense to me.
LP: Why did you feel compelled to speak out and why did you choose to voice concerns on Facebook?
ML: Obviously, a pandemic was approaching, and I had serious concerns about the health and safety of our patients, staff, and community. I knew I could not be silent, so I tried to address the subject through internal channels, but my concerns weren’t taken seriously. I had seen this before when I reported my concerns about racial and sexual discrimination, which were also ignored. I felt it was important to use whatever measure necessary that was going to implement change as rapidly as possible.
Looking back, I do feel that using social media was effective in elevating my safety concerns and causing the hospital to make changes. I can name almost a dozen safety measures I asked our hospital to adopt to improve safety among our healthcare workers, and the hospital eventually did adopt them shortly after I raised the issue publicly.
It was beneficial to the safety of staff and patients for me to express my safety concerns in a method that is transparent and well documented.
LP: Your case raises questions about protections for whistleblowers, which vary depending on factors like where they live, employment status, and so on. What has it been like for you?
ML: I can’t speculate about the legal protections available to all healthcare workers, but for me, I wanted to give the best medical advice I could give, and I’m dealing with the consequences now and addressing them in my lawsuit against TeamHealth and PeaceHealth as my joint employers.
LP: You are suing both PeaceHealth, the hospital where you worked for 17 years, and also the physician staffing firm TeamHealth, which was technically your employer. TeamHealth is owned by the private equity company the Blackstone Group. There has been a lot of criticism of the increasing role of private equity firms in healthcare. What’s your view?
ML: Emergency physicians in the past have been among the strongest patient advocates, especially for those who are financially challenged. We demand from hospitals that patients be treated equally, and receive the best care possible without regard to financial consequences. Corporate medicine has made it difficult for us to speak out for patient safety, and my situation during this is an example of that as PeaceHealth and TeamHealth placed their image and corporate relationship over health and safety.
LP: What has life been like for you since your termination?
I would say emotionally there have been a lot of ups and downs. There is such a need for skilled medical professionals in communities of color right now that I couldn’t wait on the sidelines, so I have been able to secure some temporary work with the Lakota Indian Tribe in Rosebud, South Dakota. It has been an honor serving the native population and learning about their rich and diverse cultural history.
Despite this, I do miss the diversity of people and friends I have been working with for the last 17 years.
LP: Now that we’re many months into the pandemic, how safe do you think healthcare workers are today? Is it any safer for workers to speak out if they are concerned?
ML: I think as a country we are more aware of the issues concerning healthcare worker safety and as a result more measures have been implemented by hospitals to protect healthcare workers. While the public lauds us as heroes doing battle, we are not always equipped with the protection we need to fight safely under the circumstances. This, not to mention the emotional aspect of constantly being exposed to Covid and not knowing when you or your family member may get ill.
People rely on the advice of doctors to keep them safe during times of crisis, and I think hospitals should listen, too. Sadly, I know my story isn’t unique. I’ve been contacted by healthcare workers all over about harsh policies that censor their right to speak about patients’ safety. The only reason my situation has garnered so much attention is because of the support of the diverse community of friends I have made over the years. They are the ones who held strikes in front of the hospital on my behalf, started a petition to rehire me, and helped me connect to lawyers and the ACLU so that I can bring this problem to national attention. For this I am grateful.
LP: What do you think the lessons of the pandemic are for the organization of medicine, patients, and health care workers?
ML: This pandemic obviously exposed the inadequacy of our public health system as well as the inequalities in our healthcare system. It is disheartening to see the direct correlation between race and economic standing with Covid infection and death. Although we may disagree on how to best manage this pandemic, we should all at least agree that our country’s inability to control a virus is a concern for our national security as well as our countries standing as a world leader and that we should come together to address this crisis.
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There is no such thing as a peace treaty be it between native americans or native anything.
Here is your blanket.
Many thanks to Dr. Ming Lin and those who wish to emulate.
Thanksgiving is coming up and I’ll remember the infected blanket provided to the natives.
The corporate dictators had their hands forced by an employee and retaliated. The chain of command seems more brutal than the military.
Letting finance degrees control medical policies in field during a rapidly evolving situation is colossal hubris. Hopefully, the next generation can rein in Big Finance and it’s perverse influence on society.
Sad story. Whistleblowers are so rare.
Also a rare example of positive use of internet media. The old print and TV media, of course, would suppress stories. One wonders if new social media (actually anti-social) do not have Departments of Suppression wherein stories such as Dr. Lin’s are suppressed for price or consideration. If not, they surely must be looking at such a source of profit and influence.
This is in some ways a tip of the ice-burg story. As a patient, and as someone who took a relative to all doctor’s appointments, stays at hospitals for one situation or another, etc., for well over a decade, I was quite surprised at just how many doctors were in complete ideological agreement with the whole for profit model. It’s frightening to me – when I focus on it- just how pervasive and even attractive this world view is to many medical professionals.
The for profit platform, with all the attendant respectability of such things as business degrees on top of medical ones gives many health care providers (doctors, nurses, and so on) the sense of being no nonsense rational thinkers and the profit motive seems to combine seamlessly with the medical one -getting ahead while accomplishing medical goals. It’s amazingly seductive in the way it fits into the medical world and corrupts by degree; too subtle and yet alluring at any given point to be considered even a problem, never mind an addiction. And while booze and cigarettes and drugs are openly viewed by society as “life problem conditions,” addiction to the profit motive remains by in large invisible as such (as an addiction) in the medical world.
I suspect (and know by a few doctors I know personally) just as with alcohol, some -probably many- medical professionals come to recognize the conflict at some point and come to grips as best they can with the ethical conflicts such as insurance and hospital administrative policies that directly impact quality of care. Others never succumb in the first place and either adapt as best as possible, or, like Ming Lin, make a heroic and often tragic stand against. But the fact that it remains unrecognized as a problem to the general public, and by in large to the people involved, and that it finds expression in the whole direction of medicine and pharmaceuticals is the more frightening the closer one gets to it.
