I was once the senior medical director of a three-hospital network in southern Arizona. During that time, I had an active medical license in Arizona for over 20 years. I didn’t make clinical decisions, except when a medical staff member refused to see an “on call” patient admitted to him.

I had to see the patient, write orders and ask for someone to take over the care (back in the days when medical staff took their turns to take the care of patients who needed admission but didn’t have a physician).

In the emergency department, the only time I assisted in a clinical decision was when the emergency staff physician wanted a neurologist to declare brain death in a patient with a subarachnoid hemorrhage from a brain aneurysm. I was a board certified neurologist, I happened to be in the department at the time, and I made the decision, with the emergency department physician’s support.

I did deal with length of stay issues. Before I became medical director, I was in charge of the quality assurance committee, and I was trained at Intermountain’s Advanced Training Program for Clinical Quality Improvement in Salt Lake City. Even then, however, all I asked for was documentation in the chart by a clinician of why the patient needed to be in the hospital. Nothing else.

My wife and I are both retired physicians and are stunned by what is going on here in Eugene-Springfield. Make RiverBend’s emergency department large enough to handle the load, or rebuild what was lost in Eugene. Leave current staff in place. That’s the solution I see. Will it cost? You bet it will. But what’s the cost now?

Michael S. Smith, M.D.
Former chief of neurology St. Mary’s Hospital (Tucson), 11 years
Medical director, St. Mary’s Hospital (1992-1998)
Senior medical director, Carondelet Health Network (1996-1998)