Dr. Hedy Migden was fired on July 5, leaving thousands of patients feeling stranded.

On that day, as several patients waited to see her in her office at 24 Madison Avenue Extension in Albany, Migden says, a woman she’d never met, Kellie Valenti, chief operating officer for St. Peter’s Health Partners, asked for her key. After tending to her patients, Migden was escorted from the office.

Migden, 68, had seven-and-a-half years left on her contract, which she signed in 2013. She says she has about 7,000 patients, with 60 to 70 percent of them from the Helderberg Hilltowns and Altamont area.

“I feel I was dealt with in a manner that was unprofessional and inconsiderate,” Migden said. “I can assure you, I did nothing wrong.”

Elmer Streeter, spokesman for St. Peter’s initially said he couldn’t confirm Migden’s termination nor comment on the reasons why. But he called back to tell The Enterprise, “She was terminated for what the practice believed was cause, and she was previously given notice of the behavior she needed to correct to avoid such termination.”

Streeter, however, declined to describe this “behavior.”

Migden responded, “I did receive a 30-day notice, which contained absolutely no specifics as is required by my contract. I believe they are merely trying to get out of the seven-and-a-half years that remain on my contract.”

She also said, “I really don’t know why they terminated me — and closed that office.”

Migden points out that the month before, in June, she received a commendation from the chief executive officer of St. Peter’s Health Partners, hand-delivered to her office, thanking her for her 15 years of service and looking forward to many more.

“They send out satisfaction surveys to patients and I’ve been repeatedly told I’m rated superb,” said Migden.

Dr. Barbara Hauser, who has known Migden for 20 years, said on Wednesday, “Her patients have been coming to me in dismay. I saw one of her former patients today…She has a chronic condition and St. Peter’s wouldn’t refill her prescription. It’s patient abandonment. St. Peter’s made no provisions. People are calling and can’t get answers. They made no plans for what would happen the day after they closed the practice.”

Migden said her greatest concern is for her patients. “As we speak,” she said on Monday, “no letter has reached my patients explaining that the office is closed…I have asked through my attorney to allow staff to give out my phone number. I did not intend to leave. I love what I do.”

Streeter said on Tuesday, “We were unable to send out a letter until now. They will be arriving in mailboxes shortly.”

Asked why St. Peter’s was unable to do so earlier, he said it was a “personnel matter” and he couldn’t elaborate.

Migden also said, “This had turned my life upside down. I had what I believed to be a bonafide contract, which I believe to be broken…I would never abandon my patients.”

Her lawyer, Joseph Dougherty with Hinman Straub, said, “Dr. Migden is an excellent and dedicated physician whose first and foremost concern is always her patients. We’ll take any and all actions to enforce and protect her rights as well as state and federal law.”

He also said, “There were absolutely no allegations of inappropriate patient care or financial impropriety.”

History

Migden thinks her father may be the reason she became a doctor. His family — parents and siblings — were killed in the Holocaust but, because of his medical degree, he was allowed to immigrate from Poland. He settled on the Lower East Side of Manhattan “back when the family doctor did everything,” she said. “He worked 24-7.”

In an era when doctors had no partners and no pagers, he always carried a pocketful of change when he went out with his family, so he could use a pay phone to check in for calls.

Hedy Migden was in her late 30s, working as a school psychologist, with children of her own, when she decided to go back to school to become a doctor. “I decided I had to do it then — or never,” she recalled. She applied to just one medical school, Albany’s, so as not to uproot her family. She recalls the strain of medical school and residency — 36 hours on call — while being the mother of young children.

But as a result, she thinks her son — named Jacob Israel after her father — is now a doctor who also teaches at Harvard Medical School. When he was a boy, Migden said, “I brought him to the anatomy lab to see my cadaver.”

In her quarter-century as a physician, Migden has worked for both St. Peter’s and Albany Medical Center as well as running her practice solo for 12 years.

She started her practice, called Altamont Internal Medicine and Pediatrics, in Altamont in 1992 when Albany Family Practice pulled out of the village. Migden, who had just completed her four-year joint residency in internal medicine and pediatrics, stepped in, working in Altamont for Albany Medical Center from 1992 to 1995.

