The accreditation of Northeastern Health System's Internal Medicine Residency Program has been withdrawn by the nonprofit council charged with sanctioning graduate training programs for physicians across the country.
According to documents provided to the Press, the program will cease operations June 30, and NHS will no longer be an instructional site for those looking to complete their medical training through the Oklahoma State University College of Osteopathic Medicine. NHS and the Tahlequah Medical Group are reportedly appealing the decision and have until July 1 to establish reaccreditation.
“We remain grateful for the opportunity to have been a part of this teaching program, and our partnership with OSU,” said Dr. Thomas Schneider, the program’s director, in a release. “We are proud of the wonderful physicians that have trained and flourished here. The IM Board Certification Exams have been passed 100 percent of the time by our graduate residents and all have passed on their first attempt.”
Current residents in the program will have to find another location to complete their required training. An NHS employee close to the program, who spoke on condition of anonymity due to employment concerns, said the sponsoring institution, OSU, is obligated to either absorb the 14 resident positions currently filled, or help the physicians-in-training find an alternate location.
The NHS source also expressed displeasure with Schneider, saying he did not exhibit the "appropriate ability" to run the program.
Schneider became the residency program’s director after Maria Elaine Ramos reportedly left in March 2019. Prior to securing a position at NHS, he served as chief of staff for the Jack C. Montgomery VA Medical Center before he was removed and reassigned to a temporary detail at a Tulsa outpatient clinic. That action dovetailed an investigation initiated by Sen. Jim Inhofe, R-Oklahoma, over allegations of substandard care at the VA facility. The Muskogee Phoenix reported the probe in February 2016.
A letter from Karen Lambert, associate executive director of the Review Committee of Internal Medicine, detailed 16 citations the Accreditation Council for Graduate Medical Education handed down to the NHS residency program. The first three areas the review committee cited focused on Schneider's responsibilities and qualifications.
“Based on discussions with the site visitor, the program director did not demonstrate that he had a firm understanding of the program requirements and had limited experience in dealing with related residents’ concerns, especially in the areas of maintaining a balance between education and patient care demands," Lambert wrote. "The Review Committee determined that the recently appointed program director does not have the educational and/or administrative experience required to effectively administer and manage all aspects of an internal medicine residency program.”
The committee found that the program did not provide adequate resources or support personnel for the residents’ education, and not enough medical and nursing staff to safely manage an apparent increase in patient volume.
“This resulted in reliance on residents to handle the extra patient volume, with no cap on each inpatient service [ICU and Teaching Service] and requiring residents to cover the non-teaching hospitalist service at night,” the letter states.
Furthermore, residents confirmed that because of the patient load increase, especially since a stroke team joined the NHS team, faculty members on the inpatient service had “no time to teach.” A large percentage of residents reportedly expressed dissatisfaction with the process to deal with problems and concerns.
The residents said they complained to Schneider about excessive fatigue due to the large workload, but that no followups or changes were made to address their issues. They also said they were not given written goals or objectives for any of their learning experiences.
Jim Berry, NHS executive vice president and hospital administrator, said the timing of the program's loss "couldn’t be worse.”
“The OSU College of Osteopathic Medicine at Cherokee Nation is scheduled to enroll its first class of medical students in the fall of 2020. Residency is the next step after medical school,” Berry said. “A robust, local graduate medical education program is vital to ensure health care in the future of Tahlequah. Many residents will stay where they train in residency. This is a setback, but you can’t count us out. NHS will seek opportunities to participate with OSU as the sponsoring institution for its future residency programs.”