Dr. David Williams, one of Maui Memorial Hospital’s most senior emergency room doctors, was abruptly fired last month. The exact reason remains unclear; the hospital will not discuss personnel issues. However, based on documents obtained by Politics on Maui, it seems to have little to do with his professional skills and more about hospital politics.
Williams’ termination followed an angry letter he sent to 50 members of hospital management about the actions of hospital chief of staff, Dr. Vijak Ayasanonda. After Williams was elected as vice chair of the emergency department by his peers, Ayasanonda sent a series of texts searching for complaints that could besmirch Williams’ otherwise clean personnel file. It was an unsuccessful effort. Williams’ election was subsequently ratified by the hospital’s Medical Executive Committee (MEC).
Days later, he was fired.
ER management company complaints
This latest series of events comes on the heels of publicized unrest among members of the hospital’s emergency department. The turmoil briefly boiled over into the media with a front-page story by the Honolulu Star-Advertiser’s Sophie Cocke in early August. It reported numerous mismanagement allegations leveled against Emergent Medical Associates (EMA) in an anonymous letter sent to the hospital’s Board of Directors and the MEC.
EMA is the Southern California-based group contracted to run the emergency department in 2018, shortly after the hospital was sold by the state to a Kaiser Permanente subsidiary. The anonymous letter claimed that EMA had failed to meet a number of contractual promises and that morale in the emergency department was low. Five ER physicians had departed, either permanently or on leaves of absence, with others currently looking to depart. EMA split hairs challenging many of the letter’s assertions, but the loss of physicians, for whatever reason, is real.
The story provoked a short editorial by the Star-Advertiser which read, in part, “Patients deserve better than a hospital plagued by strife between staff and management.”
Similar complaints were raised in an online petition launched in July by local trauma surgeon Dr. Stephanie Yan. In it, Yan calls for the EMA contract with the hospital to be terminated, and hospital Chief Executive Officer Mike Rembis to be replaced. She also discussed Williams, calling for “the resignation of the actors involved in falsifying career-damaging accusations regarding Dr. David Williams.”
EMA officials have denied any involvement in the Williams matter, even though Chief of Staff Ayasanonda also wears a second administerial hat–he’s employed by EMA as Co-Associate Director of the emergency department. The company said in a statement that the texts “did not involve EMA,” as Ayasanonda’s actions came from his capacity as chief of staff.
However, Maui Memorial Hospital spokesperson Tracy Dallarda also denied that Ayasanonda acted in any hospital administration role in regard to Williams. “Our physicians are part of the autonomous medical staff of Maui Health, meaning they self-govern,” she said in an email.
I reached out to Ayasanonda for comment on his texts and received no reply. I also contacted hospital Vice Chief of Staff Dr. Cordia Wan and Dr. Aaron Altura, respectively the vice chair and secretary of the Medical Executive Committee—the “self-governing” hospital organization. Wan is out of town; Altura did not respond.
Williams referred all questions to his Honolulu attorney, who declined to comment.
Retribution fears; confidentiality agreement
As I researched this story, many health professionals from the hospital and within Maui’s medical community spoke emotionally of the ongoing heavy-handedness by hospital management. They also praised Williams, whose career in the hospital’s emergency department spans almost a decade. But no one would speak on the record, fearing retribution.
Petition-writer Yan—who said she isn’t directly employed by the hospital–was the exception. “David is an excellent clinician,” she said in an interview. “He’s very safe and a proponent for patient care and an advocate for staff as well as physician wellness. That’s why I think he was very popular.”
The reluctance to speak publicly is not unfounded. On August 26, an email sent “on behalf of hospital chief of staff Vijak Ayasanonda” reminded staff of confidentiality rules—not just in relation to patients, but to hospital business. Attached to the email was a rather onerous confidentiality agreement. In addition to standard patient confidentiality language, it also contained an additional admonition: “No practitioner shall disclose information that by policy is not available to the public and/or that is acquired in the course of his/her work/placement with Maui Health.”
The consequences for doing so are severe. The agreement concludes, “I understand that any violation of these health care and business ethics constitutes grounds for disciplinary action, up to and including discharge (termination).” Other penalties are monetary: “equitable and injunctive relief” and “damages.”
Outspoken advocate
Williams has been an outspoken advocate for physicians, health personnel, and patients. In the pandemic’s chaotic early days, he argued with hospital administration about its series of confusing mask-wearing rules. At one point management prohibited mask use at all. When Williams insisted on wearing an N95 mask at work, he was yanked from the emergency room and later sent to work on Lanai. EMA says it was asked by hospital administration to “temporarily remove” him.
At that time, the American Academy of Emergency Medicine (AAEM), a national organization that advocates for “democratic physician groups,” wrote a letter in support of Williams.
