The lawsuit filed by Joel Morris against city-owned Memorial Hospital is hinged primarily on the question of whether or not hospital administrators violated Morris' constitutional rights.
In short, Morris and his attorney say the hospital tried to use the complex system of surgical cross coverage "to force the surgeon out of town," to quote Morris' attorney Tom McMahon.
In doing so, the lawsuit claims, they essentially required Morris to remain within 30 minutes of the hospital, depriving him of his constitutional rights to travel.
Hospital officials and Morris' then boss, Dr. James Albert, adamantly denies those charges. But the accusation begs the question: Why would Memorial administrators want to force the person some claim is the best heart surgeon out of the city?
If you believe the logic of McMahon and Morris, hospital administrators wanted to get Morris out of town because he posed a significant threat to the financial stability of the institution.
Why? Because as long at Morris was in town, there was the possibility that Morris would in fact team up with Pikes Peak Cardiology, Colorado Springs pre-eminent group of heart docs, on developing a heart specialty hospital that could, if successful, run Memorial's heart program into the ground.
It sounds pretty conspiratorial. But the sentiment is backed up by the words of hospital boss J. Robert Peters in a lengthy memo to then hospital board member Randy Purvis in April of 1999: "As long as Dr. Morris is active at Memorial Hospital, the threat exists that PPC can more easily restart efforts to develop a heart hospital."
The comment is one of many points Peters raised in justifying continued sanctions against Pikes Peak Cardiology, which had just opened a diagnostic catheterization lab in competition with Memorial, and had taken a series of steps toward development of a Medical Office Building that stood to compete with the hospital on some in- and out-patient care.
The only thing PPC still lacked was a well-known, highly skilled heart surgeon. Following the logic of Peters, that surgeon would most likely be Morris, arguably a gifted surgeon who gained considerable experience building up Memorial's heart surgery program from a near death in 1990.
Though hospital brass are not commenting on the case, one doesn't have to read too far between the lines in its voluminous court entries to see that the hospital is setting up a case to justify its firing of Morris based on his alleged plans to start such a heart hospital.
While there's no smoking gun, there are several documents that suggest the possibility of a covert plan. But PPC cardiologists interviewed for this story say that since the beginning, the hospital has misdiagnosed the whole situation -- ruining a surgeon's career in the process.
Morris resigned from his practice with fellow heart surgeon, Dr. Jim Albert, in June of 1998. Now in need of new office space, Morris says one of the first people he turned to was Memorial Hospital chief Bob Peters.
But Peters turned him down, saying there was no room, a point that Morris disputes. Whatever the case, Morris then asked his consultant, Jim Flack, to find him office space. When Flack came back with a recommendation that Morris move into PPC's offices, Morris says he innocently decided to take up the offer.
"I thought I was just moving into an office," Morris said, adding that he was unaware of the political fallout his move would cause. "But I ended up becoming the collateral damage of Bob Peters' war against Pikes Peak Cardiology."
Hospital legal briefs suggest otherwise: By moving in with PPC, they claim, Morris had inappropriately allied himself with a corporation in fierce competition with six other cardiology groups practicing in Colorado Springs. The move was simply a conflict of interest, the hospital contends.
And sources close to the hospital's case look at Morris' assertions of innocence with a jaundiced eye. Documents obtained through the discovery process include provisions for Morris' full partnership with PPC within six months of moving in, and his contract with PPC refers to giving Morris "right of first refusal" on the groups' referrals.
The contract also talks about possibility of an eventual "merger" of the two practices and how Morris might be affected should a "second surgeon" come on board.
In the meantime, PPC officials were characterizing Morris' relationship with the group basically as a tenant-landlord arrangement.
The second piece in the puzzle is a series of documents that show PPC was intending to build an Independent Medical Campus, that would include a four-story "hospital" building housing roughly 90 beds at the Denver Warehouse site on North Union Boulevard.
PPC cardiologist Dr. Ron Blonder has never denied the plan's existence to this reporter. But he says that PPC was not planning a heart hospital; rather the group was working with a group of area physicians of various disciplines to build a relatively small facility that would include some in- and out-patient surgery.
