“If not me, then who?”
–Travis Manion, 1st Lt., United States Marine Corps, posthumously awarded the Silver Star and Bronze Star with Valor in the Global War on Terror.
Today, my conscience compels me to write this letter. My goal is to catalyze positive change at Estes Park Health because I care about this community, EPH, and the people who work there.
The words to follow are all my opinions and mine alone. If I did not believe there are scores more who will support what I have to say, I would not speak out. My opinions are based on what I have experienced firsthand or learned from primary sources.
I believe that this hospital administration and this board of directors have failed all of hospital’s employees, its medical staff, and this community.
They do not represent the values of EPH. This hospital is failing and flailing.
I believe the situation at the hospital is dire and change needs to happen now. I wanted to write this over two years ago, but did not, out of fear of retribution towards me, my partners, and colleagues.
The progress towards an affiliation is an accomplishment to be celebrated, and I want to start by thanking this hospital administration and the board for their efforts over the last 18 months.
Unfortunately, the administration and the board of directors have otherwise failed in their mission to provide an appropriate level of services and a healthy work environment, and they have diminished and degraded this hospital, the pending “affiliation” with UCHealth notwithstanding.
Over the nine years I worked at EPH, our services were decimated. It was true that pediatrics and obstetrics were money losers, but all hospitals have services that do not pay for themselves and a well-run hospital has profit centers that compensate. We need those services back.
The chief executive officer has also eliminated the nursing home, home health and hospice. In a community with a median age of 61 years—compared with 38 in Colorado as a whole—this is unimaginable.
The numbers of surgeries and procedures in the operating room are down. The infusion center has been mismanaged. Respected specialists with long histories of service to this community have left after refusing to be bullied and abused by this administration.
We continue to hemorrhage money because of mismanagement of profitable services like the infusion center and the operating room. We have surgeons, whom I fully respect and support, rather than gastroenterologists doing screening colonoscopies for economic reasons.
There are many causes of our many problems. Employee turnover has been extraordinary. Several people have left of their own accord because of poor leadership. Multiple others have been “restructured” out of a job.
The hospital “reorganization” was an abject failure. Others have decided to “retire” or left to “spend more time with family.”
Multiple extraordinary managers have been replaced with unqualified, less capable, or less experienced employees. Many current employees are actively looking for other work.
A very good emergency department manager was forced out and replaced by someone with no emergency department experience. Many people who have been dismissed from managerial jobs have been bullied into signing non-disclosure agreements.
Multiple replacement managers were given oversight for which they were inexperienced, unqualified, or unprepared. Morale has plummeted. People who were once proud to work at EPH now feel shame and recommend that their family and friends seek care elsewhere.
I believe the hospital has become less safe because the hospital staff has become transient. The institutional memory has been degraded. We have travelers orienting travelers.
Housekeeping has been unconscionably “outsourced.” Hospital support and clerical staff are insufficient. It is nearly impossible to speak to anyone in the clinics, because there is no-one to answer the phones.
Recent local press reports have documented a toxic work environment. Employee turnover has been much higher than it should be. The administration has dismissed employee concerns with tired tropes about “disgruntled former employees.”
Their condescending and callous regard for hospital staff has been atrocious and on full display with their responses to public criticism. That nine people came forward with complaints about the toxic work environment to the Estes Valley Voice is remarkable.
They are courageous and there would be many more if not for the caustic culture of retribution and retaliation from administrators.
The problems reported in the press are a drop in the bucket. One former employee who was inappropriately fired has threatened legal action against the hospital and another may soon follow.
This administration sees its role not as supporters of the employees and physicians, but rather as masters to be obeyed.
Their behavior is often harsh and unprofessional. They have imposed hideously stupid policies on nurses because of unfounded beliefs based on inexperience and lack of expertise. This administration has harshly criticized nurses inappropriately for perceived but inaccurate policy violations. They have fired or driven away superb nurses from the emergency department. They have underused the skillsets of some nurses for specious and capricious reasons, negatively impacting patient care for profoundly incoherent reasons.
The medical staff has been effectively sidelined, ignored, and bullied by this administration. Physicians are treated with contempt and disdain by administrators. Medical decisions are being made by nurses.