“I sent [Williams] an email with attachments [regarding hospital bylaws about termination] that he shared with hospital administration,” AAEM co-founder Robert McNamara said in an interview.
Three months later, Williams was returned to work in the hospital ER.
People familiar with his situation said Williams continued to advocate on behalf of emergency room physicians. Among other issues, he insisted that the department hold a democratic election, per hospital bylaws, to vote for the chair and vice chair of the department. His election concerns were heard.
First “democratic” election
On June 3, Williams wrote in his letter, the emergency department held “our first free, fair and democratic election.” Williams was elected Vice Chair. As bylaws dictate, the vote would then be ratified by the Medical Executive Committee, which includes representatives from all hospital departments. The ratification is usually an administrative, rubber-stamp procedure.
However, at the MEC’s June 14th meeting, Ayasanonda raised vague concerns about Williams. In his letter, Williams said Ayasanonda “alluded to ‘reports,’ data and evidence of unprofessional behavior.”
As a result, the MEC postponed the ratification vote and, instead, formed an ad hoc committee (from which Ayasanonda recused himself) to investigate Williams.
Williams wrote that Ayasanonda’s actions laid the “groundwork for a tactical and intentional smear campaign, targeting a respected colleague, member of the MHS medical staff and delegitimizing the fair departmental election.”
“Williams has a total clean file”
Although Ayasanonda had recused himself, he wasn’t absent from the process. Days later, he sent out the first in a series of text messages to emergency department charge nurses seeking information on Williams. Williams included screenshots of the texts in his letter.
In one, Ayasanonda wrote, “I need your help. Williams has a total clean file…he has the chance to become the chair of er if he stays clean for 2022. If any of you and everyone else can help and please document complaints and uors [unusual occurrence reports]. If not, I worry [about] the relationship with docs and nurses moving forward.”
In another, he wrote, ‘If I have nothing by November, Williams is considered a member in good standing and can run for chair. He got enough docs to vote him in as vice chair through December already.”
Emergency room nurse supervisor/manager Julius Montehermoso subsequently wrote to a colleague, “Can you please send me the issue with Williams ASAP? I’ll pay you the time to work on it.”
And contrary to hospital statements that the matter was a “self-governing” physician matter, Ayasanonda wrote in one text, “I’m sitting with admin now.”
“Malicious and hostile” allegations
Williams was furious and wrote in his July 15th letter, “The insinuations of impropriety directed at me were and are baseless, malicious, and hostile. I believe [they] were made to derail the ratification of my fair election to Vice Chair.”
The reports Ayasanonda ultimately provided to the MEC ad hoc committee apparently didn’t reach any kind of threshold for denying Williams the elected position. The MEC subsequently ratified the emergency department’s election results.
However, following that ratification, Williams was fired. His demands for an investigation into the matter remain unanswered.
Too many stressors?
In the midst of a physician shortage on Maui, there now is one less skilled, local ER physician on duty at our hospital.
The AAEM’s McNamara is concerned by the current situation. “You can’t just fire David Williams,” he said. “This has to be done with good reason. There needs to be a chance for Dr. Williams to address those reasons in front of his peers on the medical staff. It shouldn’t just be the administration or this outside company who can cut him off.”
With the current “confidentiality agreement” mentality at the hospital, it’s doubtful that the community will learn whether Ayasanonda’s actions and Williams’ termination have been investigated or not. The standard hospital response these days: because of Covid, times are tough. Doctors and nurses are hard to find.
Still, social media comment threads fill up regularly with new complaints and allegations about conditions at Maui Memorial. As one commenter on Maui Now recently put it, “I don’t know anyone who works as a nurse or doctor that is currently happy with management. It is truly a hostile workplace.”
I heard the same sentiment voiced by dozens of hospital workers I interviewed. Said one, “We have never felt so helpless, or hopeless.”
Great article exposing Maui Memorial Aka Kaiser shenanigans!
Seems admin changed but the games remain.
How sad and frightening.
Politics aside, if you get hurt, need help, you need competent providers and you really want competent people with local experience. These people are not a dime a dozen! Locums providers come and go and they are not necessarily here for the fallout if there are issues.
The list of physicians, providers, and registered nurses who have left the hospital, without attempts on the part of MHS and Kaiser to address the issues, accommodate reasonable needs seems pretty large. Dr. Williams is a well-trained doc who cares for his patients. He is way more important to our community than the myriad of administrators running around making rules up as they go along. The first time they fired him it was because he wanted to protect himself and his patients with an N95. That is now required of the staff. Dr. Yan is a board certified trauma surgeon! She has been courageous enough to risk her career to point out out serious issues. JCAH did a “spot” visit and the hospital proudly reported they found no issues. None! So maybe there is nothing to see here. Move on, Aloha, Mahalo. Or just maybe we should open the doors and spread a little public light on our only hospital which we will all need at some point in our lives!
