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Fall 2017

The Flea That Killed the Medical Center CEO: A Cautionary Tale 

Mark F. Weiss, JD
The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CA

Earlier this year, a flea bit and killed the CEO of one of the top-ranked academic medical centers in the nation. Metaphorically speaking, of course. And the lessons of this sad (?) story cut both ways for you and your anesthesia group.

In his book, The War of The Flea, the seminal work on guerrilla warfare, Robert Taber wrote about how a small band of guerrilla fighters could emerge victorious in a conflict with a larger, well-organized enemy: “Analogically, the guerrilla fights the war of the flea, and his military enemy suffers the dog’s disadvantages: too much to defend; too small, ubiquitous, and agile an enemy to come to grips with.”

The Dog

In 2014, Ohio State University concluded a national search for the new leader of its Wexner Medical Center. It selected, and then hired, Sheldon Retchin, MD, as its CEO. His salary? Close to $1 million per year.

The Flea

In May 2017, just three letters signed by a handful of the 1,200 physicians that Wexner employs triggered Dr. Retchin’s resignation.

The first letter, dated May 1, 2017, signed by only 25 physicians, raised complaints about Dr. Retchin’s management style. According to a report in The Lantern, the Ohio State school newspaper, the complaining physicians wrote they had “no confidence” in Dr. Retchin’s leadership. The signers claimed that more than 100 other doctors supported their position, but were afraid to join in the letter.

The second and third letters were signed by just six physicians each.

Even assuming no crossover in the signatories, 37 physicians (yes, some in positions of authority) out of 1,200—that’s only three percent—were able to unseat the king.

Dr. Retchin, the frontman for a high and mighty organization, and, one can argue, the organization itself, became the latest victims in the war of the flea.

Why This Matters to You

What does this mean for your anesthesia group and for you, personally?

From the organizational perspective, as in a guerrilla war, change within the organization, as well as within a domain in which the organization interacts, can occur as a result of agitation by a vocal minority. Just as no vote was required for a dictator like Castro to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.

What you think is permanent is only temporary. Just how temporary is the question.

From the dog’s perspective, what you do, and how you do it, within your group, and how you project it to essential third parties, is all-important in maintaining relationships, contracts and even existence. It’s complex work carried out over multiple disciplines but it cannot be ignored or dispensed with. That’s the flea prevention. It’s required.

And, just the same, from the perspective of the individual, the small, the “out group,” the “flea”—a steadfast, vocal and somewhat intransigent minority—can kill the dog.

Your individual or group leader can attack much larger prey. Just how depends on the situation. But, suffice it to say, it takes time and effort and a combined arms approach.

Another group, large or small, can be made irrelevant. The hospital CEO can be forced out. The small organization can ingest the larger.

Forget silo-like thinking and the world-view that results are directly proportional to efforts: Leverage, properly and forcefully applied at the right points, can move your world.

And, yes, the dog bites back. No win is guaranteed. Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. In Dr. Retchin and Wexner’s world, it’s flea-kills-dog as well.

Whether you’re the metaphorical dog or the metaphorical flea, the same applies to you.

Mark F. Weiss, JD, is an attorney who spe-cializes in the business and legal issues affecting physicians and physician groups on a national basis. He served as a clinical assistant professor of anesthesiology at USC Keck School of Medicine and practices with The Mark F. Weiss Law Firm, a firm with offices in Dallas, TX and Los Angeles and Santa Barbara, CA, representing clients across the country. He can be reached by email at