One of the most frightening characteristics of this hospital is the impotence of the medical staff. They have been deliberately sidelined and ignored. They are now all employed or contracted by the hospital, and fearful of losing their jobs if they question policy decisions or push back when abused.
The medical staff used to be one of the three legs supporting hospitals, along with the board of directors and the administration. That leg has been effectively amputated.
New “service lines” are being forced on doctors when we really have no business offering them here. Hospital administrators, not physicians, try to determine what procedures physicians may or may not do.
And I believe that there have been bad outcomes at the hospital that can be traced directly back to poor administrative behavior and decision making.
For those unaware, burnout amongst physicians is very high nationwide. Many doctors are leaving medical careers because of mounting administrative burdens, constant battles with insurance companies, pharmaceutical intermediaries, and lack of control over their practices.
A recent article in The New England Journal of Medicine reported that low autonomy and low decisional authority are particularly stressful. “Physicians’ distress also affects the health care system through diminished quality of care, medical errors, high physician turnover and attrition from the medical field,” said the authors.
As far as I know, this administration has done nothing to address the deep frustration amongst physicians and other providers.
The manner in which the administration and board of directors interact with appropriately concerned stakeholders is alarming. Their treatment of former EPH Foundation President Kevin Mullin was appalling, resulting in his resignation and the resignation of multiple foundation members, including Teresa Mueller and Dennis Hoshiko. It is likely that charitable giving to the hospital has been negatively impacted.
The stonewalling of and passive belligerence to reporters from the Estes Valley Voice shows contempt not only for the press, but also for the community who have legitimate questions about the goals of the board of directors as they negotiate the relationship with UCHealth.
There are also appropriate concerns about whether the administration and board of directors are in compliance with the Colorado Open Records Act.
Lastly, the fact that the hospital refuses to do a hospital staff and medical staff satisfaction survey as well as a community needs assessment speaks volumes. These should be and are routine practice at well-run hospitals.
I believe, as many others do, that this administration and this board of directors do not want to know the results because they would be overwhelmingly negative. I would love to be proven wrong. And their claims that the surveys would be too expensive or that it would be too expensive administratively to address any new issues that arise are laughable at best.
These people are terrified that the results would become public.
These are just some of the many administrative mistakes and abuses of the current EPH administration. Others could provide many more examples.
The board has been complicit and protected the administration from criticism of, and consequences for, their aberrant and abhorrent behavior. Their leadership has failed in its fiduciary responsibility to this hospital and community.
Regardless of any progress made towards an “affiliation,” given the many remaining uncertainties about the specifics of the affiliation and the distrust of the community towards this hospital, the senior administrators should be replaced immediately, and the Park Hospital District board needs to be improved at the next election.
For now, though, we need to move on quickly with this much anticipated and much needed affiliation.
My recommendations are to dismiss current senior administrators and other toxic midlevel managers, support and empower the medical staff, and make every effort to restore a healthy workplace culture.
Until UCHealth administration takes over, the EPH board of directors needs to take a responsible role in ensuring effective executive oversight, better financial oversight, excellent quality care, patient safety, appropriate community relations and risk management.
Now is the time for the people of this community to speak up. Attend board meetings, ask questions, and share your views. The next meeting is Wednesday, Nov. 13 at 5:30 p.m. in the boardroom at Town Hall.
Contact the board members, David Batey in particular, and give your opinions, (970) 577-4470.
Share your concerns with the medical staff leadership by calling 970-586-2317.
Write a Letter to the Editor or your own opinion piece in the Estes Valley Voice, news@estesvalleyvoice.com.
You have the power to effect change and you need to use it. Let your voice be heard. Your health depends on it.
Thomas E. Leigh retired September 1, 2024, after a 32-year career in emergency medicine, the last nine of which were here in Estes Park. He graduated from the University of Colorado School of Medicine in 1989, completed a 3-year residency in internal medicine at the University of Michigan and a residency at the Denver Affiliated Residency in Emergency Medicine. He served as the medical chief of staff twice at Mat-Su regional Hospital in Palmer, Alaska, the emergency department medical director, and served on the board of a community mental health center for 12 years.