When Albany Medical Center no longer wanted the practice, she said, St. Peter’s was interested, and she continued her practice in Altamont, under St. Peter’s, until 1998, when St. Peter’s no longer wanted the practice, and she again worked under Albany Med, until 2000 when she started her own practice, which she ran through 2012.

During that time, she changed locations twice, with most of her patients following her. She moved from Altamont to Western Avenue in Guilderland in 2004 and was there for two years before moving to her last location on Madison Avenue Extension.

On Jan. 1, 2013, she signed a long-term contract with Saint Peter’s Health Partners, expecting it to last until she retired, Migden said.

“All of the people I dealt with in 2013 when I signed the contract — the CEO, the CFO, the COO, the chief medical officer — are gone now,” said Migden.

On May 1, 2013, Trinity Health and Catholic Health East came together, now with 92 hospitals in 22 states. Trinity Health is based in Livonia, Michigan. St. Peter’s Health Partners, according to the Trinity Health website, affiliates three health systems — St. Peter’s Health Care Services, Northeast Health, and Seton Health. It covers seven counties and has over 12,500 employees, at more than 165 locations.

On July 5, Moody's Investors Service downgraded Trinity Health System's revenue bonds from A3 to Baa1, reflecting the system's "marked decline in operating performance" in fiscal year 2015, "following several years of modest operating margins"; the service stated, "The outlook is negative" and went on, "Additional challenges include the system's small revenue base, high dependence on government payors and modest service area demographics."

Doctors’ views

Dr. Barbara Hauser, who practiced with Migden in Altamont from 1996 to 1998, has been aware of her work over the last 20 years, she said, and, for the last four years, the two physicians have cross-covered for each other, caring for each other’s patients if one of the doctors is away.

“She is smart and insightful, a great diagnostician and a font of knowledge,” Hauser said of Migden. She said she never detected any problems in how Migden handled her patients or practice over those years.

When they practiced together, Hauser said, “She would take money out of her own wallet if a poor mother couldn’t afford medicine for her child. She’d stop at the house of elderly patients who couldn’t get out. She went out of her way for her patients more than any other doctor I know.

“I’ve never seen anything like this,” Hauser concluded of the abruptly-closed practice. “It’s horrible for Hedy and horrible for her patients.”

Dr. Lance Sullenberger, a cardiologist with Capital Cardiology, a private practice, said, “as a specialist who sees a lot of patients from primary care doctors,” he believes Migden “does an excellent job — her patients are well cared for and they like her.”

He also noted that Migden saw patients in the hospital and was “good at communicating back and forth.” He went on, “I have the utmost respect for her.”

He said he hadn’t seen other practices shut down in such an abrupt fashion. “I have no insight into why that would happen with a dearth of primary-care doctors in the area,” he said.

Sullenberger concluded, “Any time you’re part of a larger medical system, there are many more levels of bureaucracy or supervision that look for different aspects in how they value a person’s work.” It is not just a matter of being valued by patients, he said.

Patient outcry

Since July 5, dozens of Migden’s patients have contacted The Enterprise, some of them expressing curiosity or seeking explanation for the closure but most of them expressing deep loyalty to Migden and outrage over her being fired.

Several said they couldn’t get prescriptions filled and had to wait weeks or months for a new doctor to see them.

“I adore my patients,” said Migden. “I practice in a style very devoted to patient care. They call me at home. I’m in the white pages….I have a lot of elderly and handicapped patients. I take it all to heart.”

Since being fired on July 5, Migden said she has received hundreds of calls from her patients. “They call and say, ‘Oh, my god, are you OK?’ They are as concerned about me as I am about them.”

Pat Dover of Altamont, at 62, has been a patient of Migden for decades. “She’s a fabulous doctor,” Dover said. “She would take the time, if you had an issue, the people in the waiting room might not like it, but she would give you as much time as you needed.”

Dover’s parents were patients of Migden, and Migden would visit Dover’s mother in the nursing home, Dover said. “She was with them both when they passed away,” said Dover.

Dover’s husband, suffering from vertigo, called Migden’s office after July 5. “They said, ‘Dr. Migden is no longer with us.’ He was like, ‘What?’ That’s all they told him,” said Dover. “I tried calling the office and didn’t get an answer.”

