Mount Sinai Myeloma Specialists Bart Barlogie & Sundar Jagannath Get Their "Blood" Database

[benmea...@gmail.com]

For Mount Sinai's Bart Barlogie & Sundar Jagannath, A Dose of Their Own Medicine



EVIDENCE EMERGES IMPLICATING JAGANNATH AND BARLOGIE IN HIRE-TO-FIRE SCHEME



Version 2.0 "A Call to Belay the Beatification of Bart Barlogie"



SYNOPSIS: "Clinical informatics specialist contends that after luring him to Mount Sinai with statements like 'It's you or it's nobody,' oncologists Sundar Jagannath, Ajai Chari, and Samir Parekh played out a termination scheme when 3 planned events they deemed more likely than not came to fruition: (1) when world-renowned myeloma specialist and former colleague Dr. Barlogie came out of retirement to join their staff, (2) when the 71-year-old Barlogie won legal rights to a database he co-created at the site of his previous employment in Arkansas, and (3) when Dr. Barlogie's septuagenarian friend and database co-creator Dr. John Crowley confirmed his availability to re-create the Arkansas database for Mount Sinai's Multiple Myeloma program."



I. Gave Up So Much



I gave up so much to come here.



I started a job in California just before the Mount Sinai Myeloma team reached out by phone to begin the courtship. The California job was not ideal in that I would have had to move my family cross-country and I only recently learned that a case of cancer in my family had taken a turn for the worse. But I was unemployed for quite some time before that, and if you want to know what unemployment of that length can do to a person's portfolio, reputation, and relationships, all you need to do is look at me. But the Mount Sinai position offered me the first-ever opportunity to do what I believe I was put on this earth to do and to make the kind of contribution I believe I could make -- AND began making with my doctoral dissertation in 1997 and my design of the Comprehensive Oncology Data Engine (CODE) for a hospital in 2006. Most importantly, it was a hospital, so there was a sense this could be the kind of place where I could drop anchor.



My wife, a 22-year veteran of the United States government, resigned her guaranteed Federal employment with superior health and retirement benefits so that her husband could work again. (I know -- ouch!).



So many of my jobs since the start of this economically and politically tumultuous millennium ended with some change in status to my employer. (Who can forget the NASDAQ Crash of 2000, hanging chads, 9/11, wars in Iraq and Afghanistan, the Great Recession, $5 a gallon gasoline, and a 5-year budget impasse on Capitol Hill leading to a government shutdown and sequestration). I also have a son with special needs, and we finally had a network of professionals in place in Virginia to develop and mainstream him when I uprooted my family for my job here in New York.



Did I mention I signed a 12-month lease?



I. Prologue



I wish to apologize in advance for being indelicate and breaking with convention in sharing the circumstances of my separation from the Mount Sinai Health System. Given the egregious nature and impact of the miscarriage, I feel compelled to avail myself of higher principles in bringing this to your attention.



Over the years I have witnessed some fairly despicable acts across the domains of corporate, academic, and Federal employment. I am alarmed every time I learn a skilled and educated worker has lost a job for reasons that have nothing to do with him (or her) or with his (or her) performance.



This one happened to me.



II. "It's You or It's Nobody" -- Sundar Jagannath



It all began with a May 6 phone call from Andrew Randall, administrative assistant to Dr. Samir Parekh, representing three oncologists specializing in Multiple Myeloma within the Mount Sinai Health System (i.e., Icahn School of Medicine / Tisch Cancer Institute). The Multiple Myeloma program needs someone to design a research database. Having designed the Comprehensive Oncology Data Engine (CODE) serving research, business intelligence, and clinical decision making for a hospital in North Carolina, I appeared an attractive option. After a phone interview with Dr. Parekh and Dr. Ajai Chari, I was summoned for an in-person interview in New York, where the two physicians were joined by the head of their program, 64-year-old Sundar Jagannath. His decision to hire me, marked by the proclamation "It's you or it's nobody," launched an onerous screening and onboarding process that did not conclude until an official date of hire on September 7 and an official start date of September 21. (I was processed through two separate and redundant screening protocols, one for the Multiple Myeloma physician group and the other for Human Resources). Over that period, I was required to make a second visit to the hospital just to meet with Natalie Lewis-Ross, an operations analyst for the Tisch Cancer Institute who serves as part of the hospital's Human Resources function. This meeting would become notable for some additional misrepresentations I will discuss later.



III. Best of the Best



Mount Sinai was in the midst of a binge hiring period, onboarding an average of 100 workers a week. The I/O psychologist who addressed my orientation group informed the room of 94 that we should feel good about having been selected from among the average 10,000 applicants for each of our positions.



"They'll make your work for it," he added. "Only the best of the best are hired at Mount Sinai."



It was here when the first of many omens emerged. After being the first of the 94 to sign into the orientation session, there was considerable confusion raised about the lack of my signature for the afternoon session.