Indeed, plans entered into evidence suggest something much smaller than Memorial's massive facility. The campus would be more similar to Penrose Community on North Academy Boulevard.
The deal ultimately fell through when the group of surgeons -- none of which were heart surgeons -- pulled out of the deal, said Blonder.
The third piece of the puzzle is a series of documents, all dated roughly in summer and fall of 1999 (almost a year after the Denver Warehouse deal fell through) between PPC officials and MedCath Incorporated, PPC's partner in their new cath lab.
The documents show that MedCath and PPC were clearly talking about opening a heart hospital at the site of the old Doctors Hospital, now housing the Springs Center for Women, on East Pikes Peak Avenue.
One document, dated June 16, 1999, is a three-page assessment of potential revenue from a proposed a heart hospital. The plan suggests the hospital could perform up to 163 open heart cases per year and bring in roughly $1.8 million in pre-tax income per year.
Another document from PPC administrator Bill Mantia, dated Sept. 13, 1999, refers to "negotiations" between the Springs Center for Women, PPC and Medcath on "surgical services" at the women's center site. "In the out years, a robust cardiac surgical program could provide significant cash flow to both MedCath and MSCW," Mantia wrote.
A third letter, from Morris' consultant Flack to MedCath also discusses the heart hospital, including Morris' potential involvement in such a facility.
So what does PPC's Blonder say to all this? First, he points to the fact that all the discussions noted in court case documents occurred almost a year after PPC was sanctioned and stripped of privileges by Memorial for supposedly trying to open a heart hospital.
The discussions with MedCath about the heart hospital were a response to the fact that Memorial had taken away diagnostic and emergency call privileges from PPC as retaliation for the alleged plans.
"We were inquiring about the feasibility of a heart hospital, but well after Memorial had already denied us privileges," Blonder said, describing the heart hospital idea as a response to Memorial's actions. "It was my feeling at the time that I didn't ever want to get in a situation where a hospital administrator had that much power over us."
In any event, Blonder said, the heart hospital idea at that point was viewed as somewhat far flung since it would take at least 20 cardiologists to open such a practice. The point is backed up by a comment in Flack's letter in which he tells MedCath VP Charlie Furr that "I am in agreement with you that having a heart hospital in Colorado Springs is probably a long shot."
To Blonder, the two efforts -- one for a general services, community-style hospital in 1998, the other for a heart hospital with MedCath in 1999 -- are two completely different animals. The hospital, he suggested, is playing an obtuse game of connect-the-dots in order to justify actions it took a year before PPC began talking with MedCath about the heart hospital.
The big picture
Hospital documents suggest a new heart hospital would not only threaten the viability of Memorial's profitable cardiac surgery department. If successful, a competing heart hospital could undermine the overall viability of the city-owned health care institution.
A competing venture like the one anticipated by Memorial administrators -- an alliance between Medcath and Pikes Peak Cardiology -- would likely "skim" the more profitable cases, leaving the uninsured, difficult cases to the public hospital, which has to take those cases.
Indeed, MedCath specifically, as well as other private community hospitals have been accused of doing just that in other cities where private specialty, or "boutique," hospitals compete with public, or non-profit, general hospitals.
"So is the city really defenseless?" one source close to the lawsuit asked rhetorically. "Does the city really have to continue doing business with a group that might ultimately put them out of business? Are the taxpayers defenseless against that?"
While some argue that competition from private specialty hospitals will benefit consumers via lower prices, supporters of Memorial dismiss that claim. Cardiac surgery comprises some of the most profitable care for hospitals, and at Memorial, the program subsidizes many other services that don't make as much money.
Since one of the few reasons that taxpayers have resisted efforts to sell Memorial is its profitability, it's quite possible the hospital could end up on the auction block if the hospital goes into the red.
When and if a jury reaches a verdict in the case, they will not be making a call on the pros and cons of private versus public hospital care. But their verdict may well take into account whether or not Memorial was right that Morris is a threat.
Their verdict may also send a message about whether or not a publicly-owned hospital can fire a top surgeon, and punish a group of independent cardiologists, simply because they want to compete.