It is insanity and beyond a poor reflection of our community that Vern and David are still employed by the city. On embarrassment of incompetency and ethics alone, one would think the normal person would want to stay out of the limelight… but I guess one has to be capable of feeling shame in order to do that.
As a current employee at the hospital, it needs to be know by the community that Vern is literally the most incompetent and least intelligent person I have ever worked with in any setting. It is baffling and scary that this man has authority over anyones’ health.
If we are playing checkers, Vern is not some savant playing chess; he is the one eating the pieces and telling Pat Samples to aggressively scream threats at you.
Thank you, Dr. Leigh, for sharing your observations with the public. Our community owes you and the many other physicians and staff who were not enablers of this toxic culture a huge debt of gratitude. To continue work in the environment you describe and so many others have experienced and observed takes courage and strength. On top of all of the other stressors you face in caring for patients, working in an environment that treats you with respect and honors your many years of medical experience should the baseline of what you and your colleagues experience. This hospital administration and board has failed this community and the many patients whose stories may never be told.
This is concerning, and it’s not the first time I’ve heard of this from other reliable sources. No one should have to work in an environment that does not feel psychologically safe. Such a situation erodes trust and that affects performance. Our hospital staff deserves better. Our community deserves better. This sounds, to me, like a plea to our community for help. I would hate for Estes Park Health to lose its chance to be affiliated with UC Health because of this not being fixed.
I worked at Estes Park Medical Center. for almost 20 years. When I started, everyone knew each other, helped out anyone in need, and were friends. Dr Leigh is spot on his evaluation of the degradation of hospital environment. The current administration, and some of the mid-level managers have created a truly hostile and toxic environment, after all these years, I could no longer tolerate. I left mainly because the administration has created an environment in which they denude any person who may descent or suggest alternative ideas of their ability to have a respectful and safe workplace. I basically could no longer watch the administration and their “underlings” mistreat employees who had no choice but to endure for fear of losing their jobs that sustained their families. I hope the new affiliation with UC Health will remove all of these people from the hospital, and it will be a place in which employees and patients can feel safe.
Sincerely, A concerned former employee…….not disgruntled, but appalled.
Since my departure from EPH, I have successfully secured a new position in the Valley. Despite the extended commute, I find myself significantly better off. Dr. Leigh’s insights are entirely accurate. Numerous exceptional staff members and talented physicians share the same sentiments, yet they are hesitant to jeopardize their employment and so they endure the situation. The current situation is beyond toxic. While UCHealth offers a promising future, the current agreement is non-binding. We fervently hope for its approval, but its outcome remains uncertain. We cannot afford complacency and assume that this issue will spontaneously resolve. Instead, we must actively advocate for change.
In the September 2024 EPH board meeting, the majority of EPH board members expressed their full support for the current management’s actions and policies. Regrettably, the board itself is a big part of the challenges we face. To effect positive change, we must alter the board’s composition, and we have an opportunity in May. By electing two board members who are committed to action, we can effectively remove the current administration and prevent the hospital from further deterioration. It is imperative that we exercise our right to vote for change in May. Together, we can ensure a brighter future for EPH.
I am both thankful and disheartened to see this commentary by Dr. Leigh. Thankful because people have the courage to tell the truth and disheartened because it’s come to this and that real harm to real people is the collateral damage from some of the poorest so-called leadership I’ve ever witnessed in healthcare.
As a nurse who’s worked at EPH, I feel compelled to add my two cents. (Interesting idiom, given that most nurses feel their value is just about this small at EPH.)
Most nurses at EPH come with experience from other workplaces, which means we’ve seen different ways of doing things. And I’m telling you: it doesn’t have to be this way. We see the leadership at EPH. We see who you are, how you treat people, your hypocrisy, your egos, your paternalism, your dehumanization, and your misguided intentions. In some ways, you’ve lucked out that some nurses rely on their jobs here because of the seclusion of Estes Park and/or their loyalty to the community in which they live. Otherwise, I believe the turnover would be much more.