Apparently, after the break for lunch, during which I scurried to have my ID photo taken and to present my I-9 documentation to some office across the street (both of which involved waiting in considerably long lines), I returned to orientation not knowing I was required to present a second "afternoon session" signature. Until I presented some evidence I attended that session, they thought I played hooky. (Maybe they thought I took in the Broadway musical adaptation of American Psycho). They tell me this had nothing to do with the bizarre disappearance of my data from the Payroll Department computers. And I believe them, considering a couple other staff members tell me that it happened to them as well and even cost them a paycheck. "I hate when that happens," reported one administrative assistant within the cancer center.

I guess it's just a shining example of Mount Sinai being the "best of the best."



And between September 21 and my date of separation January 12, I did work for it. I commuted two hours each way, arriving at my "desk" (more on that later) at 7:45 AM and after my wife fell asleep between 10 and 11 PM, I was working remotely until 2 or 3 in the morning.



But my work habits were not motivated by some imagined standard ("best of the best"), when in fact evidence of substandard work was everywhere at Mount Sinai. I worked as feverishly as I did on my analytics strategy and my analytics tool out of fear that a shocking development in the Multiple Myeloma program could render my position unnecessary.




IV. Septuagenarians Rule the Day



You see, during my interview when Sundar Jagannath was announcing to me and the other 2 oncologists that "it's you or it's nobody," there was a fourth oncologist, officially onboarded just two days after me, who was already determined to run me out of town. But for reasons I cannot as yet fathom, the fact of his existence was hidden from me. You'd think the oncologists would mention that the "world-renowned" (according to Sinai press release) 71-year-old Bart Barlogie was coming out of retirement. No one told me that in addition to practicing as a staff medical oncologist he would also hold the title of Director of Research. And no one told me that for the past 40 years he was proud to have presided over a proprietary database he co-created at the site of his former employer in Arkansas.



Fast forward to October. Office of Dr. Sundar Jagannath. I am poised to present my vision for a research database. This is what the meeting is all about. This is what I was hired to do. This is why I am here and why I might remain here for the rest of my career. This is why I relocated my family from Virginia. Why I allowed this group to lure me out of my brand new job in Brea, CA (my first opportunity in 3 years). Why my wife grudgingly left her 22-year career with the Federal government (yes, ouch!). Nothing I am disclosing to you now within the confines of this paragraph was not also known to Drs. Sundar Jagannath, Ajai Chari, and Samir Parekh.



Everyone is here. Some more fashionably late than others. But they're doctors. Last in the room is Dr. Bart Barlogie. Last in the room, but first to speak. And he didn't stop speaking. In fact, I didn't get to begin my presentation until minute 20. And by the time I received permission to address the room, every word out of my mouth was rendered all but academic. And not the good kind of academic. I mean utterly, irreparably, and irrevocably moot.



V. The Meeting



"The database is out of litigation." - Bart Barlogie



From that moment on, the revelations were delivered like bullets to my chest. He insisted that his old database from The University of Arkansas for Medical Sciences Myeloma Institute (UAMS) should be the database of record for the Multiple Myeloma program at Mount Sinai. He intended to have his old database transplanted from Arkansas and he insisted his old friend, the vaunted (and equally venerable) 70-year-old Dr. John James Crowley, should manage the implementation. (Crowley is listed as the Chief of Strategic Alliances for Cancer Research And Biostatistics, or CRAB, something akin to my Comprehensive Oncology Data Engine, or CODE).



This bares repeating. There would be no database design. And the implementation would be managed by someone other than the person these oncologists just hired to implement the database. And just in case the oncologists might object to superseding their new hire, Barlogie delivered his final bullet. This one right between my eyes. He announced that he would fund his friend's multi-million dollar consulting services out of his own pocket.



Time of death. 4:14.



Make no mistake. There was no way Dr. Bart Barlogie wasn't getting exactly what he wanted. He was nothing short of a blow-hard and a bully. I may not have known at the time that he was world-renowned, but he knows it. And in a few short days, he acquired a reputation for being a verbally aggressive if not pugnacious browbeater who likes to suppress speech and push people around. "Outspoken" or "opinionated" or even "nervy" doesn't fit the bill here. You can only get away with behavior like that when you're world-renowned, 71-years old, and bloviating within the borders of New York.

And when you claim to have cured some people of their multiple myeloma. In a Myeloma 101 presentation to the new staff, the presenter mentioned that while Barlogie boasts a cure rate, none of the physicians at Sinai have to her knowledge cured a single patient. From my review of the data dumps from EPIC, I personally believe some patients have been cured by Sinai physicians not named Barlogie, but you can see why the hospital let alone the whole world has not heard about it.



