After operating the Island’s only house call medical service for the past two and half years, Michael Michotek, M.D., is ending his practice amid issues with his patients seeking care at the Martha’s Vineyard Hospital, according to a letter he submitted to The Times.
“This is a rural access hospital, one lab, one X-ray, one cardiology, that all of us are forced to use. There should be no monopoly on healthcare,” the letter states in part. “My patients are being treated differently by their mere association with me. I cannot, and I will not continue to practice medicine that increases my patient’s liability as well as mine. Thus I plan on closing my practice Oct. 1, 2021.”
Michotek is a former hospital primary care physician (PCP) who left in 2018 after one year on the job. At the time, both the hospital and Michotek declined to give details about his departure.
After leaving the hospital, Michotek opened his house call practice, catering to people with chronic and complicated medical problems.
In his letter, Michotek states that his routine during his house call practice would be to drop off patient lab slips and X-ray requests before visiting his inpatients. But in April, he would have to come back during hospital visiting hours.
“Then, unexpectedly, on April 5, 2021, I was met in the front lobby to be informed of a memo stating, ‘If Dr. Michotek wants to see his patients, he can come back during visiting hours.’ Several employees informed me of the same the following week. Almost three months later, I still have not received official notification or explanation. I guess they showed me, no more free visits or favors for my patients!” Michtoek wrote. “This is clearly a disservice to my patients.”
In a statement to The Times, hospital president and CEO Denise Schepici stated that when Michotek resigned from the hospital, he no longer had privileges.
“The hospital cannot grant unfettered access to anyone who does not have privileges because of our obligation to protect the privacy of patients, who are in our care. This is not only our priority, but it is a mandated federal regulation through the Health Insurance Portability and Accountability Act (HIPAA),” Schepici said. “This was especially important during COVID last year, with the restrictions and safeguards put in place to protect our patients, staff, and all visitors to the hospital. Dr. Michotek is welcomed to see his patients at the hospital during regular visiting hours, which is our policy for all nonstaff providers.”
Schepici went on to say that Michotek has access to his patients’ records through the Massachusetts Health Information Highway. “The hospital offered to assist him with this process, but as of now, Dr. Michotek has not accepted our invitation,” she said. “We invite anyone who needs a primary care physician to call our patient access number, 508-684-4500.”
Michotek’s letter goes on to say his patients have “specifically and unfortunately” not had the same level of PCP access or continuity of care as patients with PCPs employed by the hospital.
“Year after year, admission after admission, discharge after discharge, my patients and their families inform the staff I am their PCP, yet nothing is done to facilitate this. Whether the ER, X-ray, acute care, this especially applies to discharge planning. I’m almost never notified of their admission, almost always called upon discharge, most of the time not even knowing my patient has been admitted. Even when I ask them to facilitate this charge, nothing is done,” his letter states.
In an email statement, hospital communications specialist Marissa Lefebvre said a physician without privileges can access Mass Health Information Highway for X-ray requests or lab slips.
“Dr. Michotek has not taken us up on our offer to show him the process,” Lefevbre wrote. “Dr. Michotek has the same level of access that any other visiting physician would have to the hospital.”
Michotek additionally sent his letter to the Joint Commission of Hospitals, U.S. Senator Elizabeth Warren, and state Rep. Dylan Fernandes. He also sent a petition with 50 of his patient’s signatures to Mass General Brigham and the commission.
Michotek declined repeated requests for comment beyond his letter. “Whether you like me or not, are a patient of mine or not, it’s your future healthcare. The patients need to speak up,” Michtoek wrote. “We shall see if this is the standard of care/standard of treatment at other rural access hospitals in the United States.”
It’s sad that the hospital could not work out some special arrangement with Dr. Michotek given the valuable and admirable service he was providing people on the island.
why were the doctor’s hospital privileges removed just because he left the hospital?
He resigned from the hospital staff.
What a wonderful true physician this man must be. It warms my heart to think that a doctor has been making hpusecalls. And how sad that our currently disconnected medical system cannot support him. Dr Michotek is to be commended for being willing to go to any lengths to provide true hands on care at home to his patients. Francis Peabody would be very pleased.
“The care of the patient means, caring for the patient.” Francis Peabody, MD 1926
https://hekint.org/2017/02/01/francis-peabody-caring-for-the-patient/
I have been retired for 10 years but worked 38 years at our hospital as an RN in the ICU, OR, and ER. When my primary care physician, Dr Stuart Kendall, retired I switched my medical care to Dr Gerald Yukevich, who subsequently retired roughly 2 years thereafter. Securing a new primary care doctor was extremely difficult at that time. Most doctors, with hospital affiliation, were not accepting patients and those that were, were transient fill ins, here for 6 months. I had switched once and did not want to sign on to another DR for an indeterminant time , so I sought the option I thought would be best for me. I have been a patient of Dr Michotek for a little over 2 years. He has been diligent, thorough, and very willing to listen to my concerns about my health care. He has guided me through some difficult health issues with compassion and medical expertise. That said, being his patient did have some road blocks to care, such as not being able to get a routine flu shot at the hospital because he did not have privileges. This happened despite the strong CDC recommendation to get one during the Covid 19 pandemic in an effort to minimize flu during the anticipated Covid 19 surge last fall. It took me 2 ½ months to get it done at a local pharmacy.
I am saddened to hear that Dr Michotek is closing his practice. But I have hope. There is always a way, a compromise, some agreement that can be arrived at between the hospital and Dr Michotek so he can continue his practice and deliver care to his Vineyard patients. Please try to find a workable solution.