In an article linked to Dr. Leigh’s commentary, there were a few quotes from Pat Samples, the CNO and Vern Carda, the CEO. The CNO is the leader of nursing personnel and should exemplify leadership for all nurses. Here are a few of her quotes from that linked article with my own commentary to follow:
Pat Samples said, “Have we had bullying culture? Every organization has it. We work on it. We address it.” The irony of this statement is that the bullying is at the top. The hypocrisy of this statement is that bullying is okay if it’s thinly veiled as “personnel management” by people in positions of power. You are correct, Pat, we do have bullying at EPH. It starts with you. Unfortunately, you’re the example others are either looking to emulate or mimic in order to keep themselves safe.
Pat Samples said, “Our goal here is to encourage hiring people that have the ability and desire to be a professional. I expect that behavior every time you’re here—to be professional. That’s not up for discussion as far as I’m concerned.” What about what we expect from our leaders? I’m not sure what Pat’s definition of “professional” is, but I expect executive leadership, directors, and managers to be courteous, emotionally intelligent, and non-ego-driven. I expect you to exemplify a just work culture. I expect a workplace culture of safety where we, as educated nurses, are encouraged to ask questions and contribute ideas based on our vast experiences and think critically alongside you. I expect that you work just as hard, if not harder, than the rest of us at continued self-awareness and regulation of your own words, actions, and behaviors. I expect that you care about the humans you affect with your decisions. The nursing profession loves to talk about how we all care, but for some reason, EPH doesn’t expect their nursing leader to be an exemplar. And to say that something is not up for discussion is no surprise to hear from Pat. Nothing much is up for discussion with this leadership group, so this statement is a self-proclaimed example of just how little they want to hear from us. We are to be seen and not heard. It seems as though Pat’s definition of “professional” is more along the lines of us nurses just shutting up and doing what we’re told without question.
Pat Samples said, “I would argue with any clinician, you are not the best clinician you can be if you have a difficult attitude, if you don’t work well with others.” What about your attitude? What about your ability to work with others? Do you believe you’re the best CNO you can be? Again, I’d like a clear definition of what “difficult” means, though I’m afraid asking for this type of clarification might seem like I’m being…well, difficult. I’d be fearful to ask this question in person because if I’m viewed as “difficult,” I might start getting written up for petty inconsequential things and being put on the track toward termination for unjust cause.
Pat Samples said that the biggest stressor at EPH after the pandemic is “getting back in line with all the quality indicators…The culture we’re looking for, and continuing to work on, is a culture of ownership and accountability. A culture where staff say, ‘can you help me?’ versus lying and hiding so that you take pride in what you do, and are accountable to practice standards.” If there is any lying and hiding going on, this type of behavior aligns with authoritarian leadership where people are fearful of asking for help to begin with. Simply saying staff should ask for help isn’t supported by the toxic responses staff get when they do ask. Where is your ownership and accountability to the staff? Shrouding toxic behavior by people in positions of power as an effect of the pandemic is a disingenuous attempt at distraction at best and, at worst, a dangerous lack of acknowledgment of an authoritarian model.
As for Vern Carda saying, “Well, you could see how they might be disgruntled,” this is simply patronizing victim blaming. We will not be gaslit into believing we are the cause of this problem. When so many people come forward, isn’t it time to stop being defensive, be quiet and actively listen, and then look in the mirror? Nurses have been told for a long time to speak up about workplace toxicity but god forbid any of the accountability be on people in leadership positions. It’s no longer acceptable for any of you in positions of power to give us the proverbial pat on the head and tell us our lived experience isn’t real.
It is shameful to have bore witness to Pat Samples being a mentor to other nurses trying to make their place in management and leadership. She is the one they are either working to please, impress, placate, appease, or simply avoid confrontation. She may even be the one they’re trying to emulate. When an authoritarian bully is in charge, what better way to stay safe than to side with the bully? Those in director or manager positions must keep their positions safe, and the rest of us are collateral damage. It is a system set up for failure.
The EPH nursing workplace environment is, instead of a culture of safety, one where the so-called leaders are either threatened, disturbed, or simply annoyed by nurses who ask clarifying questions, desire rationales for decisions, and expect clear communication. The environment is one where nurses fear (with just cause) retaliation and administrative passive-aggressive paths to termination. It is a culture where leaders’ fragile egos take a hit with challenges from people simply seeking clarity.