Dover then stopped by the office and was told only, “She isn’t here anymore,” said Dover. She said she then called St. Peter’s Health Partners to find out what had happened and was told only, “Dr. Migden no longer works for us.”

“I’m totally outraged with how St. Peter’s handled it. I’m sure there are patients out there who don’t even know.”

Dover concluded, “She’s more than a doctor; she’s a friend.”

Ashley Tenney, 29, of Guilderland, said she found out on Monday that Migden was fired. “I’ve been crying all morning,” she said. Migden had been her doctor since she was 10.

Tenney said that she suffers from anxiety. “I have trusted her all these years. She watched me grow up and become a mother…She helped me in my first steps to get pregnant..She knows me personally.”

Then, as Tenney faced the stresses of becoming a mother, she recalled, “She said, ‘Call me any time, day or night.’” Her son is now 2 ½ and Tenney had thought Migden would remain his doctor, too.

Tenney described herself as “pre-diabetic.” She is worried about prescriptions that need to be filled. “I did find one [doctor] that will take us but it will be a couple of weeks to get in,” she said. “It can be dangerous for me,” she said of waiting to get medication.

“I had to schedule an emergency visit to see my therapist,” Tenney said of coping with the news of Migden’s dismissal. Her therapist, it turned out, was also a patient of Migden.  “She couldn’t believe it,” said Tenney of the firing.

Lydia Ogaard, 65, who lives outside of Knox, said Dr. Migden had tended to her late husband as well as her parents and children.

“She’s your typical old-fashioned country doctor. If you have a list of questions, she’ll take the time to listen and answer them.”

Ogaard said she found out about Migden’s practice closing when her daughter, who lives in Georgia, called, having seen something about it on Facebook. “If you look at Hedy’s Facebook page, you’ll see nothing but praise,” she said.

She also said, “Nobody at St. Peter’s has sent me a letter.” When Ogaard called St. Peter’s, she said, she was told she could choose from a list of doctors. “I want my own doctor back,” she said.

She also told the person she talked to at St. Peter’s, “I want my medical records.” She was told that would take several weeks, she said.

She currently has a prescription to have blood work done to control cholesterol, she said. “I control it through vitamins and diet, which Hedy is supportive of. Now I don’t know if anyone will accept that script.”

Ogaard concluded that she is particularly concerned for Migden’s elderly patients. “These seniors need someone where they don’t have to rehash their whole life history,” she said.

Connie Shea, 59, who now divides her time between Guilderland and Florida had a physical exam scheduled for July 19. “They never told me Hedy wouldn’t be there,” she said. “I went to the office…I said, ‘What’s going on?’”

She asked for her file and, when it wasn’t forthcoming, she said, “They put me on the phone with the CEO…Then they said, ‘I’m going to call security.’ I wasn’t yelling. I didn’t swear.”

Shea had also asked for and was denied the file for her son, who died a year-and-a-half ago, she said. When she then did research and learned that, as his next of kin, she is entitled to it, she was told then she could have it but then said, “I still haven’t gotten it. I shouldn’t have to go through this. I’m still grieving for him.”

Shea concluded, “They didn’t take into account people’s lives.”

A half-dozen patients submitted letters to The Enterprise, copies of those they had sent to Paul Barbarotto, who served as interim chairman of the board of directors for St. Peter’s Health Partners Medical Associates.

Darcy Pulliam of Knox, who describes herself as a 72-year-old in post-mastectomy treatment for cancer writes, “To have Dr. Migden, my excellent primary care doctor, ripped away from me with no warning and no explanation is devastating.”

Merilee Grygelko and Brian Hendricks, of Altamont, also wrote Barbarotto, distressed with the abrupt disclosure of Migden’s practice, calling the manner in which it was done “abhorrent.”

Grygelko described for The Enterprise an incident referred to in the letter. During a routine annual physical exam, Migden noticed an odd sound in her husband’s carotid artery and sent him to a cardiac specialist, Sullenberger, for follow-up; the specialist found a 50-percent blockage. “She picked up the blockage with just a stethoscope,” said Grygelko. “The surgery saved him from a stroke.”