VI. Dr. John James Crowley and the Irrepressible Human Impulse to Cronyism



At first I assumed the association between the 70-year-old Dr. Crowley and 71-year-old Dr. Barlogie ran no deeper than the one database project, that is, until I did something probably not even Crony's mother and proofreader have ever done -- read his entire CV. We're talking 421 publication credits spanning 28 pages. He recorded his first publication four years after I was born but more remarkably published at a rate of 10 papers a year for 40 years. I've seen the CVs of heavy-hitters and whippersnappers like him, and I always wondered how someone can accomplish a CV like that. I tell you what. Let's come back to that. There's the more interesting question of with whom he published -- when -- and how often. Truth be told, he's been co-publishing with Bart Barlogie since 1991, since which time they've collaborated on a mind-boggling 98 projects. Ninety-eight. I was also surprised by another familiar collaborator. Sundar Jagannath. Jagannath appears in Crony's publication list 20 times. The Mount Sinai press release announcing Barlogie had un-retired to join the Myeloma program, dated two days after my start date, revealed that Barlogie and Jagannath had been colleagues over 20 years ago.



VII. What Did I Walk Into



I have no doubt that I was actually second choice all along. But the oncologists of Mount Sinai's Multiple Myeloma program led me to believe I was their first and only choice while certain questions (as yet unknown to me) surrounded the availability of Dr. Barlogie, his database, and Dr. Crowley. I find it curious the blogs of some of Barlogie's former Arkansas patients (among whom he has been elevated to the status of a Deity) hint at some prolonged period during which his whereabouts and fate were unknown. Once these questions were resolved, my fate was sealed.



I can only imagine that the Mount Sinai doctors, who've probably never known a day of unemployment in their lives and have never been short on money (Barlogie himself founded an entire institute in Arkansas with a $10 million grant), are surprised by the way I've responded to my termination. For physicians supposedly concerned with the well-being of patients, they had absolutely zero interest in the human aspect of their decision to dismiss me. The phrase "turning a blind eye" doesn't do justice to what they did. They were aware of where I came from and what I gave up to come here. I had not seen hyde or hair of any of them in the weeks prior to my termination, and Human Resources took the unprecedented move of allowing me to submit timesheets that did not carry any of their signatures. To her credit, Natalie Lewis-Ross reported some measure of frustration with the group, telling me at one time that "the doctors do not always follow the rules" and indicating that it was not acceptable that the physicians did not designate someone to provide direct managerial/administrative oversight over my position. The whole arrangement struck her and other administrative directors as odd, specifically for the jaw-dropping lack of planning and for failing to make other members of the team aware of my impending hire. The physicians decided to terminate my employment without seeking any information from me or about my work. Not one quantum of energy was expended to explore my value to the facility once John Crowley had been added to the mix. And as you have surmised, the physicians afforded me zero hint of dissatisfaction, let alone that a termination was an option, and none of them was designated to deliver the news of my termination personally. That unpleasant task was assigned to Natalie Lewis-Ross. And when she delivered the news, she acknowledged she had not been given insight into the grounds for the decision. Nothing beyond the obscure if not obfuscatory statement, "Ryan does not fit the need of the Multiple Myeloma program." I was led to believe that the physicians were pressed for details, but would not waiver from this line, which gave Natalie Lewis-Ross the vague impression there was something I was asked to do that I did not do. In a further act of estrangement, she informed me that because I was terminated during the probationary period, the physicians were prohibited by Mount Sinai policy from providing employment references for me. No doubt the physicians were aware of the policy when they availed themselves of the convenient probationary termination. Less work for them. And nothing to remind them one of their former employees needs a job.



VIII. Science and the Herd Instinct



Having been ousted for John James Crony, I felt compelled to review his CV; because at first glance, a bloated 28-page 421-credit CV has the power to hypnotize. His previous titles include "Program Head," "President and Chief Executive Officer," "Professor," "Board Chair," and "Chief," and his affiliations include the Fred Hutchinson Cancer Center, Stanford University, the University of Washington, and University of Wisconsin-Madison. But if you look beneath the surface -- beneath the cosmetic sheen -- and actually read the list of publications, a number of striking facts about science as a social enterprise begin to emerge. Publishing in science, which is the primary and arguably sole mechanism through which professional identities, reputations, and careers are created, is less about the intrinsic worth of the science performed and more about -- what else? -- networking. I began compiling statistics on each of Crowley's publications, recording the number of co-authors, Crowley's rank-order in the list, size of paper published, and when and how often Dr. Barlogie appears as a co-author. I mean it's general knowledge within these academic disciplines that the life of the scientific researcher involves a lot of outreach of the "hey, can I join your team" variety so that you end up as the 6th author on a lot of 4-page publications. That's the game. Maximum credit for minimal work. That's how careers and legends like that of Dr. Crowley are created and reinforced. Then they take their research to the national symposium where they address an auditorium of five from a panel of six. And it's a zero sum game. Your job, employability, and earning potential is determined by your rate of publication. Problem is there are only so many journals and so much space available within any journal. So science is all about safety. It's about joining a project with a large number of co-authors to confirm some binary, highly circumscribed hypothesis for which you fully expect a positive result. Even if the research is uninspired, as long as you have one author on the team with an established pedigree and reputation, or some -- ahem -- "connection" to someone on the 3-20 member editorial review committee for the journal in which you seek publication, you're as good as published. So science is about seeking safety in numbers (and boxing out the lesser known lone wolves).



