Conversations with Keith Steffen

Conversations with Keith

I spoke with an OSF administrator, Dr. Tim Miller, in early October, 2001, and he stated that I was right and that “OSF had ignored the main campus”. He was referring to my letter to Keith Steffen regarding lack of bed capacity in the hospital for emergency department patients. The focus had been on the Center for Health that OSF had just competed north of the City. It cost 38 million dollars. Some of our patients in the ED didn’t even have pillows on their gurneys to lie on. I thought the ER was quite dysfunctional and our patient satisfactions scores were 33%, the lowest at OSF.

I copied excellent articles from the journal “Society for Academic Emergency Medicine” regarding ER overcrowding for multiple administrators. I heard back from no one in administration at OSF regarding the articles.

My first meeting with Keith was on Oct. 5. I expressed to Keith my concerns with lack of bed capacity at OSF and the long waiting times for patients in the ER, and also discussed the fact that Hevesy had placed me on probation for 6 months on September 28, 2001, the day after I wrote the letter to Keith. Keith told me that things were being done about the bed problem and that he (Administrator of OSF-SFMC) could do nothing about Hevesy putting me on probation.

However, Keith changed the topic of the conversation very quickly. He seemed to be very concerned about a petition that was going around in my support and asked me the names of the nurse or nurses who started the petition. I did not tell him because I feared for their jobs if he found out their names. He repeatedly tried unsuccessfully to get their names from me.

Keith then likened me metaphorically to an uncontrolled hemorrhage in the ED and a cancer in the ED that needs to be “cut out before it metastasizes”. I was quite surprised to hear this. I really didn’t know Keith well but figured out this was going to be tough go.

He also was fixated on the concept of fear. He told me, “Fear is a good thing amongst employees.” Rather strange, I thought.

As the next couple of months went by, very unusual things happened in Keith’s office. During one meeting with him, Keith said, “You know, John, the Apostolic community has a problem with you.”(Keith is an Apostolic Christian). This statement totally caught me off guard. The Apostolic Christians in the area were host families for Haitian kids and very close friends of mine. I couldn’t understand what he was talking about. Keith would look at the carpet, shuffle his feet, smile and say, “You know, John, when this comes out about you, it won’t be good.” I would ask him the same question each time—“When what comes out about me, Keith?” He would never answer but would just shake his head and smile. He went through this same ritual several times with me over the course of a couple of months.

I wasn’t the only one he planted these seeds with.

My brother went in to talk with Keith during the next couple of months and he told Tom, “There is a side of your brother that you don’t know.” This disturbed my brother greatly because there is no side of me that he doesn’t know. What could Keith be doing or thinking with this mantra of his?

On December 5 Keith had a meeting with two Apostolic Christian nurses who had important positions at the medical center to his office and stated the following: “John has done very bad things. People don’t know this side of John.” One of the nurses had helped start another petition on my behalf that really irritated Keith. Keith threatened to sue that nurse even though she had done nothing wrong and cleared it with Human Resources at OSF before she started the petition. Keith wanted to know the status of that petition as well, and the nurse told him that people were very afraid. Keith replied that was good. He then reiterated that the people did not know what they were signing and they did not know the whole story and they did not know the “real John Carroll”. Keith told the nurses there should actually be greater fear in the hospital. Keith went on to tell the nurse that he had spoken to Representative Ray Lahood and Monsignor Rohlfs and that they now understand that I have the problem. I had spoken to both of them and they were quite complimentary towards me. (I heard through the grapevine that Keith had made a very urgent phone call to Rohlfs one day to try and explain his side of things.) Keith even went on to say that “Rick Miller had been right all along.” When I asked the nurse if she meant that Keith was referring to me being frustated in the ER, she said “no”. It appeared that Keith was referring to something else, something much worse than frustration. The other nurse said nothing but was listening to all of Steffens comments about me.

A well known lady in the Peoria community, whose family had hosted a Haitian Hearts child, told me how she went in to Keith’s office and he told her that they had asked me to seek counseling and that if she knew the OSF side of the story she would agree with Keith and OSF. She didn’t know what to think. Keith was definitely doing some damage and spreading seeds of doubt regarding me outside the medical center. She told me this story with her husband present. I could tell they were very apprehensive about what was occuring. Her husband had no idea what to say or do. They both have excellent jobs in the Peoria community and both knew what would happen if they went to bat publically for me.

Another business lady in the community who had never met Keith went in on my behalf after she was told by Sister Judith Ann to do so. Keith talked a lot about the devil with her and stated, “When the devil ensnares someone and pushes him up against the wall, we find out what that person is made of.” This lady was quite scared and wanted to leave Keith’s office at that point. Keith commented to her on the way out that if she talked about their conversation “…maybe we won’t be friends anymore.” (She had never met Keith prior to this.) She couldn’t wait to leave his office. When I asked Sue Wozniak about this a couple of months later she said “ it sounded like a threat”. The business lady thought so too.

