A group of emergency room doctors at Maui Memorial Medical Center are seeking to oust a California-based firm that took over management of the emergency department in 2018, laying out a long list of allegations against the company, Emergent Medical Associates, in a letter to the board of directors that oversees the hospital.

They say that company executives have created a hostile work environment that has led to an exodus of emergency room doctors, hasn’t delivered on promises that it made during the contract bidding process, has undermined patient care and attempted to fire a physician for employing an N95 mask at the onset of the COVID-19 pandemic, among many other grievances.

“We believe an immediate RFP to replace this off-island, California-based, contract management group is the only way to stabilize the department and to improve patient care, physician wellness, and physician retention,” according to a copy of the letter that was provided to the Honolulu Star-Advertiser and advocates for a local, physician-owned practice.

The letter was sent anonymously to Maui Health’s board of directors and its medical executive committee. Three emergency room doctors confirmed that the letter came from their department and said that the letter’s sentiments were widely shared among their colleagues. None of the emergency room doctors whom the Star-Advertiser spoke with for this story were willing to talk publicly, saying that they feared retaliation from Emergent Medical Associates, which employs them.

On Tuesday one of Maui Memorial’s emergency room doctors, David Williams, was fired. Williams declined to comment on his termination.

Irv Edwards, founder and president of Emergent Medical Associates, said that the letter was rife with inaccuracies and dismissed it as coming from a “‘coward,’ who lurks in the shadows and (files) unverified allegations.” But the situation and brewing controversy in the Maui ER was concerning enough that he told the Star-Advertiser on Monday that he was interrupting his East Coast family vacation to fly to Maui. Edwards said that airing the letter’s contents would “be adding hysteria to an issue that does not exist and simply unsettling the good citizens of Maui.”

The Star-Advertiser was subsequently contacted by renowned crisis manager Michael Sitrick, who said he was handling Emergent Medical Associates’ media inquiries. Sitrick is known for representing high-level celebrities, such as Harvey Weinstein as he battled sexual assault allegations, and powerful corporations, including Exxon during the Valdez oil spill and Enron during its accounting and fraud scandal.

Emergent Medical Associates, based in El Segundo, Calif., contracts with hospitals to provide management and human resources for their emergency departments. The company says it operates in more than two dozen locations, primarily in California, has over 425 providers and cares for 900,000 patients annually. The company won the contract for Maui Memorial’s emergency department in 2018 after ownership of the hospital was transferred from state provider Hawaii Health System Corp. to Maui Health System, a subsidiary of Kaiser Permanente.

Since then, working conditions have deteriorated, according to the letter sent to Maui Health’s board, which says three physicians have recently quit, two have taken leaves of absence and six more emergency room doctors and health care providers are actively seeking other jobs. Emergent Medical Associates is now depending on stand-in emergency room doctors who aren’t invested in the Maui community, according to the letter. Physicians say that the losses account for about one-fourth of the regular ER doctors who have staffed the emergency department.

Emergent Medical Associates tries “to compartmentalize and diminish these losses,” according to the letter. “They assume little to no responsibility for this wave of unrest.”

Emergent Medical Associates says that the doctors left for their own personal reasons and that it tried to retain them.

“The loss of these physicians … is profound and extremely disappointing, but understandable,” a company spokesperson said in written responses to the claims. “(Maui Memorial Emergent Medical Associates’) leaders did everything in their power to assist the providers and encourage them to stay or return.”

Emergent Medical Associates said that it isn’t employing what is referred to as “locum tenens” physicians, which refers to a doctor who temporarily fills in, and that it has hired four part-time emergency room doctors.

The letter also claims that Emergent Medical Associates sought to fire one ER doctor for wearing an N95 mask early on in the COVID-19 pandemic. At the time, staff at the hospital were complaining that hospital management was forbidding them from bringing in their own N95 masks, which are much more protective, amid a COVID-19 outbreak among staff and patients.

Emergent Medical Associates says that it didn’t attempt to fire the ER doctor, rather it temporarily banned the doctor from working because he failed to follow hospital policy related to personal protective equipment and created a “significant disturbance.”

The letter also alleges that Emergent Medical Associates has employed underqualified nurses to treat patients in the ER, while fraudulently billing their care at full physician rates. Emergent Medical Associates said that employing nurses was part of its contractual obligations and that it was billing the services correctly since physicians were reviewing the medical records.

Maui Health’s nine board members either did not respond to requests to comment on the letter or could not be reached.

A spokesperson for Maui Memorial Medical Center declined to comment on the claims laid out in the letter.