by Hamilton E. Davis
The Vermont hospital reform effort, which has been on a rollercoaster ride since it was launched by the Legislature in April of 2011, flew wildly out of control over the last couple of weeks, the victim of cascading failures at every political and financial level. The main perpetrators were Gov. Phil Scott and his appointees at the Green Mountain Care Board, but ultimately the most far-reaching damage came at the hands of the UVM Network’s senior leadership itself.
Eappen, whose real first name is Sunil, replaced the retiring Dr. John Brumsted as CEO of the Network on Dec. 1, 2022. Eappen was coming off a glittering 30-year career at big Boston hospitals, topped off by his leadership of the newly merged Mass General and Brigham and Women’s hospitals. Sunny was interim at Mass Gen Brigham, but he didn’t get the permanent job. Still, he was a terrific catch for little Vermont.
So, it was a huge shock earlier this month when he just quit, walked away. There was instant speculation that he must have been pushed and resigned to avoid being fired. Sources I consider impeccable, however, say that it didn’t work quite that way. What they said is that Sunny became aware that his senior docs and top executives were preparing to hang the Network’s problems around his neck, to blame him for the whole mess. Sunny decided he wouldn’t allow that. Hence the resignation.
Can Leffer do the job Sunny couldn’t?
The new interim Network Chief Executive Officer will be Dr. Stephen Leffler. Leffler will also continue in his current position as Chief Operating Officer of the Network’s flagship UVM Medical Center Hospital in Burlington. The first issue he will face will be the legally constructed agreement between the Green Mountain Board and the UVM Network in April that the Network CEO would step aside for 16 months to allow an outsider to repair an array of dysfunctional system components targeted by the Board. Under the agreement, Sunny himself agreed to turn over his management prerogatives to the outside manager, but is Leffler bound by the commitment?
A perfectly reasonable question, but getting an answer depends on the Network's public relations apparatus, which has been a pluperfect mess for a decade. The current incumbent is Jason Williams, who, despite a mid-six-figure salary, is simply not up to the job.
On a dozen or so occasions over the last couple years, the Academic Medical Center or the Network have been trashed by some yahoo, and Williams’s response has been—nothing, maybe the whole thing will just go away. The New York wing of the publicity apparatus, meanwhile, is aggressive and thorough, but is prone to hyping relatively trivial issues and has refused to fix a major medical issue.
For at least two years, Eappen’s advisers have told him he needed to replace Williams. Sunny refused. “I never can anybody,” he said.
Will Leffler make an obvious move like that? Who knows? Leffler won’t take questions from A Vermont Journal, and what passes for the local press never asks questions like that.
A second huge decision facing Leffler out of the gate will be whether to challenge the GMCB’s budget decision for FY 26 in the Vermont Supreme Court. Rutland Hospital just did precisely that—and won, a decision that so spooked the regulators that they immediately fell all over themselves giving Rutland everything they had asked for, despite the fact that Rutland had the highest cost per capita in the state, and one of the lowest quality.
In other words, there is nothing in the public record to indicate that Dr. Steve Leffler is capable of leading the UVM Network out of the wilderness. Dr. John Brumsted, the CEO of the Network for a decade, groomed Leffler to be his replacement. Yet when Brumsted retired, Leffler refused to step forward. If he didn’t have the stomach for the job in 2022, where did he find it when the job is orders of magnitude more difficult?
Beyond that, Leffler has spent the last several years as the chief spokesman for the Network, and his performance there has been extremely weak. He is very personable, but all he allows anyone to see is the charm. He religiously avoids the more than 600 pages of rock-hard evidence that the Academic Medical Center in Burlington is a full third cheaper on a per capita basis than the 11 non-Network hospitals. The same evidence trove shows that the UVMMC quality is an order of magnitude higher than the small facilities.
Yet, when the Green Mountain Care Board has trashed the Academic Medical Center’s performance, Leffler failed in every case to present a persuasive response. Granted, he should have been prepared by Jason Williams, his political guy, but Williams is still there.
If Leffler hopes to be taken seriously, he will have to replace Williams or get him professional consulting help to come up to the mark.
Yet another problem that cries out for attention is the fact that the UVM system has two coequal Boards of Trustees that don’t always agree. The seven hospitals across northwest Vermont and northeastern New York are governed by one Board; the UVM Medical Center Hospital (UVMMC), the 500-bed facility in Burlington, also has its own Board.
In my conversations with policy experts on both sides, the main point of contention has been whether UVMMC could bring in more money operating alone, or whether the whole system would be better off financially if the Vermont units are allied with the three New York hospitals. The Green Mountain Care Board has made it clear that it hates the whole UVM connection with New York.
Vermonters shouldn’t be subsidizing health care for New Yorkers is the theme.
The GMCB admits, however, that it lacks the legal authority to force that outcome.
The proponents of the broader Network, on the other hand, argue that including the flow of patients to specialist docs in Burlington for sophisticated care adds scale to the UVMMC services and hence lowers the unit cost for patients on both sides of the lake. Moreover, the systemwide approach has the advantage of applying future advances in medical technology to the broadest patient base.
In the opinion of A Vermont Journal, it seems obvious that the weight of common sense comes down decisively on the side of the Network Board, but there the issue sits. If the UVMMC Board intends to go away, there has been no evidence of it yet.
So, Where Do We Go From Here?
The above analysis touches only on the highlights of the existential mess that now serves as Vermont’s hospital system. My guess, and it’s only a guess, is that the system-wide issues will sugar off between now and the opening day of the next legislature. The fallout for a given hospital, though, could be all over the lot. So:
I will follow it as it plays out over the fall. There are a ridiculous number of specific issues to thrash out. They will include at least the following laundry list:
Will either the Network or UVMMC executives, or both, appeal the GMCB’s FY2026 budget decisions to the Vermont Supreme Court?
Will Governor Scott run for reelection a year from now? If he does not, health care reform will obviously be a major issue.
If he does run again, Scott will fall somewhere between highly unlikely and impossible to beat. Even so, Democratic challenges could compete with the hopes that they would establish a base for a run in 2028. In fact, the Democratic contest is already underway: Attorney General Charity Clark v. State Treasurer Mike Pieciak.
Will any of the marginal players influence the outcome as the health care system of the future takes shape?
Those are just the most obvious - you can be sure there will be more.
Fasten your seat belt.