Crowley's CV does not exactly buck this trend. I examined one stretch of 67 publications where he boasts an average 10.4 co-authors per project, over which time his average rank order is 7.2. I found a number of projects that involved over 20 co-authors -- and one involving over 30 co-authors. Once he found his niche within the crony network, he would know for the rest of his career (and beyond if you accept retirement age as 65) that his next publication credit was just a month away and that within just a few short years he would have the kind of CV that would blow people away (and blow up the careers of people like me just as they're getting off the ground). After all, I'm sure none of the 20 co-authors on which he collaborated on his last project would object if he asked to join him or her on their next project. That's how you turn one publication into 20. It's just something my conscience won't permit me to do. There's nothing wrong with it. In fact, it's encouraged within the scientific "community," but I feel like I need a shower every time I agree to something like that. And I also happen to think as a social psychologist that it promotes groupthink. Is it any wonder these academic fields have adopted such a leaden Procrustean framework? And is it any wonder we think we need a larger scientific workforce to learn truths to which we were blinded by -- you guessed it -- a large scientific workforce? Take Barnes-Jewish Hospital in St. Louis. Despite employing well over 200 staff devoted to process improvement -- dozens of informaticians, healthcare researchers, epidemiologists, and Six Sigma black belts in the field of business transformation -- they turned to me because they couldn't raise their patient satisfaction scores. Sometimes the perspective needed for the seemingly insoluble problem is the one precluded by the community bias.



Now I've met some whippersnappers and heavy-hitters throughout the years, including the heads of some hospital Bioinformatics units and I can tell you that you cannot measure a mind by the size of that CV. Over 10 publications a year? Either this is research of modest-to-marginal significance, or -- OR -- his link to/role in these projects is somewhat tenuous. I have been involved in just one major research project in my life (when I immersed myself in a methodology of my own invention to probe an age-old mystery), and I believe wholeheartedly that what I learned about dreams during this project-of-unprecedented-scope is more significant than what was learned over 40 years of academic research in psychology on the subject. Bold claim, I know. Maybe even mind-boggling. But I'm willing to back that up. All this CV padding and networking and name-dropping and title-primping creates a Bubble on the same order of magnitude as the ones responsible for the Great Recession.



This isn't the first time something like this happened to me. Take the U.S. Department of Health & Human Services where I was ostensibly hired as a contract employee on the strength of my Social Psych PhD to provide management consulting. While I was being assigned onerous technical writing tasks (i.e., something they called routine socialization into the department for all new hires), the Director persuaded some maven who published multiple books and who consulted with many reputable institutions to add HHS to her consulting circuit. For her trouble she walked away with a staggering paycheck and consulting credit, and I ended up remaining a glorified secretary and over-worked, underpaid note-taker for meetings of subject matter experts (i.e., "working groups"). Despite repeated promises of more significant roles (and even Federalization), I was laid off when the 5-year budget crisis on Capitol Hill (remember for years the President and Congress could not put together a budget) led to an era of fiscal austerity, scarce resources, and re-prioritization, introducing into the public lexicon terms only square haircuts inside the Beltway should know: continuing resolutions, debt ceilings, threats of government shutdowns, an actual government shutdown, and sequestration.



IX: Life after "Death"



I probably should have started looking for a new job the moment the proverbial gavel fell on that October meeting. Maybe sooner. But I knew that even if Dr. Barlogie's wishes came to fruition (and how can anyone not acquiesce to him), I imagined there was still a role for me in the Multiple Myeloma program. I even imagined there was still a role for me on the database project. *I* could imagine it. So they must too. Right? A project likes this takes months and from all indications, Dr. Barlogie's crony was not going to move to New York and work every day at the facility. They needed someone on site to coordinate the crony's vision and manage the boots on the ground. I have executed a project like this myself for a hospital in North Carolina, and you can't imagine how complex it is. Of course it gets exponentially less complex when you are foisting a pre-packaged vision on a facility, which is exactly what Dr. Barlogie was doing. There's no requirements analysis. No meeting with physicians to discuss what they would like to see in an end product. This is what "Dr. Barlogie" wants and what has already been designed and implemented by 40-year veteran of the Biostatistics trade Dr. John Crowley. Just a few weeks after the meeting, I received the copy of the data dictionary and the structure and content of all the tables that comprise the database.



But I digress.



