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Pennsylvania-based Crozer Health is appealing the shutdown of its general surgery residency program, as its 15 residents "race to the exits," according to that has since been withdrawn.

Last month, the Accreditation Council for Graduate Medical Education (ACGME) pulled the accreditation for the surgical residency program at Crozer-Chester Medical Center in Upland, Pennsylvania, giving it just 4 days to close the program.

Crozer appealed, and after some back-and-forth asking whether residents can get credit for time worked while the appeals process plays out, Los Angeles-based parent company Prospect Medical Holdings sued the ACGME, claiming the uncertainty was forcing residents to jump ship.

Nine of the 15 residents "are known to be planning to leave for another placement," the complaint stated, adding that "several residents have already departed."

Crozer Health spokesperson Lori Bookbinder said she couldn't provide the total number of residents who have left, but the company said in a statement that there have since been "additional departures."

"At this time, we will concentrate our efforts on the appeal and on securing necessary resources to accommodate for the loss of the residents to ensure no interruption of services," the statement said. The appeals process is expected to wrap by June 30.

One doctor in the Crozer system said he and colleagues were "very concerned about the status of the residency program" and that, "Needless to say, without the residents, we are going to be very challenged to cover the trauma/ED [emergency department]," according to the complaint.

Crozer-Chester Medical Center is the largest hospital in the Crozer system and is described in the complaint as serving primarily a Medicaid and Medicare population.

The exact reason why ACGME pulled the accreditation isn't publicly available, but Crozer noted in its complaint that the ACGME raised "complicated issues" about the volume and complexity of surgeries that the residents had performed.

Emails cited as evidence in the complaint also mention allegations of fraudulent case logs.

The program's troubles with ACGME appear to have started last November, when ACGME made a site visit following an anonymous complaint about declining surgical volumes, according to the lawsuit.

As it fights for its residency program, Crozer and Prospect are fighting a separate battle with the state of Pennsylvania. The state's attorney general sued Prospect after it closed one of four hospitals in the Crozer system after purchasing it in 2016, even though it was supposed to keep it open for 10 years.

However, the attorney general after Prospect agreed to sell the hospital system to a nonprofit. Its 270-day window to do so .

The Pennsylvania Attorney General even got on a Zoom call with and wrote a letter to the ACGME about the accreditation withdrawal, stating it "threatened to disrupt the Commonwealth's years-long effort to ensure that the sale of Crozer Health maintained a viable Crozer-Chester Medical Center serving Chester and the surrounding area," according to the complaint.

"Facing the possibility of litigation with the fifth-largest state in the USA, the ACGME blinked," Bryan Carmody, MD, a pediatric nephrologist at Eastern Virginia Medical School in Norfolk, who blogs extensively about residency issues, . "Prospect voluntarily withdrew their lawsuit earlier this week -- which I can only think means the ACGME agreed to allow residents credit from January to June if the appeal fails."

"It's definitely a victory for Prospect Health," . "But if this is a victory for the residents, it's a hollow one. They complained to the ACGME back in November, hoping for help -- but now many of them are stuck until June (unless another program allows a transfer without CMS funding)."

A spokesperson for the ACGME told MedPage Today in an email that "due to confidentiality between the ACGME and its accredited programs and institutions, we can't share details behind accreditation decisions."

According to its own rules and procedures, ACGME lists two possible reasons for shuttering a program: "catastrophic loss of resources, including faculty members, facilities, or funding" or "egregious non-compliance with accreditation requirements."

ACGME originally accredited Crozer's surgical residency program in January 2019, according to its records. The health system maintains accredited residency programs in emergency medicine, internal medicine, ob/gyn, and psychiatry, according to the ACGME's website.

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