(Illustration by Getty Images)

By Keila Szpaller

FEBRUARY 17, 2024 – St. James Healthcare in Butte appears to have lost more than half of its surgeons in the last year, and the Montana Nurses Association is urging Intermountain Health — which runs the hospital following a 2022 merger — to prioritize retention of critical health care providers.

Roughly one year ago, the hospital counted nine or 10 surgeons, and it has just four after Intermountain failed to retain three in contract negotiations and two others retired, according to the Montana Nurses Association.

“This is a really big impact” for surgical services, said Robin Haux, labor program director for the Montana Nurses Association.

St. James counts 67 beds in southwest Montana and is the only acute care facility in the region, according to information from Intermountain Health. A story about the merger from NBC Montana said it served nearly 40,000 members of the community in 2022; Intermountain did not provide an updated figure.

In an email Friday, Intermountain Health did not dispute the union’s count of the more than 50% decrease in surgeons in the last year. In response to a question about plans and a timeline for filling positions in Butte, Intermountain emailed a statement with remarks from an interim president.

“We are excited to welcome several new providers across various specialties to St. James and Intermountain Health in the coming months,” said Pam Palagi, interim president of St. James Hospital, in a statement from an Intermountain media relations manager. “Those specialties include neurosurgery, orthopedic surgery, general surgery, endocrinology and walk-in care.”

Intermountain Health’s corporate offices are based in Utah. Its website says it works in seven states including Montana and at 33 hospitals and 385 clinics. It touts that it is “reimagining health care,” offers “pioneering research,” provides personal and affordable care, and is a partner with the Las Vegas Raiders.

The merger between Intermountain Health and SCL Health created the 11th largest nonprofit health care system in the U.S., according to NBC. At the time, the former president of St. James said patients would see a logo change as a result, but they could expect to see a high level of care continue.

“The great quality care that you are used to receiving will stay the same, and how you access and utilize our services will not change,” said then-President Jay Doyle in 2022 to NBC.

Friday, however, Haux and Montana Nurses Association labor representative Emily Peterson said patients already are seeing impacts from the departures of providers. The lost doctors who have not been replaced include a urologist and gastroenterologist.

Peterson said the hospital recently had to reschedule three weeks’ worth of procedures for patients after Intermountain lost one surgeon. She said it canceled two weeks of appointments after it lost another.

“That is one big concern for our nurses,” Peterson said. “They know these patients need help, and it was more upsetting to them that the patients that needed procedures weren’t getting them than it was for them to not get their hours.”

However, the union is seeing employees have hours cut or have to take eight to 12 hours of paid time off a week. And without needed providers and a full schedule, they worry about the potential for staff cuts in the future.

“It is causing a lot of concern with the nurses and the surgical techs,” Peterson said.

A petition launched Friday asks Intermountain, a nonprofit healthcare system that describes itself as the largest in the intermountain West, to address the crisis by prioritizing the retention of providers, strengthening their contracts, and keeping registered nurses and other staff in Butte.

The Montana Nurses Association has roughly 25 nurses in surgical services at St. James and 132 members at the hospital altogether. The Teamsters of the Montana AFL-CIO represent additional staff such as CNAs, or certified nursing assistants.

“This is really about protecting the ability to provide high quality care and really vital services and vital care to the community,” Haux said.

To fill one gap, a traveling doctor is slated to help temporarily, but at a high cost, Peterson said.

Dr. Nathaniel Readal, a urologist, said Friday he declined to sign a new contract with Intermountain because he believes some of the language in the agreement put him at risk legally.

Most surgical specialists are generally required to take seven to 10 days a month of being on call, but in Butte Readal said he took an average of 270 to 300 days a year. That means staying within 30 minutes of the hospital and being available to deal with an emergency; in other words, it means no skiing, fishing, beer or golf.

“I take more call because there’s nobody else to do it. We have a pretty large patient base,” Readal said.

But he said he interpreted some of the language in the contract to suggest he would have to be on call and available basically around the clock and every day for existing patients he had cared for in the past.

If such a patient came in with an acute issue and Readal was, say, skiing and unreachable, he said he could be at medical legal risk as the agreement was drafted. He didn’t quibble with compensation, he said, but he requested language in the contract that would protect him legally, and Intermountain did not provide it.

“That was the thing they were unwilling to change and why I would not sign the contract,” said Readal, who had signed previous contracts before the merger.

A story about Readal in the Montana Standard in 2018 said he completed his medical degree and residency at renowned Johns Hopkins Hospital in Baltimore and was working to make healthcare better and more accessible at St. James. In a way, the story said he represented the “future of Butte.”

The story said he and his wife were already a part of the community. Friday, however, Readal, said he is evaluating all his options for the future, in part because standard healthcare contracts make it difficult to remain in a community and care for patients if a provider doesn’t want to work for the medical group that staffs the hospital, or Intermountain in this case.

In the email from Intermountain, Palagi said the industry comes with some churn.

“Transitions in hospital leadership and physicians are common in the healthcare industry,” Palagi said. “At St. James, we prioritize continuity of care and employ robust recruitment strategies to ensure smooth transitions and maintain high standards of patient care.

“ … The bottom line is that St. James Hospital and Intermountain Health remain committed to ensuring the residents of Butte and southwest Montana have access to top-notch, patient-centered care right here in their home community.”

The Montana Nurses Association said the administration at St. James wants to protect frontline employees such as nurses, CNAs, and other staff. Haux said they know how hard it is to replace those positions.

“But we also know they will not be able to continue this without providers and without a full schedule,” she said.

Haux said the petition does not force action by Intermountain. However, the Montana Nurses Association and Teamsters of the Montana AFL-CIO may pursue other options that would put pressure on the healthcare system if leaders do not respond.

“I don’t think … that will sit well with the Butte community if they choose not to respond,” Haux said. “That’s a very tight, close-knit community.”