Keith talked about my employment at his church in Washington, Il. I know who he talked to. They told me. At one point, Steffen stated, that “each time he (Steffen) sees a Haitian child, it makes me (Steffen) want to puke.” Keith’s inappropriateness knew no bounds.

So there really wasn’t any confidentiality with Keith. OSF attorney, Doug Marshall, would monitor Keith at times in Keith’s office and tell him to watch what he was saying because I was shaking my head and writing everything down. Keith’s mantra to me about “the other side of me will come out and it won’t be good” was never said in front of Marshall, that I know of, so Keith can deny this if he wants. But he will have to deny it a lot if ever questioned under oath because he said it to many people.

Does this sound like the way the CEO of the largest employer in Peoria should act? Doesn’t seem to be great management skills to me. Open and honest communication, one of the Sisters mission statements was absent with Mr. Steffen.

After Keith fired me on December 18, 2001, he distributed a fax to the rest of the medical center (that was written by hospital spokesman Chris Lofgren) as if he was trying to protect me. A lot of people told me about this nonsense. (See post "Conversations with Chris").

Then things got worse.

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Before I met with Keith as described above, I sent him this note pleading for help for the Emergency Room from OSF administration:

Handwritten Note from Dr. John Carroll

10-01-01

Dear Keith,

As you mayor may not know, the ER is in "tough straits" - patient care and waiting time is very lengthy.

I would love to have you or another administrator spend a couple of shifts with me this week in the ER. I work 3-11 and 5-1. You would see patients with me. The objectives of this would be to:

1. See the ER from "ground zero" - this would prompt ideas on how to solve some of these issues. I will tell you how I see the issues and how time could be saved for the patient (from triage to final disposition). There is a huge crisis occurring in our ER now.

2. Your presence would definitely be a "morale improver" for the ED staff and for the patient when he realizes an administrator is personally concerned as well.
I really believe an administrator's presence would be a "win-win" for OSF and ER patients.

Please strongly consider joining me in the ER.

Sincerely,

John

Addendum:

May 22, 2008--Keith refused to come to the ER when I proposed this to him in 2001. He stated that if he came to the ER other hospital departments would want his presence, and he could not be everywhere.

As I look back at it, I doubt the ER had his full attention compared to other big money making departments (like Surgery) and the new Center for Health. The ER and its overcrowding would just have to wait.

In the May 15, 2008 issue of the New England Journal of Medicine is an article written by David J. Shulkin, M.D.

Dr. Shulkin makes late night administrative rounds at the hospital where he is president and chief executive officer. He noted the "stark discrepancy in quality between daytime and nighttime inpatient services."

His goal is to improve his hospital quality of care during the nighttime hours.

Dr. Shulkin writes:

"The consequences of service deficiencies during off-hours include higher mortality and readmission rates, more surgical complications, and more medical errors."

He feels that his midnight rounds were proving a good way to help him understand and address concerns of off-hours staff.

"In order to identify problems and design effective solutions, it is critical to gather such front-line information, and to do so, senior hospital administrators need to see firsthand the working of the "other hospital". I strongly encourage my counterparts else-where to conduct at least 1 week's worth of night rounds each quarter."

"Close attention should be paid to the needs of patients and their families, any procedural and communications issues among staff members, and most important, the quality of dialogue between administration and staff members regarding the organizatiion's inpatient service and safety priorities."

Keith probably needs to read this NEJM article.


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May 14, 2006

In this weeks New England Journal of Medicine, George Annas wrote an article, "The Patients Right to Safety--Improving the Quality of Care through Litigation against Hospitals.

Annas reports, "...safety must be an explicit organizational goal that is demonstrated by clear organizational leadership...This process begins when boards of directors demonstrate their commitment to this objective by regular, close oversight of the safety of the institutuions that they shepherd."

He continues,"...(hospital) safety cannot become an institutional priority without more sustained and powerful pressure on hospital boards and leaders---pressure that must come from outside the health industry. In hospital care the challenge is to reform corporate governance to make hospital boards take their responsibility for patient safety at least as seriously as they take the hospital's financial condition."

“The major safety-related reasons for which hospitals have been successfully sued are inadequate nursing staff and inadequate facilities. Since providing a safe environment for patient care is a corporate responsibility, understaffing is corporate negligence. “

In 1991, for example the Pennsylvania Supreme Court stated simply, “Corporate negligence is a doctrine under which the hospital is liable if it fails to uphold the proper standard of care owed the patient, which is to ensure the patient’s safety and well-being while at the hospital.”

During one of my first conversations with Keith Steffen, I told him I was worried about “institutional malpractice” at OSF. He asked me to define what that meant and I remember replying that he would understand the concept better than I would. He did not reply further. I thought that too many patients were being kept for long periods of time in the ER in 2001 to their detriment. I realize that Mr. Steffen is a small player in the entire scheme and agree with Annas and the New England Journal of Medicine that the Board of Directors at OSF needs to play a bigger role in guaranteeing safety of patients at OSF.