By Gretchen Morgenson

In January, Sonali Patel, an emergency department doctor at a big Houston hospital, became ill while on duty. After testing positive for Covid, she said she told her boss she had the coronavirus and was going home.

“He insisted I stay and finish the shift,” she recalled in an interview and in a recent lawsuit. “I told him it’s not the safe thing to do. We have a ton of immunocompromised patients and we were putting them at risk.”

By requesting time off from work while sick with Covid, Patel breached an unofficial policy promoted by officials at the hospital staffing company she works for — American Physician Partners — according to the lawsuit filed against the company by her and seven physician colleagues.

Those doctors say American Physician Partners' officials pressed them to work while ill, even if they contracted Covid and could spread it to patients and colleagues, according to the suit filed in Harris County, Texas, district court in March. Physicians who worked while sick were celebrated, while those who stayed home with Covid had their pay docked, the lawsuit says.

One American Physician Partners medical director had a name for the unwritten policy about working while having Covid symptoms, the lawsuit says. It was “the 4 M’s,” which stood for “Motrin, mask, man-up and must not test.” When a physician raised concerns about this practice, he was told by a superior that “that’s just the culture” at the company, according to the suit.

American Physician Partners, founded in 2015 and based in Brentwood, Tennessee, provides emergency department staffing in more than 150 facilities in 18 states, its website says. Eighteen are hospitals in the Houston Methodist system, according to the doctors’ lawsuit. The company is backed by BBH Capital Partners, the private equity unit of Brown Brothers Harriman, a New York investment firm.

An American Physician Partners spokeswoman said it is the company’s policy not to discuss pending litigation. A BBH Capital Partners spokeswoman said the company does not comment on pending litigation at its portfolio companies.

Pressing doctors to work when they have Covid could result when an emergency department is intentionally understaffed to save money, said Dr. Mitchell Louis Judge Li, founder of Take Medicine Back, a movement to eliminate corporate control from health care. Regardless of the motivation, he said, understaffing an ER is dangerous.

“Short-staffing or inappropriate staffing chosen by a corporation does not allow physicians enough time to be effective with their patients,” he said. “That is a clear public health risk.”

It has not been confirmed whether short-staffing was an issue at the hospital.

A spokeswoman for the Houston Methodist hospital system, which is not a party to the suit, said in a statement the litigation was an internal dispute that had nothing to do with the care provided by the hospital system.

“We are unaware of any ER doctor who came to work after testing positive for Covid-19,” the statement provided by Stefanie Asin said. “Our hospital system’s quarantine and isolation policy aligns with CDC guidance, which means employees and physicians are instructed to stay home from work if they test positive for Covid-19 for the required quarantine period. Our emergency rooms saw at least 50 percent increases in patients during the worst of the pandemic, and all of our ER physicians performed heroically and took great care of our patients when they needed it the most.”

Private equity firms have taken over a broad swath of health care entities in recent years. They use large amounts of debt to acquire companies, aiming to increase profits quickly so they can resell for gains a few years later.

Their forays into emergency medicine are transforming the field, analysts and health care experts say. Today, an estimated 40-plus percent of the country’s hospital emergency departments are overseen by for-profit health care staffing companies owned by private equity firms, academic research, regulatory filings and internal documents show.

Concerned about the potential peril these takeovers have on patient care, legislators in some states are proposing bills to rein in health care acquisitions by for-profit and private equity entities. On June 16, Pennsylvania state Sen. Tim Kearney, a Democrat, and several of his colleagues in the Legislature announced a package of bills to “safeguard the integrity of local health care systems and protect patients from suffering the repercussions of greedy and irresponsible hospital schemes carried out by private equity firms.”