Houston ER doctors say they were urged to work through illness and avoid COVID testing in new lawsuit

A group of Houston emergency room doctors say representatives for their employer compelled them to work through illnesses and discouraged them from testing for COVID-19 during the most recent surge, according to a lawsuit filed last month in Harris County.

American Physician Partners, a Tennessee-based hospital management company, independently staffs and manages emergency room doctors at 15 Houston Methodist facilities through a contract with the hospital system. The petition in the 113th District Court centers on a financial dispute between APP and eight doctors, who allege the organization violated its contract, in part, by underpaying them to save money.

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Text messages show “APP’s unethical practices of requiring doctors with COVID-19 to work,” the lawsuit alleges. The messages, displayed in four screenshots, show exchanges between two ER doctors and Dr. Robert B. Saldana, an APP representative and medical director of Houston Methodist emergency care centers.

Dr. Beau Briese, who is under contract to provide services at nine Methodist locations, voiced concerns during one exchange.

“I’ve been working ill but don’t want to make others to have to come in when their (sic) already exhausted and the system is thin,” Briese wrote in a group chat that included Saldana on Jan. 1, when Texas Medical Center hospitals were seeing a new record of more than 400 COVID patients per day amid the omicron surge. “Will always take care of our people and get those patients the care they need.”

“Yes I have been secretly texted from others with the same message that they don’t want to burden others since (not feverish) and mild symptoms so they don’t even test,” Saldana replied. “Speaks to what a dedicated group we work with appreciate u.”

The lawsuit does not explicitly say whether Briese had COVID but provided examples of another doctor being asked to work through symptoms consistent with the virus. Saldana declined to comment when reached by phone.

The plaintiffs argue that APP’s protocol “discourages testing and disregards physician, staff, and patient safety when a doctor does test positive for COVID-19.” The pressure to work, the suit continues, “conveys APP’s corporate mindset of ‘profit over patient’” because the organization is trying to maximize the revenue generated by doctors during their shifts.

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APP filed a legal response Monday, largely denying their involvement in the alleged financial damages. In a statement to the Chronicle, the organization said it has been in “active dialogue” with the physicians since they brought up their concerns in late December.

“We advised them at that time that their concerns do not reflect the facts known to APP and otherwise appear to be based on misinformation,” the statement said. “Thus, we are disappointed these physicians – who represent a very small minority of the physicians APP partners with in the Houston area – have decided to move forward with this litigation. We remain open to continuing our dialogue with these physicians outside of the litigation, which, again, APP believes to be without merit. “

The lawsuit does not involved Houston Methodist employees, a spokesperson said, adding the hospital system cannot comment on the specifics of the allegations. Methodist was not named as a defendant.

Staffing strain

The text messages reflect the intense pressure on hospital staff during the most recent wave of infections, from mid-December 2021 through January 2022. The highly contagious omicron variant sickened hundreds of healthcare workers while sending a record number of COVID patients to hospitals throughout the United States.

The strain on staff became so severe that the Centers for Disease Control and Prevention issued guidance on Dec. 23 shortening the recommended isolation period for doctors from 10 days to a minimum of five, depending on staffing levels, from the time symptoms first appear. The agency said doctors and nurses could work though a COVID-19 infection if the hospital activates “crisis standards” – an official designation that maximizes resources during a disaster.

But Houston Methodist was never under crisis standards, according to hospital spokesperson Stefanie Asin, who said the hospital’s quarantine and isolation policy aligns with CDC guidance. The CDC, which has kept its framework for healthcare worker infections, currently says healthcare personnel with “even mild symptoms consistent with COVID-19” should either not report to work or stop working and notify their supervisor prior to leaving.

“These individuals should be prioritized for testing,” the guidance says.

It’s unclear how many physicians are currently employed by APP, which has staffed and managed hospital staff throughout the United States since 2015. It partnered with Methodist in 2019, when it acquired Emergigroup Physician Associates, which for 18 years provided contract services to the Houston hospital system.

At the time, Emergigroup employed a team of 150 physicians and more than 50 advanced practice clinicians, such as registered nurses and physicians’ assistants, who collectively served about 365,000 emergency department patients annually, according to a press release.

‘Mask up’

In the lawsuit, the plaintiffs highlight a “culture” at APP that they say compromises patient safety. They contend that Dr. Scott Rivenes, an APP medical director, communicated to “4 M’s” policy during the pandemic: “1. Motrin, 2. Mask, 3. Man-up, 4. Must not test. ” Rivenes did not respond to a call for comment.

In a text message exchange on Dec. 8, Dr. Sonali Patel told Saldana, the emergency care director, that she woke up feeling like her “eyes were burning up.”

“Checked my temperature and it’s not too bad… 100.9,” Patel wrote. “Wondering what you want me to do about this … I can come in for a shift and just get the (COVID test) while I’m there?”

“Mask up and come on in,” Saldana replied.

Patel, who is immunocompromised, later tested herself and discovered she had the flu, according to the lawsuit.

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Nearly a month later, during her Jan. 5 shift, Patel told Saldana that she had a worsening cough and fatigue and felt she needed to go home and rest for “at least five days,” according to the lawsuit.

“We have no one its (sic) not right to leave your colleagues like this,” Saldana said, adding that the hospital was in “crisis mode.”

At the time of the exchange, Texas Medical Center hospitals were seeing an average of 497 patient per day – a number that remains the all-time high. The hospital, however, had not declared a crisis.

“Ur colleagues are working according to cdc crisis guidelines like u it’s the right thing to do plz hang in there,” Saldana said.

The lawsuit says a third plaintiff, Dr. Prasanth Boyareddigari, “experienced similar ridicule” from Saldana when he stayed home with COVID. When there was in issue finding someone to cover for his shift of lui, Saldana told colleagues that Boyareddigari decided to stay home “with a sore throat,” according to the lawsuit.

“Doctor Patel and Doctor Boyareddigari’s experiences are just two of many similar encounters,” the lawsuit says.


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