Sounds like Dr. Michotek is trying to make a public issue over things he should be communicating directly with the hospital about. It makes perfect sense to me that if a medical person doesn’t have privileges they can’t come and go as they please. BTW, the visiting hours are a generous time span.
Why can’t an outside doctor get privileges? Why can’t he serve a segment of our community in desperate need of this form of care AND get privileges at the hospital? Why isn’t he, after many years, be listed as my father’s primary care doctor in the hospital records, while my pcp is listed, even though they don’t work for the hospital? We have told the hospital every time my father has been in there that Dr. Michotek is his doctor but they will not change it on his record. Dr. Yukevich is still listed as his doctor and he retired how many years ago?
Without Dr. Michotek caring for my dad and my mother in law, I don’t know what we would have done for the last few years. He is obviously current in everything and still able to practice. But they don’t inform him when my father is admitted to the hospital nor was he when my mother in law was admitted. His patients should have a choice of who their doctor is, they shouldn’t be forced to have a pcp that works for the hospital when getting there is so difficult, and they should be able to see their doctor when they are admitted to the hospital, regardless of what time it is. Privacy of other patients is an easy excuse to fall back on but the reality is, something else is at work or my father would be able to see his doctor when he needs to, even if admitted in the hospital, and his pcp would be listed on his records after we’ve tried to correct it so many times. And homebound seniors deserve his care. This is a huge loss for our community and huge disservice to our seniors.
If you don’t have hospital privileges you can’t practice medicine in the hospital and have unfettered access to patients. This physician knows this, as it is standard practice in every state in the Union and the territories. Hospital privileging insures a few things:
-the doctor is credentialed and in good standing with the hospital credentialing committee obligations, the state board, and the American board of medicine.
-the doctor is compliant with continuing medical education mandates by the hospital and the state
-the doctor has adequate and active malpractice insurance
-the doctor adheres to minimal practice standards as established by the hospital by laws and there are systems in place to monitor the physician and protocols to correct /improve deficient practice patterns.
This doctor -it seems-prefers to skirt these obligations and, in addition, ignore HIPAA regulations, while enlists unknowing patients to carry his water.
Thank you…an intelligent reply.
Having worked in Long Term Care ( now Windermere) for many years in the past, I know that the elderly thrive when they can stay in their own homes surrounded by family, friends and neighbors. Rural health care needs to have access to Dr.s who are willing and able to make house calls. Please contact your representatives, especially Elizabeth Warren, to push for a change in the mandated ruling mentioned in this article. Health care laws are important to all of us!
How sad to read a very compassionate , skilled doctor will be lost once again to the Vineyard community’s ( as I see it) due to corporate actions. Dr . Michotek was at MV Hospital as a Primary Care Physician so had to have met all criteria mentioned . I have noticed it has not been mentioned Dr. Michotek primararly work’s with the Senior Community – many have dementia etc. Because of this doctor many of the Vineyards elderly, yes our parents, grandparents …are allowed to stay in there homes with dignity excellent care and family around them. It is my wish this can be resolved between Dr. Michotek and the Hospital soon, we can not afford to lose another Dr. that is willing to stay longer than 6 months.
I have read and then read again the letter written by Dr. Michotek. Nowhere in that correspondence do I see where he mentions that he can’t obtain the medical records for his patients. His letter specifies that he cannot visit his own patients while they are inpatients at MVH unless he visits during the hours that the rest of the community can visit with patients. Absurd…absolutely absurd. Where are the HIPPA violations coming into play that the spokesperson for the hospital refers to a few times in their response? Seeing your own patients and checking their welfare at the hospital is violating HIPPA? I work with the elderly in their homes on a daily basis and if it weren’t for Dr. Michotek a lot of my clients would be without any medical care as they have no access to the PCP’s at the hospital and often times can’t even get to the hospital for a visit with a doctor if it was for a prescheduled visit. They don’t drive, they don’t have someone to take them, they’re bedridden, they’re full of anxiety about going out into public, etc. Dr. Michotek is an absolutely wonderful doctor and he has helped so many people that otherwise wouldn’t have had care if not for him. I’m so sorry to see him go. Instead of driving him out, MVH should be working with him to ensure that ALL people who need medical care can get it. It’s not just Dr. Michotek that the hospital is doing an injustice to, it’s also many of our old and frail and those are exactly the people who we SHOULD be taking care of. Shame on the hospital administration for having a hair across their arse because Dr. Michotek doesn’t bow down to them. Shame on them for not truly caring about our elderly and sick people. If they are trying to “look good” to the community, they have failed on this one!
Losing Dr. Michotek as our primary care physician means a reduction in the quality of health care we will receive. When we first moved here year round, it took the hospital seven months to find us a primary care physician and that was Dr. Michotek. My husband, Doug West, and I agreed we had the best physical exams we’ve ever had in our lives. When he left the hospital, we were reassigned to Dr. Krause, who died unexpectedly. After her death, we decided to reconnect with Dr. Michotek and couldn’t have been more pleased and confident in our health care. As seniors, we feel we are getting the care we need from him and his in home visits. We only wish the hospital, health care entities, and county and state governments could accommodate this excellent, much needed health care professional in our rural, Island community.
It’s understandable that a physician without privileges can’t come and go at will. The question, however, is why was Dr. Michotek not granted hospital privileges. Why do you have to be an employee of Partners to be able to see patients? There are hundreds/thousands of rural hospitals around the country that do not have this onerous rule.
The hospital administration is unable to provide adequate primary care due to many circumstances beyond their control. Now is the time to look closely at their
“rules” and get creative. End this “employee-only” privileges rule and allow qualified doctors to practice on this island and see patients in our hospital. We need all the help we can get.
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