Positions of power do not equal true leadership. What EPH has now is simply people holding positions of power.
People of Estes Park and of EPH: you can demand better. There are other options. There are people out there who lead differently.
Thank you, Dr. Leigh, for this spot-on article. The current administration manages with intimidation. They do not care about the employees, patients or the community they are supposed to serve. The hospital will not survive long enough for affiliation without immediate change at the top
We applaud your courage in speaking out against the unfortunate occurrences that have been ongoing at EPH. Your dedication to the community of Estes Park has been evident during the time you served as a physician at the hospital. An independently conducted survey of the EPH employees would help to create an atmosphere of transparency and a true desire to deal with current frustrations so that EPH can meet the needs of the community. We hope the citizens of Estes Park will take your concerns to heart, do what is necessary to restore the good name of the hospital and once again provide the level of healthcare that is essential to the well-being of the citizens of the Estes Valley.
Liz and Ken Zornes
First, Do No Harm?
This morning we read Dr. Thomas Leigh’s cogent article on the downward spiral of health care at Estes Valley Hospital. Our reaction: senior citizen medical angst. Over the 14 years we have lived in Estes Park, we have bonded with the Hospital and have had enough medical mishaps to have “skin in the game,” as they say.
For instance, the gastroenterologist we see periodically no longer does exams at the Hospital. The reason: the Hospital insists that all such procedures be done by a staff surgeon. The practical impact on us: two 75-year-olds now have to make an eighty-mile roundtrip in possibly inclement weather, including an overnight hotel stay about half the time, since only one of us has a driver’s license.
In addition, the Hospital has closed down its residential elder and home healthcare programs when there is almost nothing to replace it. The impact on us: we most likely will have to move away from our beloved small town for purely
logistical reasons.
The list could go on and on, and it’s likely that other senior citizens will have their own lists, but we think the real question for us all is this: Has your own health care at Estes Valley Hospital improved in recent years? Or has it declined? Do you think change is probable without new leadership?
From our own point of view, it seems to us that whatever measures the Hospital management has instituted, the result has been a very noticeable decline in effective health support for us all. Nurses do not leave good hospitals in massive numbers, and it seems to us that it’s been years since we’ve seen a nurse’s face a second time.
We believe that this unfortunate situation has come about because Hospital management has, to put things simply, violated one of medicine’s oldest guidelines: don’t kill your patient before you cure him. It is high time to conduct a top-down evaluation of Hospital policies, practices, and personnel.
Paul D. Moore, PhD
Janice Moore, JD
David if you have any integrity you will step down and fire Vern tonight. Here are some other very basic reasons he should be gone even if he was not a complete moron and jerk.
1) Vern does not use email. This is WILD. There is no other full time position in America (even at minimum wage) that this acceptable. How on earth is he supposed to stay up to date and care about the community if he refuses to interact with anyone via email? Moreover, this implies one of two things or both; not using email says one does not care about the job or is doing something shady and does not want a paper trail. This is a major MAJOR red flag and he should have been terminated on the spot when this was discovered. David, Exxon would have laughed you out of the building if you did this.
2) Vern does not come to work. That is the mystery question around the hospital… where is this guy? He doesn’t get to work until about lunchtime and leaves early afternoon if the board is not on campus that. Ask Bridgette, she knows! Heck, when he axed the nursing home and the community ‘hurt his feelings’ he did not come to work for 6 weeks. I mean what are we even doing here?
3) He doesn’t care about the hospital; he doesn’t come to holiday parties and doesn’t allow departure celebrations for long term employees. Samples almost fired me for having the audacity of bringing a gift to work for a 20 year employees departure.
4) He lies to you and the board constantly. Everything is “another 2 weeks.” Don’t believe me David? Go look at the board packets for the last 4 years… every single one is 80% identical. He cuts and pastes last month’s data and then has mid level managers email the newest applicable topic to cover a page or two. Rinse and repeat. It is pathetic.
