Three weeks after a leading surgeon at Martha's Vineyard Hospital submitted his resignation, hospital board trustees devoted an entire press conference to the matter, also releasing new letters, from both the surgeon and a group of doctors, that paint a picture of souring relations between hospital leadership and the medical staff.
That picture expanded as board members fielded questions about other troubles at the hospital: the ongoing nurses' contract dispute and continued concerns about the management style of chief executive officer Kevin Burchill.
Mr. Burchill was not present for Saturday's press conference, which followed a regular meeting of the board; neither was Dr. Richard Koehler, the laparoscopic surgeon whose resignation has triggered an avalanche of supportive letters to the editor.
Dr. Koehler cited irreconcilable differences with Mr. Burchill as the main reason for his resignation, but on Saturday the hospital board distributed a Jan. 17 letter from Dr. Koehler that it described as a list of demands - including one calling for trustees to negotiate a new nurses' contract within a week and to reinstate other nurses who were recently fired.
But while trustees praised Dr. Koehler and promised to redouble efforts to convince him to stay on board, they showed no sign of caving to his pressure.
"Dr. Koehler is a very respected and well-liked surgeon who has saved many lives and changed many lives," said board secretary Tim Sweet, who led the meeting in the absence of the still-recuperating chairman Fred B. Morgan Jr. "Do we have issues? Yes, we do."
As for Dr. Koehler's list, there was no chance of acquiescence. "We are unable to set those conditions," Mr. Sweet said, "because, basically, they usurp responsibility of this board to run the hospital."
Mr. Sweet said he hoped Dr. Koehler would reconsider his decision, but with the surgeon's future at the hospital looking tenuous, the board quickly turned its attention to the rest of the medical staff, 18 of whom signed a letter calling for more input into hospital management and better relations with the board and the administration.
As board members passed out copies of the letter dated Jan. 22, Dr. Bill Tsikitas - speaking as a representative of the medical staff - explained that the letter was intended "to improve communications and stop what appeared to be a runaway process."
But the doctor made it clear that the medical staff's discontent had been brewing long before the current flare-up brought on by Dr. Koehler's resignation. Dr. Tsikitas said the medical staff has increasingly felt left out of important decisions. "It leads to people feeling frustrated and demoralized," he said.
According to two other doctors who asked not to be named, the letter submitted Saturday is a much tamer version of what some other staffers pushed for in recent months. At a gathering last month at the Howes House in West Tisbury, doctors split over whether to publicly spurn the hospital board and its administration with a vote of no confidence, according to the sources.
But at the press conference, both board members and Dr. Tsikitas took pains to describe the letter as a step toward more constructive and collaborative relations. Acting on one recommendation from the letter, the board agreed to appoint two liaisons to schedule a new series of meetings between the two sides. Dr. James Butterick, the hospital's chief medical officer who also serves in the same capacity for South Coast Hospitals, will represent the medical staff, and John Ferguson will represent the board. Mr. Ferguson is the chief executive officer at Hackensack University Medical Center in New Jersey.
The concerns of the medical staff need to be addressed or "it could quickly and easily affect patient care," said Dr. Kathleen Koehler, a board member and a gastroenterologist, who is married to Dr. Richard Koehler.
On the issue of the nurses' contract, which is currently being handled by federal mediators, board members said they are close to a settlement. One of the remaining sticking points is over vacation time and the desire to limit nurses to no more than two weeks' time off in summer.
"It seems reasonable, but it's not been the practice in the past," said board member Charles Harff. "There's a significant cost to bring in temporary people - $160,000 just on housing."
Finally, when pressed on the matter of Mr. Burchill's management style, hospital trustees acknowledged, as they have before, that their chief officer needs, as Mr. Harff said, "to tone it down."
Dr. Tsikitas said that while there has been "a strained relationship" with Mr. Burchill, he viewed the CEO as a "tough guy" having to make hard decisions. "I've cringed at the poor delivery of a good decision," he said. "But if we are to have any hope of moving to the next level, we must work collaboratively."