Crozer Health faces ‘rush to the exits’ over threat to surgical residency program’s accreditation

Editor’s note: Crozer dropped its lawsuit in Delaware County Court on Tuesday, but said it will continue its appeal at the Accreditation Council for Graduate Medical Education in a bid to save its general surgery residency program.

Doctors in training are fleeing Crozer-Chester Medical Center’s general surgery residency program because they fear their work from January through June might not count toward educational requirements, according to a lawsuit filed last week. The program’s accreditation has been in limbo since last month.

Prospect Medical Holdings Inc., the California-based for-profit that owns Crozer, warned in its lawsuit against the Accreditation Council for Graduate Medical Education that the loss of the residents’ services will undermine the viability of Delaware County’s largest health system — and its potential sale.

The lawsuit in the Delaware County Court came in response to the decision last month by the council, known as ACGME, to withdraw accreditation for Crozer’s general surgery training program, which has 15 residents.

Lack of surgical volume was among the reasons for the decision, according to court documents.

Crozer has already cut back on services at the Upland hospital, prompting a reduction last month in the level of stroke care it provides. It is relying on Jefferson Health and Temple University Health System to provide certain services in neurosurgery and cardiac surgery.

Crozer has struggled to regain its financial footing since the pandemic. The system has closed two of its four hospitals, fallen behind on its bills, and had at least two rounds of layoffs. Last week, Prospect reached an agreement to pause litigation over the closure of Delaware County Memorial Hospital while Prospect tries to find a nonprofit willing to acquire Crozer.

Crozer prevented the immediate closure by appealing the ACGME decision, a 12-page notice that details 31 issues for which the hospital’s program was cited. The document was not included in court filings, so details are not widely known, but Crozer’s lawsuit noted the citations include allegations that the case logs for residents were fraudulent.

If Crozer loses the appeal in June, the ACGME says the loss of accreditation will be retroactive to Jan. 30.

That has caused a “rush to the exits,” according to Prospect’s complaint.

Nine of 15 residents were planning to leave as of Wednesday, the day Prospect filed its complaint.

In an emergency motion last week, Crozer asked for a preliminary injunction to block ACGME from retroactively rescinding the accreditation if Crozer loses its appeal.

“Left unchecked, the cloud that ACGME has put over the surgical residencies at Crozer Health may force the trauma center to divert patients to other hospitals, and otherwise disrupt normal hospital services, including emergency services,” Luke P. McLoughlin, of Duane Morris LLP, wrote in Crozer’s complaint.

The Pennsylvania Office of Attorney General weighed in on Crozer’s behalf, asking ACGME in a Jan. 26 letter to reverse its stance on retroactively withdrawing the accreditation.

ACGME said it does not comment on pending litigation.

Crozer issued a statement last week: “We took action to protect our trauma center and essential services in the face of an abrupt and unwarranted action by ACGME that seeks to put a cloud over our surgical residencies.”

An anonymous complaint that surgical volumes were insufficient for the residents’ training needs triggered the ACGME’s investigation of the Crozer program.

The complaint led to an ACGME site visit on Nov. 8, then the Jan. 8 notice that accreditation would be withdrawn four days later. Normally, when a training program losses its accreditation, the change occurs June 30, the end of the residency year.

A medical education expert said he wasn’t surprised by the ACGME action.

“These are the very kinds of situations in which the ACGME is obligated to act — because if they don’t, these residents will be out in practice operating on patients independently without the necessary experience and training,” said Bryan Carmody, an associate professor of pediatrics at Eastern Virginia Medical School.

The ACGME notice was not included in the public court filing, but letters and emails appended to Crozer’s complaint contain insights on the unusual nature of the ACGME’s action.

Most accreditation withdrawal notices “do not have the extreme urgency issues expressed in the Crozer notification letter,” an ACGME attorney, Douglas Carlson wrote, without giving reasons for the urgency in Crozer’s case.

In response to the allegations that case logs for residents were fraudulent, Crozer is reviewing every resident case since November 2021, when Crozer adopted electronic medical records, said Kirsten McAuliffe Raleigh, who works in the King of Prussia office of Stevens & Lee, in court filings.

A hurdle for surgical residents trying to leave Crozer is the Medicare payments that help defray the costs of training would stay with Crozer until the residency program closes. “It is likely harder for residents to find placements that will accept them unfunded,” Raleigh wrote.