He is playing you for a fool and knows he can just steamroll over you because you are scared of confrontation. Step down and give the Board to Alper or Bridgette because they are not scared of Vern and thus have the ability to do the fiduciary role required of the job.
I don’t know who wrote this but it is so funny and so true! Reminds me of the game “ where’s Waldo” but it’s “ where ‘s Vern”!
There are so many insane actions of this administration that has made me shake my head and think I was in some type of twilight zone! It’s crazy making, sadly, at the expense of the community inside and outside of the hospital.
I have a question for the board.
What in the world is it going to take for you all to take action? A few more law suites perhaps?
Shame on you board for letting the insanity continue. The downfall of this hospital lies squarely on your shoulders.
You have known, or at least have been told, for several years how badly Vern and Pat are not only in management responsibilities but fiscally as well.
I can collaborate much of what has been said here from personal experience. Having served 12 years at EPH I have a deep love for EPH, my coworkers, pt, and for the community as a whole. It has been an honor to serve, but the environment at EPH is no longer the wonderful team work and pt centered care that it has been in the past it is instead an environment driven by a dictatorship and bulling leadership style. Questions are not acceptable, feedback is discouraged, and you cannot collaborate because asking for help may be seen as a weakness to jump on and push you out the door. Under this leadership I have watched the failing of the team work and environment around me. I have watched the abuse, the lies, the gas lighting, and the silencing of my coworkers. I have witnessed policies that have not prioritized pt. care. I have tried to show up to work every day to do my best for my pt, my community, and my team. Even in a hostile and toxic work environment this was important to me, maybe even more important as there were those who need the protection and structure I could offer. I wanted to be part of building something better. I have questioned policies that made no sense I have sought to learn the reasons behind the things we did. And for this I, like so many before me, and others who have fallowed, received a “target on my back”. I was marched down a path that ultimately lead to my termination. From manipulated meetings to being pulled into a closet and yelled at, to being under a “double super secret” corrective action plan for 8 months (the action plan was never signed by either me or the administrator who held me to it), there was no attempt to help me improve just the next step to push me out the door. But we can do better we can have better. This is not an end it can be a new beginning but change needs to happen and that pressure has to come from all of us as a community because these concerns have been brought to administration and the board on all levels and have fallen on deft ears. There have been multiple requests for an employ survey and for a third party investigation all have so far been declined by current management and some members of the board. There needs to be new management for EPH to survive!!!
Why haven’t the Medical Staff come together and “in unity” demand for changes?
Mark , great question , but leading physicians is like herding cats. Sometimes 2 or 3 can agree to something. 4 or more, forget it. And any employed physician who crosses an administrator will almost certainly be fired. That’s pretty disruptive when you are working in a rural area. I have asked the same question. There is strength in numbers, especially in unanimity but many people are too self centered to put the needs of their community and colleagues above the needs of themselves or to even see the connection between their own needs and the common good. Maybe things will change. In all fairness though, I didn’t feel safe speaking out until I was retired and the administration can’t hurt me now. I can’t blame people for not sticking their necks out. Hope that helps. Encourage your friends to continue to speak out. That’s our only hope – pressure on the BOD. And after the “affiliation” goes through, pressure on UCHealth.
Do you think the hospital would function if they fired more than 25% of the employed physicians. Would it get the Board’s attention? I’ll wager that if they fired more than 1 or two physicians, their patients would be burning up the phones to the administration and the City of Estes Park.
How hard would it be for the employed physicians at EPH to stand up and form their own organization or private practice group demanding reasonable changes in the administration of their community’s hospital?
By the way, when UCH takes over, are they (the Medical Staff) simply going to be engulfed and diluted by the UCH Medical Staff to the point that they are irrelevant and have no influence in the organization and management of the community’s hospital?
The Estes Park Medical Staff actually should be standing up for appropriate administrative decisions for the betterment of this community. Perhaps the administrative decisions should, in some part, be influenced by the providers taking care of our citizens.
Over the past few months, I have not heard one thing from the hospital administration that would indicate that they give any weight to relevant medical staff input.
While I have no delusions that the Medical Staff “runs” any hospitals anymore, I do know that hospitals do not operate WITHOUT A MEDICAL STAFF.