Dr. Richard Koehler will rejoin Martha’s Vineyard Hospital staff

Dr. Richard Koehler will divide his time between Nantucket Cottage Hospital and Martha's Vineyard Hospital. — Photo courtesy Nantucket Hospita

Beginning in the new year, Dr. Richard Koehler will return to the medical staff of the Martha’s Vineyard Hospital (MVH), from which he resigned amid a storm of controversy in July 2002, during a very public battle with an earlier hospital administration. Widely regarded as a talented surgeon, his once tempestuous relationship with the hospital’s non-medical leadership now healed, he will have an office and regular hours with full access to the surgical suites, hospital chief executive Tim Walsh confirmed Tuesday.

Hesitant to speak about the past, Dr. Koehler, 57, who lives in Tisbury, told The Times in a telephone conversation that he wanted to put the rough spots in his relationship with the hospital behind him.

“They have made a huge, successful effort, I think, to change things in a positive direction, and I would say the same is true for me,” he said. “It just feels right.”

Mr. Walsh said the decision to hire Dr. Koehler, who specializes in laparoscopic surgery, was based on the hospital’s assessment that it would benefit the Island community and provide another level of care. Dr. Koehler has been filling in at the hospital as needed. His new status will allow him to see his own patients during office hours at the hospital and schedule surgery in one of the two surgical suites.

“He wanted to be here,” Mr. Walsh told The Times about what led to the decision to hire Dr. Koehler. “He has been working full-time on Nantucket, but he wanted to be part-time here. He’s done call coverage over the last couple of years, but now he will have office hours and do surgery. I think it’s a good thing for the Vineyard. I know he has a following, and a lot of people really like him and would like to see him here. He’s a good doctor.”

Asked to address the hospital’s stormy history with Dr. Koehler, Mr. Walsh said the hospital and Dr. Koehler have both changed and moved on from the events that precipitated his earlier departure.

Mr. Walsh said that adding Dr. Koehler to the staff would be convenient for his patients who now travel off-Island and that it would add another skill set to a surgical team, which includes Dr. Pieter Pil and Dr. Denise Fraser.

“I am excited that we are able to welcome Dr. Koehler back to the Martha’s Vineyard Hospital,” Dr. Pil, hospital chief of staff, said in an email to The Times. “Dr. Koehler is a great guy who has been on our replacement staff for several years. Having him join our surgical team will allow us to expand our services to the Island community. We both enjoy performing minimally invasive surgical interventions and I look forward to collaborating with him on challenging cases.”

Shared surgeon

Dr. Koehler, is currently employed full time at the Nantucket Cottage Hospital, which, like Martha’s Vineyard Hospital, is a member of the Partners Healthcare network, founded by the Massachusetts General and Brigham and Women’s Hospitals. He will continue to work at the Nantucket Cottage Hospital and work part-time on Martha’s Vineyard, Mr. Walsh said.

Dr. Koehler said he expects to see patients on Mondays and operate on Fridays. He will also be on call one weekend each month. When not on Nantucket, where he also provides weekend coverage, he said he will also be available to help out whenever needed. “The hospital is just a short drive down the road,” he said.

Following his departure from Martha’s Vineyard Hospital, Dr. Koehler went to Springfield Hospital in Vermont. He later opened up a private practice at Jordan Hospital in Plymouth where he continued to see Island patients and established residency. His former Island connection was strengthened when he began a romantic relationship with singer-songwriter Carly Simon of Tisbury, with whom he now lives. He joined the Nantucket hospital staff in 2012. But in the last several years, he also began filling in for MVH surgeons on a replacement basis, which gave him the opportunity to become reacquainted with the hospital staff.

Returning Dr. Koehler to the fold will also allow the hospital to better take advantage of its two surgical suites, both linked to Mass General, which also provides its affiliate with staff anesthesiologists. An idle surgical suite generates no billable procedures. When one of Dr. Koehler’s Island patients now travels off Island for a medical procedure that could be done on Island, it is inconvenient for the patient and lost revenue for the hospital.

Resignation and upheaval

Since the upheavals of the 1990s, news from the hospital has been mostly good, including the successful community campaign that raised almost $50 million to construct and equip a new hospital building, the hiring of new physicians, industry awards for quality care, the hospital’s affiliation with Partners Healthcare, and generally positive year-end financial reports for the hospital and Windemere, the Island’s only nursing home.

It was a much different story in the winter of 2001/2002. The hospital and Windemere were awash in red ink, and contract talks between Kevin Burchill, hospital CEO at the time, and union representatives for 35 permanent hospital staff nurses had turned contentious.

Dr. Koehler was a hospital staff surgeon, and his wife at the time, Kathleen Koehler, was a highly respected gastroenterologist and member of the hospital board in private practice.

It was at that time that continuing friction between the tough-talking Mr. Burchill and the self-assured Dr. Koehler reached a head. The catalyst was a series of written communications from the hospital administration to Dr. Koehler concerning administrative procedures.

