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Doctor says she was fired for reporting low staffing at Brandon Regional ER

Published Feb. 21, 2015

TAMPA — A Tampa doctor is suing HCA Inc., alleging she was fired from a physician-staffing company because she complained about low staffing levels at the emergency room of the chain's Brandon Regional Hospital.

In her lawsuit, Dr. Wanda Espinoza-Cruz, 44, alleged that so few doctors were available during a January 2014 night shift that a man with "obvious stroke symptoms" was forced to wait four hours for medical care. A CT scan later showed blood on his brain, her suit says.

In another instance, she said a patient endured a similarly long wait despite signs of hyperglycemia — excessive blood sugar — which can lead to a coma if untreated.

Espinoza-Cruz's suit, filed Feb. 4, comes as Nashville-based HCA, the nation's largest for-profit hospital chain, is promoting short wait times at its emergency rooms.

In addition to HCA, the suit names Espinoza-Cruz's former employer, Florida EM-I Medical Services, and its parent company, EMCare Inc.

EMCare, a unit of Envision Healthcare, is one of the largest physician outsourcing companies in the country, employing about 8,000 doctors and other clinicians.

Spokespeople for EMCare and Brandon Regional called the allegations untrue.

"Brandon Regional Hospital is committed to providing the highest quality patient care as demonstrated by receiving a Top 100 Hospital designation by Truven Health this year," said Brandon Regional spokeswoman J.C. Sadler. Truven Health is a multinational health care company that studies hospital services.

According to the eight-page complaint, Espinoza-Cruz, an osteopathic doctor, completed her residency in 2011 and joined EM-I Medical Services that August. She was assigned as a full-time ER physician to Brandon Regional, where she maintained "an unblemished personnel file."

That changed after Jan. 2, 2014.

She said she reported for work at 7 p.m. to find a "standing-room-only crowd" in the emergency department. After asking why more doctors weren't working that night, a nursing supervisor told her that she no longer had the authority to call in doctors, Espinoza-Cruz said in her suit.

"It's her understanding that she (the nursing supervisor) was told there was a change in protocol as a response to concerns about profitability," her attorney, Chris Gray, said. "It's expensive to call in a doctor."

Two days later, Espinoza-Cruz met with Brandon Regional chief executive officer Bland Eng to complain. Nine days after that she was fired.

According to her suit, Eng said during their meeting that, "he knew there was a problem, but that he had talked to corporate and that the emergency room staffing model was untouchable because of HCA's relationship with (staffing company) EMCare."

EMCare gives a different reason for her dismissal, that she violated a company policy. She said an EMCare vice president told her she was caught trying to launch her own physician-staffing company and enlist Brandon Regional as a client.

Gray denied the allegation.

"That's ridiculous," he said. "It's ridiculous to suggest that a person who has only been doctor for two years would have a plan to take over an account that has been serviced by a company as large as EMCare."

Wait times are a big part of HCA's marketing, as the chain uses billboards and other media to boast of shorter lines than other hospitals.

The Centers for Disease Control and Prevention reports that nationally ER wait times average about an hour. From check-in to discharge the average patient spends 4 hours, 7 minutes in the ER, according to a 2010 analysis of 1,893 emergency rooms by Press Ganey, which consults for about 40 percent of U.S. hospitals.

HCA began highlighting ER wait times in promotional materials a few years ago. Along with other HCA hospitals, Brandon Regional posts wait times on billboards and its website. This past week, the wait there averaged 13 minutes, according to the hospital's website.

Additionally, HCA's Florida division sent out mailers last summer urging residents to "make seconds count" in emergencies by requesting they be taken to HCA hospitals.

Espinoza-Cruz currently works as an ER doctor at the Indian River Medical Center in Vero Beach.

Contact Rich Shopes at rshopes@tampabay.com or (813) 225-3110. Follow @richshopes.

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