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A New Jersey hospital is suing an anesthesiology staffing firm over what it describes as serious staff shortages, while the firm is suing the hospital for poaching its doctors and other clinicians, according to a pair of lawsuits filed late last month.

Cooperman Barnabas Medical Center (CBMC) in Livingston, New Jersey, claimed in a lawsuit filed in late July that the local subsidiary of North American Partners in Anesthesia (NAPA) chronically understaffed its anesthesia department, charging the company failed to provide enough anesthesiologists "nearly every single day" from September 2021 to June 2022.

"NAPA's understaffing is not an innocent mistake, but rather is the result of a callous business decision aimed at maximizing profits at the extreme cost of patient care and safety," the lawsuit stated, .

But NAPA subsidiary American Anesthesiology of New Jersey (AANJ) had filed its own lawsuit just a few days prior, alleging that CBMC, which is part of RWJBarnabas Health, poached its clinicians and created its own anesthesiology department.

"We feel as if we are the aggrieved party here and that they basically filed a countersuit in order to justify the actions that they took against us," Rafael Cartagena, MD, chief operating officer of NAPA, told MedPage Today. "They were expecting us to file suit, and they had their counter-complaint ready to go."

Cartagena said his company had been in contract negotiations with CBMC for 18 months, and had never had a formal contract for providing anesthesiology services to the hospital, though it has contracts with other RWJBarnabas Health facilities.

According to AANJ's complaint, CBMC recruited 11 doctors and 22 certified registered nurse anesthetists (CRNAs) away from the staffing firm. Cartagena described this as a significant number of AANJ's clinicians.

CBMC maintains it had to create its own department after NAPA pushed for contract terms that would continue to lead to "inadequate and unsafe staffing levels" while a contract was being negotiated, according to the lawsuit. Negotiations broke down in June, NJ.com reported.

"Unfortunately, the company contracted to provide these services has been unable to consistently meet the needs of our system and patients in a timely manner," CBMC said in an emailed statement to MedPage Today. "This is why we are pleased that these caregivers are now being directly employed by the system, which will ensure no disruption of services to our community."

"While litigation is never desirable, our actions continue to be driven by what is in the best interests of patient care," the statement noted.

NJ.com reported that CBMC often found itself without enough anesthesiologists, typically with little notice. In one instance, at 10 a.m. one morning a hospital administrator learned that the majority of the 70 scheduled surgeries that day would have to be cancelled because there weren't enough anesthesiologists to perform the procedures.

Cartagena said AANJ is "not aware of any specific complaints related to a day where there was a meaningful number of surgeries that we weren't able to cover."

CBMC subsequently created its own anesthesia department by directly employing doctors and CRNAs who had been employed by AANJ. The AANJ suit alleges that the hospital "pirated AANJ's clinicians by intimidating them into breaching their narrow and enforceable non-compete covenants with AANJ and becoming employees of CBMC."

"Members of the highest level of CBMC management engaged in intimidation tactics, as its CEO arranged for multiple meetings with AANJ clinicians at which CBMC and its lawyers boldly and bluntly directed AANJ's clinicians to resign from their employment with AANJ, sign new employment agreements with CBMC, and work for CBMC directly (despite CBMC's knowledge of the non-compete covenants which prohibited the AANJ clinicians from doing so); and told them that CBMC would indemnify any AANJ employees if AANJ filed suit against them for breaching their restrictive covenants," the complaint stated.

CBMC said in its lawsuit that it tried to get AANJ to hire more clinicians, to no avail. It also stated that the proposed contract didn't allow the hospital to hire per diem anesthesiologists to fill staffing gaps.

The hospital called the impact of the staff shortage "severe," tallying 286 adverse events from January through June that were related to understaffing issues. At least 12 of these created a "patient care issue," according to the lawsuit.

CBMC also alleged that surgeons have opted to perform procedures at other hospitals as a "direct consequence of the delays caused by NAPA's understaffing."

Cartagena charged that CBMC's actions will drive up the cost of healthcare in New Jersey, by paying above-market rates to recruit talent away from their original employment agreements, and defending them in litigation.

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