“We and the specialist credit Dr. Migden’s excellent diagnosis for saving Brian from a possible stroke or worse,” she wrote.

Joyce Martin, 62, of Albany was particularly concerned about her twin sister, whom she described as “totally developmentally disabled.” Both were devoted patients of Migden. “She’s the only one who could ever do a Pap smear for her,” Martin said of her twin who was frightened by the procedure.

“My sister ran out of her prescription yesterday,” Martin said on Monday. When Martin called Migden’s office, she was told, “We can give you a list of physicians,” she said, and she then asked, “What about prescriptions?” She was told, “You’ll have to figure that out,” Martin said.

Martin, who called Migden, said of the doctor, “She cannot write any prescriptions. Her hands are tied. I don’t know what to do now.”

SPHP responds

“We have taken several measures to notify patients,” Streeter told The Enterprise on Tuesday.  “As people have called in, we’ve been trying to address immediate needs,” he said, naming prescriptions and “care for urgent needs.”

Streeter said, “We help patients identify and find a new physician….We do have other practices in the same geographic area.” He said patients can go online to www.sphp.com and look under “find a provider.”

“We have 80 practice locations in total,” he said.

Told that some patients with ongoing medical conditions were having trouble finding a doctor who could take them before prescriptions ran out, Streeter said,  “We want to address their immediate needs. We’re committed to helping.”

To obtain medical records, he advised patients to call the practice at (518) 452-5447. Although there is no doctor on site, records may be requested from Monday through Friday from 8:30 to 4 p.m.

Asked if it was unusual for SPHP to fire a doctor so abruptly, Streeter said, “I can’t confirm someone was terminated.”

Told about the number of calls The Enterprise has received from upset patients, Streeter said, “Some people are upset. We’re trying to do everything we can to help. The vast majority have been happy with the transition — for most it’s been going smoothly.”

Method of practice

Migden said her method of practice fostered “continuity of care.” She said she sees a patient in the context of family, often serving several generations of the same family.

“I’ve established a fine cadre of specialists,” she said “I advocate strongly and get that patient seen quickly by someone I trust.”

She said she spends time with each patient “to discuss various parts of their health.” She went on, “People divulge a lot to their doctors. People go to a doctor for one problem and will ask about another.”

James Gaughan, Altamont’s mayor and a long-time patient of Migden, wrote in February to Tom Lawrence, chief medical officer for St. Peter’s Health Partners Medical Associates, expressing concern that her practice “soon may be losing its additional doctor specializing in pediatric care.” His letter was never answered, Gaughan said.

He wrote of how patients from the Hilltowns, New Scotland, and Altamont depended on her service and he wrote, “It would be a tragic outcome if St. Peter’s did not continue to support the facility with the resources it needs….”

Gaughan told The Enterprise this week, “I was informed by her as it was evolving several months ago…She was concerned this might be happening. You have a doctor who spends quality time and doesn’t meet usual quotas of 20 minutes per patient.”

Gaughan described a “dissonance” between “a money-making enterprise” and “the philosophy I believe more doctors should have.”

Gaughan went on, “I’ve observed the resources that help her to run that office have been depleted — the support staff and office manager.” He speculated, “It could be purposeful.”

Joyce Martin, a registered nurse and case manager at St. Peter’s for 25 years recently retired ahead of schedule because she felt there have been changes since it became part of Trinity Health.

Martin said every physician she’s known has “the highest regard” for Migden. “When you were sick in the hospital, she came and saw you,” Martin said.

She said she could understand closing down a practice abruptly only if the doctor had died. “It’s not St. Peter’s anymore,” Martin said. “This is Trinity Health. St. Peter’s never would have done that…I loved St. Peter’s my whole life; I started and ended my career there. It’s not St. Peter’s anymore,” she reiterated. “You can’t do this to patients.”

Streeter said of suppositions that lack of efficiency, financial pressures, or corporate directives had led to Migden’s firing, “All of those characterizations are inaccurate.” He declined to give the reason, saying again it is a “personnel matter.”

