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Small town doctor fights managed health care
by Mark Steil, Minnesota Public Radio
June 1, 2004

Doctor Richard Mulder plans to fight to keep his clinic in this building. Mulder served 8 years in the Minnesota legislature. (MPR Photo/Mark Steil)

A small town doctor in southwest Minnesota is taking on a big opponent: managed health care. Richard Mulder has some experience at political infighting, he served 8 years in the Minnesota House of Representatives. The Divine Providence Health Center in Ivanhoe wants to boot Mulder's clinic out of their building, effective June 1st. The man everyone calls "Doc" says he won't leave. The hospital says Mulder's personality is the problem, the doctor says it's all about money.

Ivanhoe, Minn. — During his years in the Minnesota House of Representatives Mulder was known as a blunt talker. He's still that way.

"For a managed care organization to kick a resident physician who's been there 35 years out of practice, isn't the best medicine," says Mulder. "It isn't the best way to treat people. Bottom line right now for these big managed care organizations is money, not patients."

	A morning poker game at an Ivanhoe cafe

Mulder operates an independent clinic. He rents space in the Divine Providence medical complex in Ivanhoe. Divine Providence is locally owned, but not locally managed. This small town hospital has a big city partner. It's called Avera McKennan. The company is based in Sioux Falls, South Dakota. It oversees day to day management of the Ivanhoe complex. That's the root of Mulder's problem. He says Avera McKennan dictates policy. And he says part of that policy is to get rid of independent competition, like Richard Mulder.

"The only reason for them to not renew my lease and try to evict me is to take over the patients that come here and take over that income," says Mulder.

It looks like the lease issue is headed for court. Mulder says if he loses, he'll likely remodel a building he owns in town and practice there.

"I came to Ivanhoe originally with the plan of living here and working here and dying here." says Mulder. "This is my home, these are my people."

Most people in Ivanhoe know about Mulder's fight with the hospital. At a local café a group of men playing poker say Mulder is a good doctor. They want him to stay. Harvey Suhr says Mulder has the town's medical history stored in his head.

	Harvey Suhr

"When you come into see a doctor and you've known the guy for 20 years and he knows your health history and everything, that's hard to see pass," says Suhr.

The poker bunch know small town life. They've seen power struggles. They like Mulder, but admit he has flaws. As one man puts it, "Mulder has an ego." They say he can be difficult to work with. He's used to getting his way and doesn't back down.

Avera McKennan's manager in Ivanhoe is Mark Vortherms. He says the decision to terminate Mulder's lease came after the doctor refused to cooperate on several medical issues. Vortherms says Mulder would not take on emergency room duty and refused to consult with other doctors.

"If you have physicians that disagree or don't get along, it's very difficult for the care of the patients and the residents that we have here," says Vortherms. "Ultimately the goal of the board and myself was to have a unified medical staff."

	Mark Vortherms

Mulder later said he would do emergency room duty and consult. Vortherms says Mulder's new position will not change the lease decision. Vortherms says Mulder brought on the trouble himself. He says when Mulder was in the legislature he asked Divine Providence to hire another doctor is help with the work load. But when the hospital did that, Mulder refused to work with her. He said she didn't have the right expertise. To give the new doctor a place to practice, Divine Providence started its own clinic, in direct competition with Mulder. Mulder's refusal to consult with the new clinic lead to the lease termination. Vortherms says it was a difficult decision.

"Doctor Mulder's been a great provider here for close to 35 years," says Vortherms. "There were times when he covered the ER for weeks, months on end. You don't find physicians that do that anymore."

Doctor Richard Mulder says his fight symbolizes all that's wrong with health care. Faceless corporations replacing the reassuring smile of the small town doctor. But other's say it's more about an independent doctor who's too independent. When the time came to join the team, Mulder refused.

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