“The longer corporate leadership remains, the greater our decline,” Robert Safian, MD, wrote in one of the letters, which was obtained by local news site Deadline Detroit.

The letters come after healthcare workers and local leaders fought off a proposed merger between eight-hospital Beaumont and 26-hospital Advocate-Aurora. Executives called off the deal in early October, after many physicians opposed it and expressed a lack of confidence in corporate leadership via an internal survey.

In the letters, Safian requested the board terminate CEO John Fox as well as the system’s chief operating officer and chief medical officer. Safian said more than 100 “physician-leaders” at Beaumont’s Royal Oak hospital alone will make major changes to their practices this year, including relocating, “as a result of the toxic culture” at Beaumont.

“When hospital leadership cuts costs by cutting essential services, forcing physician leaders out of the institution, failing to support unique programs, bartering physician and nursing services to the lowest bidder, severely reducing supplies, mandating use of equipment against the will of physicians, and instituting any other ‘cost-saving’ strategies that are anti-patient, then leadership has crossed the line into fiscal irresponsibility (malfeasance?),” wrote Safian, who has been with Beaumont since 1991.

Noting executives and administrators accepted bonuses in March — including $2.6 million for Fox — Safian added: “And to use financial hardship as a justification for cuts, and then to receive financial incentives to make such cuts, is ethically and morally reprehensible.”

This year Beaumont has accepted a combined $866.9 million in CARES Act funds, including $363.1 million in grants that do not have to be paid back, according to Good Jobs First. Sources and reports say Beaumont also sits on more than $2 billion in reserves. (Beaumont did not list reserves in its most recent federal Form 990 tax filing, from 2018, and system representatives did not answer MedPage Today’s questions about them.)

Brian Berman, MD, Beaumont’s former pediatrics chief, was fired after he objected to Royal Oak emergency center cutbacks, according to Deadline Detroit. He was escorted out of the hospital in front of his staff.

Safian writes that an internal medicine and emergency room physician were also terminated for raising concerns. Kelly Levasseur, DO, who directed the pediatric ED, resigned because she lacked “confidence in corporate leadership.”

“Corporate leadership has created a culture of fear and intimidation, and many Beaumont workers, including physicians, have been ‘forced out’ after disagreeing with corporate decisions. This toxic culture has been progressively worsening over the last few years,” he wrote.

The urology department chair, 25 orthopedic surgeons, and a cardiology practice have sent letters to board chair John Lewis, a former Comerica executive, complaining about Beaumont executives.

Safian also asserted that more than 200 Beaumont nurse anesthetists were coerced into signing contracts with NorthStar, which Beaumont hired this year to replace its longtime independent anesthesia services provider. Meanwhile, dozens of anesthesiologists are leaving the system, he said.

The NorthStar decision “has upset the personal and professional careers of hundreds of Beaumont anesthesiologists and [nurse anesthetists], and has created a situation in which the quality of our specialty anesthesiology services in 2021 will be much lower than what we have experienced for the last 3 decades,” he wrote.

Safian could not be reached for comment this week, but he emailed MedPage Today when the Advocate-Aurora deal fell through on Oct. 2: “Merger is relatively minor in terms of imminent threat to the system.”

In calling for Beaumont executives to be removed, Safian echoed the sentiments expressed in a letter written by Mark Shaevsky, JD, a prominent local attorney and former board member, in August. “There’s been a lack of respect for professionals in the organization,” Shaevsky told MedPage Today then, with Fox aiming primarily to achieve a 4% operating margin despite Beaumont’s nonprofit status.

Fox’s employment contract with Beaumont was extended by two years beyond this year, he said during an August interview with a local publisher.

Beaumont is planning a time to discuss Safian’s first letter, according to a statement it provided to Becker’s Hospital Review last week, saying that the letter contains several errors.

A Beaumont spokesperson did not respond to MedPage Today’s request for comment on Tuesday.