There would be no work toward the database until January. John Crowley and his D.B.A. Keith Goodman were not available until early January for an on site visit. But they arrived with fanfare and an itinerary that included all the major players -- all the stakeholders, end users, subject matter experts. Participants included the Director of the Tisch Cancer Institute, Steven Burakoff; Vice-Chair of Molecular Pathology & Genetics, Janina Longtine; Director of Oncology Pharmacy, Talaat Aggour; Director of Hematopathology, Julie Teruya-Feldstein; Oncology Investigational Drug Pharmacist, Kendra Yum; Administrative Director of the Bone Marrow Transplantation Team, Zachary Galitzeck; Multiple Myeloma Research Manager, Lisa La; Senior Director of Clinical Data and Analytics, Ken McCardle; and Director of Cancer Clinical Programs, Luis Isola.

I informed the Multiple Myeloma team when I was hired that I would need to organize such a series of meetings, but none of them followed through for me.



Now life at Mount Sinai did go on for me into the month of January. A $100 pre-paid gift card, A Holiday gift from the doctors, came with a curiously foreboding note of "thanks for all your help." It had a ring of finality to it. But from the October meeting forward, I was relieved of my broad database responsibilities and assigned, yes, you got it, onerous work of minor significance. I was reconciling large lists of patients and referral sources stored on multiple Word and Excel documents maintained by the physician's administrative assistants, past and present. Not that the work wasn't necessary. Three oncologists on that referral list have been deceased for over 6 years and one was recently arrested outside a cancer conference for failure to pay child support. But this was my new present and made me worry for my future.



I tried to take control of my fate by designing an analytics tool for the database. (Regardless of how the database is designed, an export of the data into my analytics tool would prove a major force multiplier in understanding both any individual patient and the patient population). For 3 months I worked night and day on my Tool. By January 6, the Tool was finished. And not too soon. For this was the day of Dr. Crowley's visit to Mount Sinai. His itinerary was regal. He was scheduled to present to multiple meetings of clinical, analytics, and I.T. administrators across the facility. Why this was not arranged for me, especially after my suggestion early in my tenure, boggles my mind. This is how I launched my own version of a database for a hospital in North Carolina, something I called CODE (Comprehensive Oncology Data Engine). And I could tell you from experience that this requires the support of a lot of professionals representing multiple disciplines and information systems. Even after Dr. Crowley was anointed as the lead for this project, I was surprised I was not assigned a supporting role in the vein of project manager, requirements analyst, and for lack of a better word, "sales rep." Even within their own ranks the Multiple Myeloma team has no consensus vision of what they want this thing to do. And such a system is more than just a static repository of data. For the data to be actionable, it needs a graphic user interface (i.e., dashboards) to enter data and order analyses, a tool to integrate and analyze the data, and a reporting capability. From what I gathered from my one meeting with Dr. Crowley (and mind you, I was assigned only to the very last meeting of the day lacking all the key stakeholders and principals), they do not appear to have such a broad interpretation of the enterprise functionality.



During the meeting, I did in fact discuss my analytics strategy, as I intended for the purposes of underscoring my value to the project and a number of possible roles. Unfortunately, none of the physicians from the Multiple Myeloma team were in my meeting group while I was making my case and outlining a few possible roles within the program moving forward. Three days later, I was fired.



"Ryan does not fit the need of the Multiple Myeloma program."



That was the reason for my dismissal, delivered by Human Resources Operations Analyst Natalie Lewis-Ross.



X. The Termination



There were more humane options than termination. They could have found another role for me within the project, within the program, or within the hospital. They could have phased out my position over a few months. Or they could have put together a severance package for me. Any one of these would have been fair. But no. Bart Barlogie needed me out. John Crowley and his Cancer Research and Biostatistics (CRAB) needed me out. And Mount Sinai needed me out. And they all need me out *yesterday*. Only a giant can of RAID could have killed me faster.

I guess they got their "blood" database after all.



As you know, it's customary when terminating an employee to rescind his access to company property and equipment prior to delivering the bad news. The method employed by Mount Sinai was particularly artful. They used a two-step process to distance me from my PC. Had they been successful -- had Mount Sinai had it's way -- I would have been deprived not only of references, but samples of my own work. I would have nothing to show for my time there. Here's how it worked. Research Manager Lisa La, who is usually the one who informs me when I need to vacate my PC for a monitor, tells me she needs my PC and that she's booked the large conference room for me for the day.



Now there were a number of clues to my fate in this maneuver. First, I was displaced mid-day and with no notice. Usually I have at least one day's notice and I am informed at the beginning or end of the day. Secondly, no conference room, let alone the large conference room, is ever available for the day. You'd have a hard enough time booking the thing for an hour let alone a whole day. The third clue was in the canary-eating Cheshire cat grin on Lisa's face. She knew what this all about. And it meant she'd never have to fight me for that primitive PC again. So in 60 seconds of nervous paranoia I copied the contents of the PC onto my flash drive.



