This diary began with the story of a highly decorated Air Force that was fired from a California hospital chain while serving a tour of duty in Iraq. As I read the story of Lieutenant Colonel Debra Muhl, it became apparent to me that she was an extraordinary nurse that has probably contributed to the survival and recovery of thousands of US troops wounded in combat. I decided to take a much closer at the hospital chain that would fire a nurse of this caliber while on active duty treating the wounded in Iraq. It was an eye-opening experience. This organization is the reason the medical care system in America is becoming the most expensive in the world and ultimately jeopardizing the health of millions of Americans. This is an organization that practices what nyceve referred to as murder by spreadsheet.
Please join me for the story of LTC Debra Muhl, one of the most skilled and decorated nurses in the US Air Force, and the story of her former employer Sutter Health, a hospital chain becoming a monopoly in Northern California.
Meet LTC Debra Muhl.
LTC Muhl has served as nurse in four combat zones – Bosnia, Somalia, Afghanistan, and Iraq. She has received 20 medals for valor and distinguished service. She was promoted to LTC on October 1, 2006.
This tidbit from the story of her firing from Sutter Health Systems describes her service in Iraq.
In Balad, Muhl tended to “thousands of wounded soldiers.” The Air Force’s Balad medical facilities handled the lion’s share of U.S. casualties before they are flown to military hospitals in Europe or the U.S.
Muhl was one of the nurses who attended to ABC newsman Bob Woodruff when he was seriously injured by a roadside bomb in January last year.
Her unit, the 349th Aero Medical Squadron, based out of Travis Air Force Base in Fairfield, was responsible for the evac and care for Private Jessica Lynch.
When a combat health professional provides care to VIPs, you know they are the best of the best.
This comes from Sutter Health Systems promotional literature. I urge you to look at this full color brochure because it features LTC Muhl's picture in several places (pages 3 and 5). [I desperately want to violate image copyrights to include her picture directly in the diary rather than increasing web traffic to Sutter.]
Debra Muhl, R.N., the administrative director of the joint cardiac programs at California Pacific Medical Center, Marin General Hospital, St. Luke’s Hospital and Novato Community Hospital returned from duty in Iraq. Major Muhl, who has been an Air Force reservist for 22 years, was deployed to Kuwait where she served as chief nurse for 11 months.
Muhl is among the many nurses and physicians across our system extending their skill to
help the people and medical community in countries such as Iraq.
While serving in Iraq, tending to the wounds of thousands of US soldiers and at least one journalist, she was fired by Sutter Health Systems.
“Sutter Health ignored its obligations under those laws and fired Lt. Col. Muhl after she served for four months at Balad Air Base in Iraq, ” said Muhl’s attorney David A. Lowe of the San Francisco-based law firm Rudy, Exelrod & Zieff.
Muhl was the $175,000-a-year administrative director of Sutter Health’s Joint Cardiac Program, when she learned she was being sent to Iraq for four months, starting on Jan. 16 last year.
“I never thought that they would fire me from my position.” Muhl said. “I was devastated. I felt betrayed.” The 56-year-old San Francisco resident with two grown daughters had been with Sutter Health for 10 years. She has been in the military for 32 years, with seven years of active duty.
And the reason given by Sutter?
Karen Garner, Sutter Health communication director, says Muhl’s termination was a result of cost-cutting decisions made well before her military leave, an explanation Muhl disputes. Garner says Sutter supported Muhl’s three military leaves of absence and made “two exceptions” to its military leave policy.
Ms. Garner, LTC Muhl was serving in combat, not taking a leave of absence to sail the tropics. She was serving her community and country, unlike your parasitic organization.
Muhl says she knew her boss at Sutter Health, Dr. Richard Gray, was unhappy that her military service took her away from work. After her first deployment for 11 months in 2003 to 2004, Gray allegedly asked her frequently, “How can you live like this?”
She tried to reach a compromise by transfering to a ground-based unit, but it didn’t satisfy her superiors, she said.
Two days after she told Gray about the imminent deployment, he called her to a meeting. “He told me, ‘You had news for me on Tuesday, I have news for you today. You will have no job when you return from the desert,’” Muhl says.
