SOUTH KINGSTOWN, R.I. (WPRI) – A group of doctors, nurses and community members are calling for leadership changes at South County Hospital, saying recent management decisions are threatening to erode the hospital's future and quality of care.

The group sent an open letter Wednesday to the hospital's Board of Trustees, lawmakers and state agencies, saying they felt the need to speak out because of the deteriorating situation at the 100-bed South Kingstown facility that provides health care to residents of southern Rhode Island. (Read the full letter at the bottom of this article.)

"We, the undersigned, express our deep concern and urge that the pressing issues facing South County Health and South County Hospital be addressed immediately to prevent systemic impacts on both the overall health system and patient care," wrote the group of nearly 40 people.

"We have taken the unusual step of coming together to highlight that these are not isolated complaints, but broader systemic and administrative concerns that require urgent attention," they added.

The letter follows months of mounting strife between staff and administrators behind the scenes at the hospital, according to Target 12 interviews with doctors and other community members.

The situation began spilling out publicly last month when most of the hospital’s oncology doctors – who treat cancer patients – announced they were leaving the hospital. Many of them signed onto the letter sent Wednesday.

The group described a "lack of support and an adversarial relationship between executive leadership and providers, most recently exemplified by the resignations of the entire Cancer Center staff due to irreconcilable differences over issues directly affecting patient care."

The hospital's top executives, however, are pushing back. They point to the fact that federal regulators consider the century-old hospital a five-star facility, and how they've received top marks for several consecutive years from hospital-rating groups, such as Leapfrog.

"If it were so bad, how would that be possible?" CEO Aaron Robinson told Target 12 during an interview last week. "How would we be achieving those results if it was such an awful place?"

Management vs. money

Robinson himself is a target of the letter, which alleged that his management style has “fostered division rather than collaboration.” The group characterized Robinson as having an “abrupt, callous, and confrontational attitude, as well as disinterest in the well-being of practitioners, former trustees, and donors.”

Asked about the criticism, Robinson acknowledged he's made some unpopular decisions in recent years. But he said those have been necessary to keep the hospital afloat financially.

"We're underfunded," he said.

He also blamed state health care policy for making it nearly impossible to compete with Massachusetts and Connecticut, where insurance companies reimburse health providers at higher rates than Rhode Island.

South County Health – the hospital’s parent organization – reported an operating loss of more than $6 million last fiscal year, and another $1 million in operating losses through June of the current fiscal year, which ends in October.

"Just like the Washington Bridge had signs of a failing infrastructure, there's a failing infrastructure in health care in this state and we've kicked the can down the road year after year," Robinson said, adding he hopes state leaders will get more serious about tackling these issues.

"Let's not be in the same position where the house burns down, or the Washington Bridge fails, before we act on it," he added.

The group of concerned medical professionals, however, said the internal issues are more attributable to leadership than finances. And they said whenever they tried raising their concerns with leadership in the past it “fell on deaf ears.”

"Many patients are understandably worried over who would treat them during potentially life-ending illnesses and do not want to rely on unknown temporary providers to develop trust and confidence required for keeping positive attitudes during these serious health challenges," wrote the group.

For example, the group said leadership has demanded that doctors see greater volumes of patients who come through the hospital -- which generates more money but means doctors spend less time with each patient.

The group also pointed to staffing shortages they said have “led to increased patient wait times, backlogs for diagnostic tests, and the relocation of staff offices to the basement.”

The letter also highlighted “unresolved issues” within the OB-GYN practice, "unreasonable organizational benchmarks" for patient care visits, and “a critical shortage of pulmonary services, with only one doctor currently managing an overwhelming backlog of patients.”

Asked whether he considers himself a tough person to work with, Robinson defended his record and suggested it's more reflective of people getting upset because he's had to make tough decisions.

“Unfortunately, we as a small subscale health system in an under-reimbursed state that has many, many challenges – we have to make Sophie’s choices on an ongoing basis and sometimes those decisions are unpopular,” Robinson said.

He pointed to the oncology doctors leaving, saying there was a disagreement over what to do with the department. Robinson said the doctors wanted to merge with a Florida-based for-profit company, but executives determined it wasn't a good fit for the nonprofit health system.

“They can say it’s a style issue,” he added. “But at the end of the day, I think it’s more that people don’t like to hear ‘no,’ and we have to say ‘no,’ sometimes.”

But Dr. John O'Leary and Dr. Steven Fera, who both worked at South County Hospital for decades, believe mismanagement has driven most physicians away.

"No physicians have left because of inadequate compensation," Fera explained. "Most of them haven't fled to Massachusetts or Connecticut .... they've gone elsewhere in Rhode Island. Clearly, they're being driven out by management decisions that directly impact their ability to provide quality, safe care to their patients."

O'Leary said that a management overhaul will give the hospital a chance to turn the ship around, but hw acknowledged that chance isn't guaranteed.

"We're concerned that it's too little, too late," O'Leary said. "I'm not sure how long [the hospital] can survive."

The future of South County Hospital

Sitting alongside Robinson for the interview, Board of Trustees Chairman Joseph Matthews stood by his CEO.

He said Robinson is the right person to usher the hospital through tough financial times, and he likewise blamed state policy for causing financial hardship at hospitals in Rhode Island.

“The executive leadership team that Aaron leads is following the directives of the board,” Matthews told Target 12. “It’s a high-performing team and the results show it.”

To highlight his point, Matthews pointed to a hospital-commissioned Rhode Island Foundation report released earlier this year that showed private insurance, Medicaid and Medicare in Rhode Island reimbursed providers at rates roughly 20% lower than Massachusetts and Connecticut.

The disparity, he said, means South County Health is making about $20 million less than it might if it were operating in a neighboring state. And he said the dynamic makes it challenging to compete regionally when it comes to hiring, wages and balancing budgets.

“If we were on rate parity with our adjoining states – that would be a $20 million swing and we wouldn’t be talking about a $6 million loss,” he said.

Despite the financial woes, Robinson and Matthews downplayed the idea that South County Hospital will close its doors. But they acknowledged a growing need to affiliate with another organizations in order to survive.

And they suggested some specialty services -- especially those losing money -- may need to slim down, affiliate or shut down.

"We can’t continue to lose $6 million each year," Matthews said. "We have to get to zero."

The group of concerned health care workers, however, didn't share in the optimism that the hospital would remain a viable health care facility under the status quo. And they urged the board and state officials take note of what's happening and to take action.

“The potential decline in care stems from management decisions that challenge the survival of the hospital founded 105 years ago,” wrote the group. “This is a pivotal moment and we have taken the extraordinary step to let our voices be heard to help find necessary remedies, including the replacement of top management."

Fera expressed concern over the hospital's potential closure, especially since so many Rhode Islanders in the southern part of the state depend on its services.

"If this goes under of if the services become so constricted that they lose access to care and they have to go to Providence or elsewhere, it will really impact the health of the community," Fera said. "We don't want to see that happen."

Read the full letter to the hospital's Board of Trustees