I wasn't in the conference room for more than 15 minutes before Zachary Galitzeck arrived to tell me Natalie was waiting for me in his office. I don't know if you've ever seen the Coen Brother's film, Burn after Reading, but Natalie is the equivalent of the cryptic agent "Olsen" who is known only by reputation and who's present for all termination meetings. John Malkovich delivers one of the funniest lines in the film when his character -- a Senior Analyst with the State Department -- laments "Palmer, with all due respect, what the ^%!$ are you talking about? And why is Olson here?"



I never saw any of the physicians again. Actually, I had not seen any of the physicians in the weeks leading up to the termination. I will repeat what I am about to say, but it's something that bears repeating. None of the Multiple Myeloma program oncologists ever met with me to assess my workload. None of them ever met with me to explore my role or value to the program in the John Crowley Era. Ms. Ross was somewhat confused by the circumstances surrounding my dismissal. The physicians were stingy with their explanation and seemed determined not to reveal the circumstances under which I was phased out of the program. All she said she could get out of them was, "Ryan does not fit the need of the Multiple Myeloma program." It was also important that I know that since I was inside the 6 month probationary period, it was designated a "probationary termination." I endure this 3 1/2 month gauntlet of interviewing, screening, and onboarding, and my reward is 6 months of probation?



Before I committed to composing this blog, I gave the physicians one last chance to commit a decent, rational act. I sent each a letter expressing my dismay over the circumstances surrounding my termination. Had any of them wrote, "we apologize for the inconvenience. This was not an easy decision. We realize this must be difficult for you. We would be more than happy to endorse you in your pursuit of employment elsewhere ... " Had any of the physicians communicated any of the elements above -- had they shown any compassion or cognizance -- I would have had no incentive to dream up this blog. Bart Barlogie was the only physician who replied at all, and he replied with "Why am I getting this?" which he copied to Ms. Natalie Lewis Ross and administrative manager Zachary Galitzeck . And the paragon of compassion that he is, Barlogie did this because he knew Sinai officials would take issue with a statement in my letter vowing to continue my work following the end of my Sinai career. Barlogie's CC set in motion a chain of events that included a cease and desist letter from Sinai Chief Counsel and an accusation that I made off with public health information. (I did not). I retained a copy of an analytics tool I created and which included some data, all de-identified, because that's what I had in my possession when they abruptly terminated me. It was okay for me to possess this when I was their employee; but now that I wasn't, it was cause for Sinai to issue threats that included the Department of Justice and the New York State Police. And I would have taken these threats very seriously had I been in non-compliance and had I believed their threats were motivated by health laws. But they weren't. If they had been, Sinai would have contacted these authorities without alerting me first. The way they conducted themselves throughout the ensuing discourse strongly suggests that this is all about the blog. The physicians are leaning on hospital administrators to pressure me into removing the blog. In a rational world, someone would just tell these shmucks, "hey, what you did to this fellow was somewhat dishonest / dishonorable. You did it because you thought he'd shrug it off and move on. He did not. So now you have another choice. You can either reach out to him and try to make things right, or you can live with the blog."



But the physicians don't like those choices. They're bullies. And they believe they can have their cake and eat it too. And the same goes for the organization. (Seriously, the more I learn about Mount Sinai, the more I begin to think I am dealing with a shady organization). They secretly hired me as insurance policy in the event Barlogie, the Arkansas CRAB database, and/or John James Crowley would not become available, uprooting me at great expense to my family. They put me through an onerous screening and onboarding process that would make the Department of Defense blush. Then they terminate me (one week before I would have qualified for unemployment benefits, which would have also cost the hospital). Deny me references (citing policy). Revoke the verbal agreement to reimburse me for 3 days severance (like they reneged on the $2,500 in reimbursement for moving expenses). Add insult to injury by informing me that it's policy to prohibit any entity within the Mount Sinai Health System from hiring someone who had been terminated from any other entity in their system (which is significant given their Blob-like appetite for mergers and acquisitions within the City). And after all these unfair acts, they harassed me for writing that I was the victim of unfair acts.



Nice organization.



I think what really creeped me out about Mount Sinai was the way they kept trying to gain access to their employee's bloodstreams. They ordered groups of employees to 8-hour mandatory annual health assessments and proudly trumpet their random drug screening mechanism as a means to protect the organization. Also, based on the large data sets I have had an opportunity to review, it's also clear they subject their cancer patients to frequent substance use testing. (I wonder whether the patients are aware). And to top it off, they contracted with a new insurance carrier and the new benefits products provides a strong monetary disincentive to use physicians outside the Mount Sinai Health system. As a resident of Connecticut who also likes to maintain relationships with some physicians from my former state of Virginia, my premium went up $100 when I elected to use non-Sinai physicians. You know, for an organization that sounds a sanctimonious alarm about protecting public health information, they sure are anxious to gain access to the private health data of those in their employ. Personally, I would never give an employer that much control over me. You'd never know if you were terminated based on performance outcomes or if a spike in blood sugar or pressure (or that of a family member) ran afoul of their sensibilities or risk calculus.