“It was three days before Christmas,” she recalls. “There were moments in Balad, when I was distracted. Mortars are flying over the base, there were soldiers in trauma or dying, and I’d be crying. I had to verbally shake myself at times to focus on my work."
I hereby call for the draft of Dr. Richard Gray into the armed forces with immediate deployment to Iraq. Dr. Gray needs to serve indefinitely treating wounded troops until combat operations in Iraq cease or he is killed or wounded serving his country.
Sutter Health calls itself a not-for-profit health care provider.
Sutter Health is a family of not-for-profit hospitals and physician organizations that share resources and expertise to advance health care quality. Serving more than 100 communities in Northern California, Sutter Health doctors and hospitals are regional leaders in pediatric, obstetrical, heart and cancer care.
Our Role as Not-for-profit
Unlike investor-owned health care systems, Sutter Health is a not-for-profit organization. As such, any money left over after employees and bills have been paid is reinvested in health care.
It's better for patients
We believe this community-owned, not-for-profit approach to health care best serves our patients and our communities – for multiple reasons. First of all, its good for patients. According to the Journal of General Internal Medicine (April 2000), patients treated at for-profit or government-owned hospitals were two-to-four times more likely to suffer preventable adverse events than patients treated at not-for-profit institutions.
Not everyone is convinced. In fact, there is now an organization called Sutter Corporate Watch dedicated to investigating and documenting the practices of Sutter Health and its impact on the community.
Here is what they say about Sutter as a not-for-profit health care system:
Sutter Health's intense focus on profits - often at the expense of patients, caregivers and communities - has made the company one of the most profitable hospital systems in the nation. In 2003, Sutter reported profits of $465 million, an increase of 64 percent from the prior year. The company's 2003 profit margin of 8.2% was nearly four times the average for hospital systems nationwide.
If you look at the itemized list, you will find that the profit margin for the Sutter Health hospital in Richard Pombo's hometown of Tracy earned a whopping 25% profit in the past year.
Sutter Health has become a monopoly in Northern California and is using its monopoly status to raise prices and demand exclusive contracting.
Sutter Health's aggressive pricing strategy is having harmful effects on consumers across Northern California. Through mergers and acquisitions, Sutter has become the largest health system in Northern California. The company uses its monopoly-like control to demand high prices from consumers in order to boost its profits. Sutter's exorbitant prices have prompted sharp reactions from individual consumers and institutional health care purchasers like CalPERS, which report that Sutter's high prices are contributing to steep increases in health premiums. Health insurance premiums in California have grown by nearly 40% in just the past three years, according to a survey of California employers performed by the Kaiser Family Foundation.
According to Blue Shield, prices at Sutter hospitals are 80% higher than the statewide average, and 60% higher than the Northern California average. In the Sacramento area, charges at Sutter's hospitals were as much as 68% higher than at comparable non-Sutter hospitals during 2002.
Sutter uses an aggressive bargaining strategy that leverages its overwhelming market power in particular geographic regions to win high priced contracts for all of its facilities. HMOs and insurance companies are forced to negotiate with Sutter in regions where Sutter controls the hospital market. Sutter's control is so dominant in some markets that insurance companies virtually have no other option. For example, Sutter controls the only non-Kaiser hospitals in Marin County. When HMOs and insurance companies seek to contract with Sutter's Marin County hospitals, Sutter forces them to contract with all of Sutter's hospitals and physician groups throughout Northern California.
This is what murder by spreadsheet looks like:
Sutter Health has been widely criticized by community groups, health care advocates and government officials for business practices that often put community needs last. These practices include:
- Reducing critical health care services
- Reducing community control over local hospitals
- Abusing market power to increase prices for consumers
- Refusing to adopt community standards that have been adopted by every other major hospital chain in California
While going through Sutter's slick self-promotional literature, I happened upon this gem:
Award-winning hospitals, receiving such honors as "Top 100 ICUs" (Alta Bates Summit Medical Center) and "Top 100 Hospitals" in the U.S. (Mills-Peninsula Health Services and Sutter Medical Center, Sacramento), and "Best Place to Wok in the Bay Area" (Mills-Peninsula Health Services).
I am always looking for a nice place to wok. When stir-fry really matters, head to Sutter Health.