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Open Letter By: Dr. Steven W. Orlow

Mr. Poore;

With deep sadness, I write to you in your role as market CEO, to give written 90-day notice of the termination of my employment agreement with Lutheran Medical Group and termination of my position as Chief Medical Information Officer for Lutheran Hospital of Indiana.

I began my productive association with Lutheran Hospital when it was located at the old Fairfield site back in 1990. I practiced interventional cardiology until 2012 and was the Medical Director of the Catheterization Laboratory for almost 10 years. During those years, I experienced the organizational effects of the sale of Lutheran Hospital by the Lutheran Church to Quorum, who sold to Triad, who sold to Community Health Systems (CHS). I have experienced firsthand three different publicly traded corporate owners and have witnessed firsthand the effects of CHS operations compared to Quorum and Triad.

In 2012 I became Chief Medical Information Officer for Lutheran Hospital. In this position, I have had deep visibility into the methods under which CHS operates Information Services and have had significant visibility into how CHS operates hospitals. Under CHS leadership, Lutheran Health Network (LHN) Information Services (IS) has been very difficult to manage because of below market pay, lack of professional security, and understaffing both in LHN and at CHS. As a result, in my years as CMIO I have seen 2 Chief Information Officers, 2 Chief Technology Officers, 1 Chief Nursing Informatics Officer, 1 Chief Medical Information Officer and numerous IS staff resign because CHS provides such a frustrating and unrewarding IS work environment. Evidence for low pay is that at least two of these IS leaders left LHN to enjoy a 100% pay increase. Exit interviews reveal that recently resigned IS staff received 40% pay increases at their new jobs. Regarding inadequate staffing, even though a local LHN competitor added 100 IS positions as they changed Electronic Medical Records, CHS fired 19 IS people as LHN prepares for a new EMR. Of course, the IS work environment is mirrored in the overall patient care environment at LHN.

CHS has always reinvested less in LHN than did Triad. Recently the financial hardships orchestrated by the majority owner, CHS, have been even more extreme. As the CHS stock price fell from $65 per share to the $5 to $10 range, and bond covenants triggered CHS debt renegotiation, the physicians (minority shareholders) began to become concerned regarding the overall viability of LHN as the majority owner failed to match the reinvestment exhibited by our competition. We all became concerned that CHS financial weakness would drag LHN down. A group of 10 concerned and Brave physicians sought a new majority owner and raised the visibility of issues such that CHS was forced to address the problems affecting patient care including facility maintenance, professional salaries, antiquated assets such as beds and imaging equipment and inadequate physician recruiting. For example, IS made our first request for the 26 Cerner modules needed to create a competitively competent Electronic Health Record platform back in 2015. Before the Brave 10, CHS had authorized only 2 of the 26 EHR modules. After the Brave 10 increased visibility to CHS business practices, as late as last week, CHS has approved all 26 modules. Almost none of the recently announced pay raises and capital investments by CHS in the LHN market would have happened if not for the Brave 10.

When I raised these issues at a heavily attended meeting at which you were present, I feared retaliation and sent my employment contract for review. The next day Marty Bonick and I discussed the fact that CHS had left the Brave 10 no choice but to attempt to broker a new owner. I coached Mr. Bonick that for the LHN/CHS relationship to heal, CHS had to take responsibility for the current market unrest—to take responsibility for CHS reinvesting too little in the LHN market.

Instead, CHS continued targeting scapegoats. I have reason to believe that you fired Dr. Randolph because he spent too much time focusing on staffing ratios and wages and not enough time on quality. However, under CHS management, the nursing wages were so low we could not keep nurses. The patient to nurse ratios were sufficiently extreme to be a quality issue. CHS should have thanked Dr. Randolph for his heroic service. His leadership was part of the teamwork that kept Lutheran Hospital safe. Firing Geoff Randolph demonstrates that CHS has not changed their corporate culture.

The most recent CHS generated false news is the assertion that Fort Wayne Physicians voluntarily disbanded their LLC. You threatened the Brave 10 physicians with personal litigation. You have threatened, “termination of employment agreements, involuntary redemption of membership interests in related LHN affiliated limited liability companies, and removal from officer and board member positions among the LHN-affiliated entities’ advisory boards of trustees and boards of directors.” You held a gun to the head of the Brave 10 and they chose to protect their families by allowing a joint news release. The CHS tactics executed in the Fort Wayne market are evidence of failing to take responsibility for having dangerously drained LHN financial resources.

Even though I am giving notice of termination of my employment by Lutheran Medical Group and my position as CMIO, I am maintaining my current ‘courtesy’ medical staff privileges for Lutheran Hospital of Indiana and Dupont Hospital. In addition, I am maintaining my Lutheran Hospital of Indiana Advisory Board membership. Finally, please be informed that I am seeking purchasers for my interest in Dupont Hospital, LLC and my interest in Lutheran Health Network Investors, LLC.

Steven W. Orlow, MD, FACP, Board Certified Clinical Informatics
Chief Medical Information Officer, Lutheran Hospital of Indiana