A lawsuit from a group of hospitalists against Saint Agnes Medical Center says an exclusive contract agreed to by the hospital will take away many patients’ ability to see their current physician.

Since at least 2020, Saint Agnes policy allowed physicians to see patients on an open basis, according to the lawsuit.

But in September 2024, the hospital informed Central California Hospital Medicine Group that it would only provide patient access to physicians contracted with Vituity, Inc., a major nationwide medical group. The hospital’s new CEO, Dr. Gurvinder Kaur, used to be a board member of Vituity, according to her LinkedIn.

More than 150 primary care physicians use the Hospital Medicine Group as their preferred provider, the lawsuit states. For patients at Saint Agnes, including many nursing home patients, ending access means patients can’t see their physician at the hospital anymore.

“The familiarity of CCHMG physicians with these patients’ histories and treatment plans is crucially important, as it ensures the highest quality of care for these very sick patients immediately upon their admission,” the lawsuit states. “It also … provides the emotional comfort of a familiar face when that is needed most.”

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Exclusive Contract Improves Quality of Care, Reduces Costs: Saint Agnes

Saint Agnes said it would not comment on pending litigation, but that the transition to Vituity went seamlessly.

“Vituity has had a long-standing relationship with Saint Agnes in the Emergency Department,” a statement read. “All hospitalist physicians have been welcome to join Vituity to continue their practice at Saint Agnes.”

In a letter to the medical group’s attorney filed in Fresno County Superior Court, lawyers with Saint Agnes said that “improvements are clearly needed.”

The partnership with Vituity includes full-time onsite coverage, better scheduling, documentation, and other benefits. Attorneys said hospitals can legally enter into exclusive contracts if it means improved quality of patient care, reduced costs, or better use of hospital resources. A request to the hospital for comment was not returned before publication of this story.

“SAMC has repeatedly encountered significant deficiencies in the current hospitalist care environment, which have undermined patient safety, created increased regulatory scrutiny, and resulted in inappropriate utilization of hospital resources,” the letter from the hospital’s legal team stated. “It is clear to any reasonable observer that change must take place.”

Conflict Between Medical Group and Hospital

Attorney Daniel Horowitz in an October 2024 letter to the hospital’s medical staff president says physicians with the Hospital Medicine Group are highly qualified.

“Its members have a long history at SAMC with documented results that far exceed expectations at any hospital even those … at some tertiary hospitals,” Horowitz said in his letter.

Twelve physicians came together in 2019 to form the Hospital Medicine Group. The physicians have specialties in pulmonology, infectious diseases, geriatrics, endocrinology, and cardiology, according to Horowitz’ letter.

If quality of care was the issue, he said that a hearing would have to be held to determine if that was the case.

Horowitz says enmity had grown between the hospital and the medical group.

Horowitz cites one instance where a patient had to wait two weeks for treatment for an infectious disease. It wasn’t until a physician threatened to call the state of California that care was provided, the letter states.

Hospital Violated its Own Rules in Exclusive Contract

The lawsuit from the Hospital Medicine Group states the decision to agree to an exclusive contract violates the hospital’s own rules. Before it enters into an exclusive contract and closes a department, the hospital must get a recommendation from the Medical Executive Committee and a two-thirds vote from medical staff, according to the lawsuit.

But medical staff only had seven days to make the determination. Two of the hospitalists on the executive committee who belong to the medical group had to recuse themselves.

“Seven days did not provide a meaningful amount of time to adequately address the alarming quality of care issues that could arise from (Saint Agnes’) proposal,” the lawsuit states. The lawsuit alleges that the hospital had already made its decision even before the presentation from the executive committee.

Vituity has sued numerous hospitals for breach of contract.

In his October letter, Horowitz said a “major inquiry” needed to be held as to whether those lawsuits were advocating for better patient care. He also said the hospital needs to examine whether Saint Agnes’ new CEO has any remaining financial connection with the group.

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Who Is Vituity?

In the age of private equity investment capital increasing its presence in the medical industry, Vituity distinguishes itself as being 100% physician-owned, according to its website.

“When it comes to patient care, Vituity puts physicians — not shareholders — in the driver’s seat,” the website states. “Our clinicians have the support and autonomy to make patient-first care decisions, get involved with their hospitals, and meet the needs of their communities, all without pressure or influence from external investors.”

In 2018, CEP America rebranded as Vituity. The organization has 5,000 doctors and clinicians in its group, according to its filing with Indeed.com.

An email request sent to Vituity for comment was not returned before this story was published.

Kaur’s tenure at Vituity played at least some role in the decision to name her as hospital’s CEO. In Trinity Health’s statement about Kaur’s appointment in January 2024, Odette Bolano — Trinity’s president and CEO — said it was Kaur’s background in internal medicine as well as her time at Vituity that helped make the decision.

Kaur’s LinkedIn lists her as a member of Vituity’s board of directors from January 2019 to December 2022.

Horowitz in his October letter says having an exclusive contract could jeopardize the ability of the hospital to make decisions about care.

“Having a former Vituity leader as President of Saint Agnes provides zero sense of objectivity and raises concerns of conflicts of interest,” Horowitz’ letter states. “Certainly a Vituity takeover engineered by Dr. Kaur will cement power and control over medical decisions.”