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August 15, 2014
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Doctors lend support, others critical of Tahoe Forest CEO

TRUCKEE, Calif. — Several Tahoe Forest medical staff recently came out to defend the district’s leadership amid reports that point to potential conflicts of interest involving CEO Bob Schapper.

“In 2002, Tahoe Forest Hospital was a small hospital providing adequate care to our community,” a July 21 letter signed by 21 TFH medical staff members stated. “Complex cases were transferred to larger facilities in Nevada or California. Commonly, patients and their families would need to spend significant time away from their homes and jobs to deal with their illnesses. We did not have a relationship with a medical school, had minimal educational programs for the clinical staff, and minimal expectations for change.

“After Robert Schapper took the helm, those expectations were rapidly altered.”

The letter goes on to list 28 perceived positive changes in the district in the past 12 years, including being named a Rural Center of Excellence by UC Davis; the Gene Upshaw Memorial Tahoe Forest Cancer Center opening in 2012; and educational programs created for medical staff and hospital employees on changes expected with national health care reform.

“Absolutely none of these changes would have taken place without the vision, experience and stability of our CEO, Robert Schapper,” the letter states.

In reviewing the letter’s contents, Mark Spohr, a Carnelian Bay resident who worked briefly as a Tahoe Forest Hospital ER doctor in the late ‘70s, said it appears to be “a PR effort to deflect attention from the issues raised by Moonshine Ink.”

“It’s a laundry list of things that have happened in the past 10 years with all credit to Schapper,” said Spohr, who is running for one of three seats up on the Tahoe Forest Health District Board of Directors in the November election. “In the process, it manages to disparage the state of the hospital, staff and doctors prior to his arrival, and this is just not true. It does not address the conflict of interest issue.”

‘FEELS LIKE A WITCH HUNT’

Moonshine Ink published a July 11 report, raising examples of a potential conflict of interest with Schapper, and the hospital’s involvement with Medical Practice Solutions Inc., a company operated by his wife, Marsha Schapper.

Schapper has defended himself in previous Sierra Sun stories, saying he was a “participant in name only in Medical Practice Solutions” and that he “factually had no involvement.”

The hospital board reportedly began an internal investigation in connection with the district’s conflict of interest policies in May, and a report of any findings or conclusions is expected soon.

As news of the potential conflict of interest issue spread, some residents have called for Schapper to be put on leave and/or for a third party — such as the Nevada County District Attorney or California Attorney General — to do an investigation.

“I think it feels like a witch hunt,” said Dr. Laurence Heifetz, medical director of Gene Upshaw Memorial Tahoe Forest Cancer Center, and one of the physicians to sign the July 21 letter.

Randy Riddle, whose focus includes ethics laws, including conflict of interest matters, was hired in July by Schapper’s personal attorney.

Riddle, a partner with San Francisco-based Renne Sloan Holtzman Sakai, previously said he concluded Schapper committed no conflict of interest violations, considering he was not involved in the making of the MPS contract.

COST OF CARE

Richard Ganong, a physician with the private Truckee Tahoe Medical Group, takes issue with another topic that has been discussed in recent weeks ­— health care cost.

“There is a responsibility that the CEO and (board of directors) has to the community and its staff and physicians,” Ganong said. “... Foremost is to ensure quality care to the community. However, this care needs to be appropriate and affordable.”

In a July 15 letter to the community, Schapper said “there is no denying the cost of health care is high.”

“Hospitals must, without exception, care for everyone who comes through our doors, regardless of their ability to pay,” Schapper wrote. “Everyone must be served, yet no one is ‘forced’ to pay. No other business in the world is required by law to operate in this fashion. Hospitals have no reliable revenue sources, are expected to employ highly skilled workers and care for thousands of patients with less and less resources. These are national issues.”

As for outpatient care, Ganong said: “I think (Schapper) is trying to control all of the outpatient health care, which makes it equally expensive. In so doing, he is taking health care out of the hands of physicians not paid by the hospital.”

For example, in 2013, as in years past, TTMG expected to partner with Tahoe Forest Hospital in operating Northstar California’s medical clinic, Ganong said.

However, without discussing it with TTMG, the hospital district submitted its own proposal to operate the clinic, which it ultimately won.

“I think there’s a real question of trusting the CEO with outpatient health care and cost of that care,” Ganong said. “I think the CEO has not been forthcoming with certain physicians and the (board of directors) about issues surrounding the community health care dollar and the sustainability of physicians in private practice who are trying their best to practice good cost effective medicine.”

DEFENDING THE DISTRICT

It was amid all this critical commentary that members of Tahoe Forest’s medical staff signed and released their statement.

“One of the reasons I signed the letter was that I felt it was a very lopsided presentation (by media) with a lot of focus on negativity when there’s been so much progress that’s been done by a hospital, by our district, for our community, with our community,” said Nina Winans, sports medicine physician and medical director for the Tahoe Center for Health and Sports Performance.

Since signing the letter at the end of last month, Winans said her opinion has not changed.

“I absolutely still feel the same way that we have a lot of positives at Tahoe Forest Hospital,” she said.

Fellow letter-signer Benjamin Kaufman, a psychiatrist who gained appointment to the staff of Tahoe Forest Hospital about two years ago, added: “TFH is unlike other hospitals of its size and demographic circumstances. TFH has grown in excellence over a short 12-year time period into a cohesive multispecialty teaching hospital ... Good things need protection from those dedicated to distraction and personalization of naturally occurring imperfections in systems.”

To learn more about TFH, visit www.tfhd.com.


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Tahoe Daily Tribune Updated Aug 19, 2014 07:40PM Published Aug 20, 2014 02:43PM Copyright 2014 Tahoe Daily Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.