But the bottom line is that, if these physicians' careless actions put my family in harm's way and if they denied me access to references, what's to keep me from doing what I'm doing now? Sharing my story with the world and letting everyone willing to listen know that clinical acumen aside (and I don't know what kind of doctors these are), they are not good people.

Mount Sinai also appears to have retaliated against me for posting this blog. Ms. Natalie Lewis-Ross informed me during the termination meeting that I while I was being dismissed mid-day Tuesday, that I would be paid through the end of the week. I reached out to Ms. Lewis-Ross by email to remind her of what she told me, and this is what she had to say:



Hi Ryan,



Nowhere during the meeting did I inform you that you would be paid for the entire week. Your final day was the final day. I am not allowed by law to do such a thing.



Uh huh. So apparently severance pay is now against the law. Why can't she just admit the offer, which was no doubt approved by the physicians, was rescinded by the physicians? I can't even get the physicians to admit to the real reason they terminated me. A reason -- any reason -- would have been nice. Because "Matt does not fit the needs of the myeloma program" is not a reason. I fit the need when I was hired. I fit the need when I was thanked for "all my help." Now suddenly I don't fit the need.



So my doomed tenure at Mount Sinai ended like it began, with deception. I remember when I was informed that I had been pre-selected for the position and that I only had to wait out the screening process. Despite repeated claims to the contrary, I was strung along for nearly 3.5 months. I was also misled with respect to the leave accrual structure at Mount Sinai. There was also this talk of 29 PTO days. This was a major recruiting point with them. 29 PTO days. Then when I arrived, I learned I did not have any leave to minister to my relocation. I needed special permission to advance 2 days leave from October so I could take 2 days to move in September. And I thank Ms. Ross for that special dispensation. As it turns out, by 29 PTO days they mean that you are allowed to accrue up to 29 PTO days. But you have nothing to start. Lie #2. I was informed that $2,500 of my relocation expenses would be reimbursed. When I submitted my receipt to HR, I was informed that because an assessment by the recruiting division determined my job is "not hard to fill" (pardon me), that my request was denied. My first reaction was that I was recruited under false pretenses, but only after a lot of stressful emails and perceived sleights, it was determined that in the 3.5 months between the intent to hire and the actual date of hire, the organization changed its policy. The new policy does not offer reimbursement only to top executives or to faculty, but to only positions that HR deems were more difficult to fill that year. So some people get the reimbursement. Some don't.



And who could forget the fact I was never assigned a dedicated workstation. No office. No cube. No corner within a cube. Apparently, Stephanie Stoss, Director of the Bone Marrow Transplantation program, was so miffed with the physicians for failing to disclose their plans to hire me that she decided I would never have a dedicated workstation. When I met her, she was fit to be tied. She welcomed me with a tirade of sorts, complaining that no one had made her aware that I was joining the program. The fact of my existence was completely hidden from her.



Sound familiar?



Even the staff was aware of the situation. Two different staff members approached me with the rumor that I would never get an assigned space or computer at Mount Sinai.

I was eventually assigned a laptop. Otherwise I was allowed to use a primitive computer earmarked for monitors and I was required to vacate the PC when it was needed by a monitor. The laptop was inadequate, so I would then head to the hospital library.



I hope that database they're building is worth it. I really do. In the end I think that it will be a serviceable product placed in the service of conventional and uninspired minds lacking analytical acumen. All throughout orientation, and during the videos Mount Sinai uploaded to YouTube, I heard that Mount Sinai is all about thinking outside the box. That this is a place for innovative minds who push the boundaries.



A more conventional group and organization I have not met.



And that includes the world-renowned Dr. Barlogie.



XI. Throwing out Baby & Bathwater for Someone Who Likes to Throw Kitchen Sinks



I reviewed Barlogie's list of achievements. I can surmise where ideas like his come from. They don't come from clinical trials but rather from a blend of "let's throw everything but the kitchen sink at the disease out of desperation" (which became "Total Therapy 3") and an acute sensitivity to patient data. I applaud him for putting himself in the position to make the observations he made, but if that's what passes as genius -- the kind of genius that gives you the right to behave like a complete prick for the rest of your life -- then my Analytics Strategy & Tool would have made pricks of all of us, because the tool he's currently having replicated for Sinai is downright Lilliputian by comparison. One journalist even headlined Barlogie as a "myeloma pioneer." I guess we've really lost sense of what terms like these really mean. This is a man who's clearly trying to innovate from inside the proverbial box.



