Hospital fires 3 doctors without explanation

LACONIA — An employment shakeup at Concord Hospital-Laconia resulted in jobs for three fewer doctors, with thousands of patients left to seek care from another provider, raising questions about patient abandonment. 

Three doctors in the hospital’s internal medicine department were fired last week, and patients received notices the next day to call the hospital to reschedule existing appointments. It's not clear whether the Lakes Region medical infrastructure is robust enough to absorb the number of patients left by the wayside or if those patients will necessarily seek care elsewhere. 

Drs. Gurvinder Bali, Valentin Milchev and Daniel Kallmerten, all internal medicine specialists, were apparently let go on Sept. 26 — that makes four departures in recent months, after another doctor with that department resigned earlier this summer — and they’re not sure why.

The New Hampshire Department of Health and Human Services designates Laconia as an "exceptionally medically underserved population," owing to “unusual local conditions” which create a barrier to the access to or availability of personal health services. Just under 41% of all full-time hours worked in the Winnipesaukee region are by primary care physicians.

Rural Winnipesaukee and Carroll County populations have the highest rates of travel time and the lowest number of doctor visits in the state. Winnipesaukee has the highest rate of no or delayed prenatal care received. 

Hospital spokesperson Dawn Beers said Monday afternoon there were recent departures from the internal medicine department but could not confirm how many nor disclose the reasons why, citing confidentiality concerns. 

But one of those doctors, Daniel Kallmerten, said he was informed personally that he'd been released from his job by Vice President of Operations and Chief Administrative Officer William Dooley, who alluded to hospital leadership wishing for a change.

“I did not resign,” Kallmerten said Monday afternoon. 

None of the doctors were fired for cause, Kallmerten said.

“What they told me is they’ve decided to go in a different direction,” he said, adding executives referred to “problems within the practice.”  

Each doctor is meant to serve about 1,200 to 1,400 patients, spending 32 hours each week face-to-face with clients, leaving over 4,000 patients without their primary care provider for the time being, Kallmerten explained. Bali served around 1,400 patients and Milchev’s numbered around 1,600.

Linda Knightly of Gilford was formerly a patient of Kallmerten. She said Tuesday he was a great doctor and so was Milchev, who sometimes filled in for Kallmerten, but challenges in gaining appointments through the Concord Hospital system influenced her decision to seek primary care elsewhere. She switched to a different medical provider unaffiliated with Concord Hospital just before she learned Kallmerten was let go.

“It’s just ongoing,” Knightly said. “You can never get through, when you call you get a call center located in Concord.”

Knightly said being routed through a call center is not beneficial to the patient, particularly if they are experiencing an immediate medical issue. Through the call center, a patient may be given an appointment months in the future, and if they were to explain they need medical attention urgently, they’ll be connected with a triage nurse who may give them a call a couple of days down the line.

“It’s too bad,” Knightly said. “That’s what we have and that’s what you get.”

Knightly expressed satisfaction with the performance of the individual doctors at Concord Hospital-Laconia, but lamented restrictions laid upon them she believed came from hospital administrators. She said she would sometimes be shuffled into the schedule of another doctor, one who she wasn’t familiar with, because her primary care physician was busy taking care of new patients. 

“They don’t have the time to take care of the patient,” she said. “They’ve got them on, like, a clock.”

“I have no complaints with the doctors,” Knightly said. “It’s the administration that’s doing this.”

By the time she received an email from the hospital instructing her to view an item in her “patient portal” last week, Knightly had already set herself up with the care of a new primary care physician. She was surprised, however, to learn Kallmerten was no longer working for Concord Hospital-Laconia — she’d been seen by him three weeks prior.

“I personally think they’re going after the older docs,” she said.

Monday, Beers said patient access is not an issue across the Concord Hospital Health System, noting there are 15 primary care practices, four of which are located in Belmont, Meredith and Laconia.

“Affected patients can locate a new physician who's accepting patients by calling our Physician Referral Line at 603-224-7879 or toll-free at 800-322-2711,” Beers wrote in an email. “In addition, we are actively bringing on additional providers at all practices.”

That phone number was included in a letter sent to patients informing them their primary care physician is no longer employed by Concord Hospital-Laconia. But upon calling that phone number, and waiting on hold for the better part of 10 minutes, a caller is informed the number is to be used for switching out of internal medicine and to a different department. Those who need to reschedule with internal medicine will be contacted by representatives of the hospital this week. 

“It makes you wonder what commitment Concord has to Laconia,” Kallmerten said. 

Kallmerten was an independent contractor with the hospital, where he started his career in the 1980s. In those times, most doctors operated as their own limited liability companies and were compensated a daily rate for their services. He said the hospital canceled his contract on Thursday, and he’ll be paid through November. 

“For the first 35 years of my career, I worked in the emergency department,” he said. 

When Concord Hospital purchased LRGHealthcare in 2021, executives offered Kallmerten a salaried position, but he opted to remain an independent contractor. Bali and Milchev were apparently salaried employees of Concord Hospital-Laconia. 

The department has experienced turnover in recent years, he explained, noting disagreements between hospital management and staff doctors influenced some physicians to seek work elsewhere. 

Dr. Hillary Conkling, formerly an internist with Concord Hospital-Laconia, apparently resigned her position in July after experiencing what Kallmerten described as “bullying behavior,” including high-pressure and humiliation tactics from hospital management.

“Most of them feel like it was a toxic and hostile environment,” Kallmerten said. 

Remaining doctors, who already served full panels of patients, had to absorb those individuals served by Conkling, increasing the workload on the rest of them.

“Somewhere around 5,500 and 6,000” patients, Kallmerten explained. “I was part-time," as was Conkling.

Since his departure, Kallmerten has received numerous calls from former patients, unsure of how to navigate the medical system.

“I’ve had all sorts of calls of all kinds from people,” he said. “There aren’t many people doing primary care.”

Kallmerten said he doesn’t know what to tell them.

One of his former patients, Alan Posnack of Alton Bay, received a letter from the hospital which informed him of Kallmerten’s leaving as of Sept. 26. The letter, dated Sept. 27, stated a new physician would join the team in November and said the hospital is recruiting other physicians to join the practice. For any urgent or acute care needs, the patient is told to contact the internal medicine department directly to schedule a new appointment. To see a physician at another hospital practice with openings for new patients, the letter instructs the reader to call the hospital’s physician referral line.

A statement released by the hospital acknowledged challenges faced by patients when switching primary care providers and said they’re looking forward to adding new physicians in internal medicine. 

“At all Concord Hospital Health System locations, providing our patients with quality service and care come first. We recognize any change in provider personnel can be challenging to our patients. As with any departures of primary care providers, patients were notified of these vacancies and given options to see other providers,” the statement reads. “We are committed to ensuring no patient is without the quality care they need and are in the process of evaluating the highest-quality candidates for vacancies at Concord Hospital Internal Medicine-Laconia and are looking forward to having new physicians join our team. Concord Hospital Health System continues to be strong, stable, and growing.”