In a Letter to the Editor published in The Times on Jan. 10, 2002, Dr. Koehler announced his resignation, effective July 8, 2002, and he and his wife’s departure from the Island. News of the resignation and Dr. Koehler’s continuing public and private criticism of the hospital leadership fueled a storm of public protest from Koehler supporters.

Critics accused Mr. Burchill of bullying behavior and excessive concern with the hospital’s bottom line. His supporters credited him with leading the hospital out of bankruptcy, a new focus on the quality of medical care, and securing critical care access designation from the federal government, gaining the hospital thousands of dollars in added Medicare reimbursements.

Perhaps the signature moment in the months-long barrage of claims, counterclaims and letters to the editor was a public forum on Island health care held at the high school performing arts center that attracted more than 200 people, most of them supporters of the Koehlers. Hospital leaders sat stone-faced as speaker after speaker took aim.

That March, Mr. Burchill announced his departure, and the hospital trustees elected West Tisbury seasonal resident John Ferguson chairman. Mr. Ferguson, chief executive of Hackensack University Medical Center in New Jersey and a Vineyard summer resident, ushered in a new era.

In the months that followed, the board named chief financial officer Tim Walsh the new chief executive, began hiring new doctors, and planning for a new building. The turmoil that had enveloped the hospital receded.

That summer, the hospital hired Dr. Pil, who had recently completed his surgical residency training at Harvard Medical School and Brigham and Women’s Hospital, and Dr. Fraser, a surgeon in the department of surgery and the director of the breast health program at Roger Williams Medical Center in Providence.

Perspective gained

Speaking about the career trajectory that that took him to the Vineyard, Dr. Koehler said, “When I came here in 1994, I was straight out of training, straight out of a huge academic program, straight out of a military situation where, you know, you just snapped your fingers, and things either did or did not work, there was no gray zone.”

He said he was successful, energetic, and motivated but he added with a laugh, “I think perhaps patience was not my forte. You get a little more perspective as you get older.”

Reminded of the high school assembly, when he stood in front of a mostly admiring crowd, championing change as hospital leaders remained mostly silent, he reflected on the person he once was. “That was interesting and I would sit here today and look at who that somewhat interesting, perhaps well-intentioned, but stiff, arrogant surgeon was and say, ‘Boy, that guy’s got a little bit of negotiating learning to do.'”

Dr. Koehler earned his medical degree from Tufts University School of Medicine. He completed his postgraduate work at the National Institute of Health/Heart, Lung and Blood Institute and Tufts New England Medical Center in General Surgery and joined the Navy to satisfy his scholarship obligations. Out of the military, about 20 years ago, at the suggestion of an Army friend he traveled to the Vineyard to inquire about the hospital’s need for a surgeon.

After he left the Island, he said he decided to go into private practice at Jordan Hospital because it was something he always wanted to prove to himself he could do. But change in the medical landscape was evident. One by one, all the surgeons in private practice either became employees of the hospital or retired, he said.

Dr. Koehler had been covering for Dr. Tim Lepore on Nantucket, that island’s much loved and respected doctor. He wanted to slow down and Nantucket Hospital offered Dr. Koehler a job. “The timing was right and they made a very good offer,” he said. He joined the staff in September 2012.

Dr. Koehler prefers a humorous take on the past. “I think maybe the fact that I lasted more than a few days at another island hospital and they didn’t see any mushroom cloud over Nantucket, I think maybe that was a little bit of a green light for the folks back here to contact me and see if maybe there was a place where I could help out here.”

Feels right

Dr. Koehler speaks with enthusiasm about the opportunity to collaborate with Dr. Pil, who also is experienced in laparoscopic surgery, and the rest of the surgical team. “Dr. Pil is clearly very excited to have another colleague there that he can do some laparoscopic surgery with,” said Dr. Koehler. “And so am I. Dr. Pil has an outstanding background in laparoscopy.”

Dr. Koehler expects to do what he has always done, which includes laparoscopic appendectomies, standard and complicated hernias, and some bowel surgery. He is also experienced in treating younger patients.

He said it is always important to recognize the limits when working in a small community hospital, particularly on an Island. When he began his career in a high-level academic institution, he said there were always experts or colleagues to turn to for a second opinion. In a small hospital, he said, “If you want a second opinion, you generally look in the mirror, it’s a different kind of challenge. You are at the end of the responsibility chain.”

Nantucket Hospital was the key to the arrangement. “Nantucket has been very gracious,” he said. “It would not have happened without them.”

Initially, Nantucket was concerned he might leave. Dr. Koehler has assured them he would not and he pointed out, splitting his time will help him maintain his caseload experience, and increase the caseload on Martha’s Vineyard. For practicing surgeons, time in the operating room helps maintain skills. “It really is a win-win situation,” he said.

Dr. Koehler said he still relishes the personal nature of practicing medicine in a small community. “I think that is a huge important quality in medicine that is rapidly evaporating from the general scene out there,” he said.

He said the small things in medicine are the big things.

Speaking from his home in Tisbury on a foggy, Sunday afternoon, and anticipating his return to the Martha’s Vineyard Hospital staff, Dr. Koehler said, “On this perfect New England day it really feels right. If you’re patient enough in life the things come around that are really important to you.”