Why Does It Seem That The More Things Change, The More They Stay The Same at UNM’s Neurosurgery Department?
“Piscis primum a capite foetet.” Or, translated colloquially, “The fish rots first from the head.”
In November of 2019, when a legislator asked him to explain the precipitating factors that led to the loss of accreditation by UNM School of Medicine’s Neurosurgery accreditation, Paul Roth, M.D., the Executive Vice President for Health Sciences, University of New Mexico (UNM) Health Sciences Center (HSC), and Dean for the UNM School Of Medicine (SOM), responded, “it was a combination of poor leadership, young and inexperienced residents and physicians and a lack of skills. He asserted that all of these issues are currently being addressed.” (Legislative Health and Human Service Committee Minutes, November 2019)
(A complete copy of the minutes of that LHHS meeting can be found at the end of this article – beginning on page 14 and through page 16.)
A few months earlier, in a long letter to Peter C Shin, MD, MBA, MS Assistant Professor, Program Director, and Interim Chair of UNM Department of Neurosurgery, the Accreditation Council for Graduate Medical Education (ACGME) explained why it was withdrawing accreditation of the Neurosurgery program, the national organization:
“…On review of the 2018-2019 resident survey, the Committee noted continued significant dissatisfaction with the program. Seven of nine respondents indicated a neutral to very negative opinion of the program. At the time of the site visit, a history of unstable leadership, lack of trust, and infighting involving Drs. Yonas, Taylor, and Carlson (all having served as the program director and Drs. Yonas and Taylor also having served as department chair) was described.“
(Upcoming reporting informing the need for more oversight of the various graduate medical programs for which the legislature appropriates funds, will reveal more of what was reported in the 2019 ACGME letter to UNM, and subsequent communications regarding morale and conditions at the Neurosurgery department since 2019.)
A little more than two years later, after UNM SOM had hired a new leadership team to right the ship, the program received initial accreditation.
But, shortly after accreditation was reinstated, the new team was gone.
Why?
A coup of sorts is the best explanation The Candle has been able to gather from conversations with hospital personnel, documents, and communications between hospital personnel.
Some of the old guard of attending (faculty) physicians seemed to feel they should be in charge, despite having been part of the previous team that lost the accreditation.
(Later this week The Candle will report on old guard UNM HSC insiders, and their playbooks.)
Since sometime in 2023, the Neurosurgery department has had multiple complaints about how it runs its residency.
As The Candle reported late last year, in 2023, newly graduated Samantha Varela, MD, complained of discrimination and bullying by SOM leadership and Neurosurgery attending (faculty) physicians.
She had to file a complaint with the New Mexico Human Rights Bureau due to the leadership of the SOM Dean Patricia Finn, MD, and the leadership of the Learning Environment Office (LEO) Director Diana Martinez, abandoning their duties to protect the young woman doctor from harassment.
Dr. Varela’s Human Rights Complaint alleged the University essentially turned a blind eye to, among other things, the discrimination she experienced in the residency program – as other physicians made racist comments suggesting she was the token Hispanic in the program.
Dr. Varela was also forced to file a second complaint that dealt with retaliation she encountered after she filed the initial Human Rights Bureau Complaint.
The UNM settled the Human Rights Complaint, but required that the young doctor, who graduated first in her class at UNM’s Medical School, to sign a non-disparaging agreement.
She left UNM and was accepted to a prestigious Neurosurgery program in Texas.
Others have serious concerns have also been raised by medical personnel about patients not being properly informed of the use of certain medical devices and harm done to neurosurgery patients due to the alleged misuse of those devices – possibly contributing to death.
In the matters reviewed by The Candle regarding the continued use of a medical device that may have contributed to harm of patients, it was not the attending physicians who raised the concerns.
The concerns were raised by the residents and other support staff.
The learners and support staff appear to be the conscience of the operating room.
Recently, The Candle learned that some of those residents may now be on the receiving end of some of the types of retaliation previously reported in The Candle’s articles about Dr. Varela’s Human Rights Bureau complaint and the matter of the whistleblower lawsuit brought by former UNM research doctor, Hakim Djaballah, Ph.D.
UNM settled with Dr. Djaballah for about $2.1 million – also insisting on a non-disparaging agreement.
Concerns about a lack of leadership, even-handedness, and trust have been raised by residents and others about those in charge of the Neurosurgery department since sometime in 2023, through the end of last year.
Early this year, the School of Medicine’s Department of Neurosurgery gained full accreditation for its physician residency program five years after it was revoked – just several weeks after the SOM chose Dr. Griffith Harsh to be the department Chair.
Dr. Harsh has been in charge for about five months.
Given the reemergence in 2023 and 2024 of the type of problems that led to the 2019 loss of accreditation, it will be interesting to see if Dr. Harsh will finally hold the attending physicians (the faculty) responsible for the failures of deteriorating moral, and safety of patients, as raised by residents, support personnel, and some of the faculty.
Or will those attending physicians, who have created a hostile and unfair workplace for the past two years, be able to throw learners, residents, and other support personnel under the bus?
What’s Compensation Got To Do With It?
Another Neurosurgery department matter that The Candle is still researching, and awaiting a response from UNM to an Inspection of Public Records Act (IPRA) request, relates to the full compensation of the attending physicians (faculty) for the past several years.
It turns out that the UNM Sunshine Portal listing regarding the UNM related pay to these doctors is only partly sunny.
UNM throws more than a little shade on their full compensation, by only listing what seems to be their BASE pay – not the “incentive” type pay, nor the “on-call” type pay each of them receives.
Once we receive UNM’s response to the IPRA request, The Candle will report bout the relatively obscure but lucrative compensation structure provided the Neurosurgery leadership personnel.
However, The Candle can report this, the leadership team that took over after the accreditation was safely in hand, each received between $383,850 and $675,125 in on-call type pay in just one stretch of twelve months.
Some of our sources indicate that while many UNM doctors in other departments are also on-call, most if not all of them are paid nowhere near the amount that these doctors received in a year’s time for being on-call.
As a contrast, UNM compensation for resident physicians comes in the form of an annual stipend, starting at $65,550 year one to no higher than $81,902 in year seven.
These resident doctors work 80 hours per week and even more sometimes – with no overtime pay.
It seems the people running the Neurosurgery department for the last two years have focused more on their personal financial health and less on developing a healthy environment for the program that not so long ago lost its accreditation.
“Piscis primum a capite foetet” or, as it’s more colloquially translated: “A fish rots from the head down.”
Legislative Health and Human Service Committee Minutes, November 2019
(See pages 14 and through page 16, for matters relevant to the reporting above.)
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