Bureaucrats feel the need to exercise power over popular staff to demonstrate their superiority. I have seen this over and over, the county and state governments are full of these useless office dwellers.
Been there, done that and got fired for similar reasoning. This is just another part of the Rape of Emergency Medicine that was told so well by the Phoenix back in the 80’s. I hope David Williams takes it to them and gets everything he deserves. Reality, they lost an incredible Pit Doc. A member of a dwindling species.
Smart comments. Wow what a mess. And was hospitalized there 13 months ago for 5 days. Even in my critical condition I barred 1 nurse from getting near me.
Over the years my father as well as myself had to go to the ER and Dr. Williams was such a great, professional physician. This is so sad that our good physicians, nurses and other staff are going through such nonsense. Our Maui community deserve so much better than this. Thank you for bringing this to our attention.
Working as a provider and living as a permanent resident in Maui is a coveted coup for many:
But, permanent staff are leaving Maui Health in significant numbers, which continues even after the Covid-19 crisis is resolving;
And a well-respected physician writes a petition with frightening descriptions of what the staff experiences and feels.
I have lived on Maui since 1990 and worked as a medical professional until 2001. This is an unprecedented series of events.
The latest news is a record low in JCAHO infractions, but does this equate to communication and resolution of staff requests being unneeded? Should not the response of administrators be: what can we do to better serve the staff?
When the public no longer has faith in an institution; it is time for a Change.
When the employees of that institution don’t have faith in management; it is time for Change.
When management does not provide a physically safe work place for the employees and patients; it is time for a Change.
When the employees of that institution compromise principles & ethics in order to keep their job or gain favor; it is time for Change.
When well trained & experienced physicians and nurses leave due to the above conditions; things are Changing …. for the worse.
The public needs to let this go. Most of this article is invalid and the public are being drawn into something they don’t understand. The ER provider in question had a contract with a private company that supplies physicians for Maui Health’s emergency room. The reason for his termination is between the physician and his contract company, based on a contract he signed with them. It has nothing to do with the hospital or hospital administration.
Dr Williams, with the spotless record, is fired without a job now, while the people involved in this scandal is still chief of staff and still working and some people still wonder why people are afraid to speak out. This silencing is a patient care and safety issue. We know what has happened to good doctors who have gone the formal channels. They are no longer here. I have tried the formal channels but if you keep pushing they will target you. I had to do this this way to get community support before I put a big target on my back. The community awareness is for our and everyone’s protection.
Dr Williams, with the spotless record, is fired without a job now, while the people involved in this scandal is still chief of staff and still working and some people still wonder why people are afraid to speak out. This silencing is a patient care and safety issue. We know what has happened to good doctors who have gone the formal channels. They are no longer here. I have tried the formal channels but if you keep pushing they will target you. I had to do this this way to get community support before I put a big target on my back. The community awareness is for our and everyone’s protection.
I trained with Dr. Williams in Emergency Medicine Residency at Emergency Medicine LAC + USC County in the busiest ER in the country and I followed his career as an attending there as well. He is a amazing physician and advocate. He rooted out some evil characters at the county as well. It’s hard to believe that he has been fired twice now, once for protecting himself from Covid and spreading Covid by improper masks and now for speaking up against an organization that endangers physicians’ and patients’ lives. I worked at Maui Memorial for a few weeks as a Locums and took a job in Kauai instead because of all the political shenanigans. Maui Memorial would be lucky to have David running the ER and root out the administrators that block physician and patient well-being.
Wholeheartedly agree
Need reliable, professional care. Hawaiian Airlines can take you to Oahu for $39. Don’t risk your life at Maui Memorial. Sheesh. What an embarrassing article.
Former RN
Management is beyond corrupt at this hospital on many levels. I could not believe what management gets away with through intimidation tactics, bullying, and retaliation. I speak from personal experience but wish to remain anonymous. When you try to address these issues and speak up, you quickly become a target. I resigned as I knew things were never going to change.
The legal issue of mmmc got paid for each Covid diagnosis of patients and standard treatment remdesevir as prescription even if their cause of deaths was not due to Covid
Lots of staff docs Kaiser general will be going to court over this issue
People are suing Kaiser
Let this go? WTF?! Do you really think that Dr. Williams is just blowing this stuff out of his ass for kicks and giggles? We go to med school and do a residency for many years to do the right thing for our patients regardless of how much profit the Crips and Bloods want to take. As for the contracts we sign, “without cause”, “at will”. Termination clauses that only benefit the suits when they want to get rid of a scrub that knows too much. The public needs to know the details as do the parties involved. This is what democracy and the concept of facing your accuser is all about.
Sounds like they fired the wrong individual. Maui Memorial’s Board should considering a hospital employee wide democratic vote to terminate Chief of Staff Ayasanonda, and re-hire Dr. David Williams. they people of Maui deserve better.