>I was quite surprised at just how many doctors were in complete ideological agreement with the whole for profit model.
You shouldn’t be. They made patient care an extremely high-income (especially when you became a senior partner in a “practice”) profession so along with the do-gooders it attracted a bunch of people that care mostly about money and prestige.
The how-to-do-business preachers say incentives matter, but they don’t always point out that sometimes they are at cross-purposes to what you need done.
I don’t know. I grew up in the 50’s and the medical ethos was significantly different. Not that there weren’t wealthy doctors, but rather that by in large the profession itself emphasized the care of the patient over economic concerns. Sacrifice was emphasized more than it is today. Doctors made house calls without a second thought. You could call them in the middle of the night. They didn’t have armies of people between them and the patient. Even if they did have a receptionist answering the phone, you could ask to speak to them without being treated as if you were asking to talk to a head of state. You didn’t need insurance to cover a simple visit. They were far more likely to cut people slack when money was an issue. Anyway, I think surprise at how much that all changed and more particularly at how deep the change was, is pretty reasonable.
My dad was a surgeon. I recall many ‘trades’ with various patients (not ‘consumers’ back then) who were unable to pay with money. Homegrown pork from the Portuguese patients, horse riding lessons for moi…babysitting exchanged for surgeries. We even took in a pregnant person for some months while she carried her secret in *secret*. She was an artist and I credit her for much of my trajectory in life.
Yeah. When I was in nursing school, it was disappointing to realize that most of my classmates were there so they could marry doctors.
Many of them did.
(don’t get me started…so much of what passes for ‘health care’ is purely revenuing)
Nicely said. From a Health Affairs study:
– From 2007 to 2014, hospital-prices for inpatient care grew 42 percent compared to 18 percent for physician-prices for inpatient hospital care
– For hospital-based outpatient care, hospital-prices rose 25 percent compared to 6 percent for physician-prices
– There was no difference in results between hospitals directly employing physicians and indirectly employing physicians
– Hospital prices accounted for over 60 percent of the total price of hospital-based care.
– Hospital prices accounted for most of the cost of the four high-volume services included in the study. The hospital component ranged from 61 percent for vaginal deliveries to 84 percent for knee replacements.
Physicians need to unionize. One thing I noticed is that our local fireman had brand new N-95s all the way back in March, but the ER docs did not. Not too mention the young docs starting out In the ED with 300k in debt and retiring 15 years later than the fireman.
Private equity is on a tear buying up ortho, ophthalmology and dermatology practices everywhere. They cash out the senior docs and then install indentured servants right out of training. The insanity of our tax code is the only reason for this debacle.
Insanity of our tax code ??? Perhaps, GREED absolutely. The mantra repeated all over the country by young folks, “How much does it pay ” . Doctors have been painted by most folks as “rich” because that’s the way we judge people now. HOW MUCH The idea that a doctor or anybody else might have a different philosophy about the work they do has flown out the window. It’s what happens when too many people have control over society that have only one thing on their minds. MONEY In your spare time, Google “Robber Barons”.
“Advocating for clean hands while our mouth and nose were exposed to this airborne organism did not seem to make sense to me.”
No kidding. The NCarolina public health czar Mandy Cohen was interviewed on PBS yesterday about our rising cases, hospitalizations, and deaths and I was frustrated beyond belief with her smug repeated mantra of the 3 Ws, saying nothing of the fourth one: Windows, for ventilation.
It was a half-hour one on one public interest program and the words airborne and aerosol were not uttered once. And we just opened up indoor movie theaters woo-hoo!
Truly we are on our own.
Opening windows in the Carolinas? That’s almost considered a deadly sin. My neighbors were appalled when we did that in the Hayes-Barton area of Raleigh, NC.
The hospitals beat personnel over the head with their licenses. Any complaint is instantly met with a threat against your license. For nurses, being called before the Board is fatal, even if you win a lawsuit against them you will never work again and will be accused of everything under the sun. Physicians, at least, have the ability to fight for themselves. I hope Dr. Lin writes a book.
And I want to buy that book. (Paging Dr. Lin!)
This is what you get from a Health Profit Industrial Complex.
Here’s a nerdy finance question.
TeamHealth has bragged in internal memos that although it did a deal with Blackstone, it was an all-equity deal. They generally imply that this puts them on sounder financial and perhaps ethical footing than their main competitor, Envision, whose deal with the firm KKR involved debt.
Are there any real differences in resulting corporate control or behavior associated with these two kinds of deals, equity vs debt? Or is this just more capitalist BS, a distinction without a functional difference in the ultimate way the acquired company is run?
As an aside, I used to work for TeamHealth in an ER owned by HCA. The things that HCA did to maximize its profit, the entire money-centered system it had engineered that often resulted in us treating patients like cattle, was a major reason I started reading NC.
I’m so sorry bad experiences at work led you to us, even though we do appreciate having you as a reader!
Ha, I will send this on to Eileen Appelbaum, an economist who has been all over TeamHealth.
First, the deal wasn’t just with Blackstone:
https://www.teamhealth.com/news-and-resources/press-release/blackstone/
Second, they could have put debt on right after the closing, or used a subscription line of credit (borrowing at the fund level as opposed to borrowing against the company). It’s frankly inconceivable for Blackstone et al not to borrow. The interest payments create a tax shield as well as greatly increase returns on the upside.
Yves, I imagine in one way or another, bad experiences led us all to Naked Capitalism. For me, it was watching the lives of those around me, including someone very close to me, implode as a result of the Great Financial Crisis. Thanks for being here when we need you!