An insider’s view

Lisa Carr, the medical records clerk in Migden’s office for seven years, starting in 2009, described what the office atmosphere was like.

“When St. Peter’s took over, they made promises to improve the office,” she said. “They did nothing.” She said, for example, St. Peter’s management said they planned to paint the office and repair the worn spots in the walls but never did.

Then one day the television in the waiting room stopped working. The office staff noted it turned on, and wondered if the cable bill hadn’t been paid, Carr said. Either way, she said, “They put paper on the front of the TV…and the patients just had to sit there, looking at the dirty carpet and the holes in the wall.”

One of the reasons Migden signed on, giving up her solo practice, was because of new legal requirements for electronic medical records, Carr said, a transition she termed “very expensive.”

Carr also said of Migden’s reason for joining Saint Peter’s Health Partners, “She thought that it would be better for employees.”

On electronic records, Carr said, “They gave me a scanner that sat on my desk and got dusty. They never followed through. It was empty promises.”

For the first year and a half under SPHP, Carr said, “They wouldn’t let me buy any chart supplies.” Once a patient’s chart had been saved the required seven years, or until a child turns 18, she said, “I would take out the insides and re-use them…My nails got shot from pulling stickers off.”

When, finally, she was sent chart supplies, Carr recalled she thought “uh-oh,” the plan to make records electronic must have been scrapped.

The paper records took up so much space she was asked to set up an inventory control system so that they could be stored in a facility out of the office. She set up a searchable excel spreadsheet, stored on a flash drive, and printed out the data on paper; the barcodes were noted so files could be found in stored boxes.

Carr said she urged that the data instead be stored safely in a cloud. “If anybody ever lost that flash drive,” she said,  access to the records would be lost as well. “When I left, it was still there, tucked in the back of a binder. They never cared.”

Before Migden signed on with St. Peter’s Carr said, “We had a really great team going. They did what they could to destroy it.”

She described a staff firing where no reason was given. “They said she slammed a door; I didn’t hear a door slam,” said Carr.

Carr described Migden as serious about her work but fair with office staff. “If Dr. Migden didn’t think someone was doing their job, she’d let them know. It can be stressful dealing with sick patients. People know if you’re not pulling your weight.”

As time went on, after the initial period of great expectations in working for SPHP, Carr said, there were more and more reductions. “As a file clerk, I wound up answering the phone a lot because they weren’t going to hire anybody,” she said.

The full staff had included two doctors, a nurse practitioner, two full-time receptionists, two medical assistants, and a nurse as well as Carr, the part-time medical records clerk.

In May, when Carr quit her job,  there was one doctor, Migden; one medical assistant; one receptionist; “and the nurse was leaving the following week,” said Carr.

“Days when we had no openings, we would send patients to urgent care,” said Carr.

The district manager held a meeting, Carr said, when one of the two receptionists left for a better-paying job, and told the staff the vacant post wouldn’t be filled. “She said there was a hiring freeze,’ said Carr. When office staff asked why the St. Peter’s website listed job openings, the manager said, “We don’t want to scare people,” Carr reported.

She also said staff had to sign agreements not to put anything negative about SPHP on social media.

On May 9, a day when Migden was out of the office, Carr said, the district manager held a phone meeting with the office staff about Migden. “They wanted her fired…They said, ‘Hang in there. We know you’re overworked. We want to get you out of that situation.’…They reassured us we’d have a position with the organization and said it will be uncomfortable for awhile. I said to the office manager, it sounds like you are out to hang her. She smiled and nodded.”

The office manager, she said, kept notes of things like Migden making a personal phone call. “They were just trying to hang her,” she said. “They were trying to set her up to fail.”

Carr, who lives in Berne, put in for her resignation that week. “It was a financial hit but I couldn’t live with myself and do that to her,” Carr said of Migden.

“It was hard to leave a great family atmosphere. You get to know the patients,” she said. “I didn’t get fired. I quit because I felt like what they were doing to her was so very wrong…I would still be there if it weren’t for Saint Peter’s Health Partners’ wrongdoing… I wouldn’t have been able to sleep if I stayed. I wouldn’t be able to live with myself.”

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Updated on July 22, 2016: The information from Moody's Investors Service was added.