I had an opportunity to review the data dictionary for the CRAB database thoroughly. In Crowley's database lies the potential to access data stored in the data warehouse feeding the EPIC EMR system. But that's all they're achieving here. They're re-creating the hospital Data Warehouse (DW) for their own use. And no question that will afford them a newfangled measure of autonomy, as they will no longer have to submit requests for data to the I.T. department. (These requests are not executed free of charge). But there's no analytical value add here. No emergent property that gives them the capacity to mine hidden patterns in patient data at either the individual or cohort level. My tool does this, and I am already observing relationships that I believe represent fresh insights worthy of publication. (One of the things my tool enabled me to do was to identify patients for which combination therapies (like Total Therapy 3) present too great a risk for infection. My tool allowed me to compare lab values (e.g., WBCs) on days on which the patients received two or more chemotherapeutic agents with lab values on days on which patients received only one agent. In some cases the differences were striking.



XII. "ADHD Science"



A kinetic profile of each patient like the kind afforded by my Tool is invaluable for clinical decision making, offering insights into the course of the disease as well as the response to treatment and ultimately forecasts of near-, mid-, and long-term conditions. Just paste the lab values from the EPIC data dump into my Tool and thousands of analyses are executed simultaneously and instantaneously.



My analyses include novel hematologic malignancy constructs that assess not only central tendency and variability but provides for each chemical and at each assessment metrics quantifying various types and combinations of stability (e.g., rate of change), direction/favorability, magnitude, and trend. It's these patient-level constructs that clinical research is sorely lacking, and it's the key to advancing our knowledge of this and any other cancer. My next step will be to develop the Tool so that these statistics assessed at the level of the individual automatically populate another spreadsheet with embedded formulae to execute hundreds of aggregate analyses so as to harness insights that can only be obtained through comparisons across patients.



It's the cohort level analysis where nearly all conventional analytics strategies begin and end. That initial, individual level phase, is seldom articulated, and that's a real shame, because I happen to believe it offers insights that cannot be gained from any cohort level analysis alone; and moreover, what is learned from the first phase can greatly inform how we design our plan to analyze the cohort. Statisticians and clinicians alike have not shown the tendency or the temperament to figure out how to partition variance within individuals and effectively treat a population of let's say 2,000 patients as a series of 2,000 n = 1 experiments. Everyone wants to herd patients through a statistical sausage grinder. I refer to this as the "agricultural approach" (AKA the "Harvest") or "ADHD Science," and it's a real rate limiting factor in cancer research.

As it presently stands, the Analytics Strategy of the Mount Sinai Multiple Myeloma program is not a coherent, well-articulated Strategy at all (i.e., not a systematic and iterative strata of analyses) but rather the usual hodge-podge of cross-patient comparisons involving myeloma markers under different treatment conditions. Like I said, "ADHD Science."



Unfortunately, they fired me just as I reached a point where I can begin assessing the results. They never saw the Tool. I had not had an opportunity to reveal the Tool and none of the physicians thought it would be useful to meet with me to assess my workload or explore my value to the program in the John Crowley Era. They just assumed I was no longer needed. I never had an opportunity to challenge that presumption. Now that did not stop them from demanding I surrender all rights to the Tool once they learned of its existence from this blog. I assured them the Tool I created remains available to them (I did not delete it from my "workstation"), but that wasn't enough for them. They had their Lead Counsel demand I forfeit all rights to it. Suffice to say that after a volley of snarky emails, I refused to succumb to their intimidation tactics.



It wasn't enough they took my job and living wage. It wasn't enough they left my family exposed to all sorts of risks. It wasn't enough they derailed my vocation and put it in the hands of an old man who's had his time in the sun building the "eunuch" version of what I could have been building. They had to steal my idea. (Whether they ever use my Tool is another question entirely. Their intent may have been to ensure only that *I* could not profit from my hard work and ingenuity). Think about this a moment. This is an institution that is dedicated to the mission of science and medicine. Yet they would deny someone from advancing these causes just because he is no longer affiliated with their institution. How philanthropic is that? How *scholarly* is that? You really have to question their scholarly motives. Is Mount Sinai still worthy of its name? Is Bart Barlogie still worthy of the adulation his peers and patients have heaped on him?



So I will continue to analyze the data I collected from Sinai. You see, as artfully clever as they were in the way they separated me from the PC I used at Mount Sinai, I'm no fool. I'm quite familiar at this time in my life with the evil men do, so to speak, and I managed to retain copies on a flash drive of the tools I created during my brief tenure. Thanks to this foresight and a little functional paranoia, the end of my career at Mount Sinai does not spell the end of my larger vocation, and I will continue to learn what I can from the work I put into this.



UPDATE: I intimated in a letter to the physicians following my termination that I might do something like this; and every day since the letter, I have captured visits to my LinkedIn page from Dr. Jagannath's administrative assistant and from the med student with whom I was working to support research by Dr. Ajai Chari.