MARYSVILLE — After 47 citations and the exodus of 30 physicians-in-training, Sea Mar Community Health Centers is battling in court to keep its Marysville residency program afloat.
In April, a nationwide council revoked accreditation from Sea Mar Marysville Family Medicine Residency, citing improper oversight, education and working conditions. Sea Mar vehemently disputed the decision, and in June sued the Accreditation Council for Graduate Medical Education — the nation’s largest body for reviewing medical graduate programs — in U.S. District Court in Seattle.
Sea Mar is a government-supported health center that serves at least 200,000 low-income patients, mostly Latino, at more than 60 clinics across Washington each year. Since 2015, the nonprofit’s three-year residency program based in Marysville has trained medical school graduates to become primary care physicians. These physicians-in-training, called residents, practice at Sea Mar clinics as well as Seattle Children’s Hospital and Providence Regional Medical Center Everett.
As Sea Mar scrambles to salvage its reputation and fill gaps in clinical care left by residents, health care experts said the loss is a step back for Snohomish County.
“This will impact a key federally qualified health center partner’s patient care capacity,” said Dr. James Lewis, health officer for Snohomish County, “as well as curtail a meaningful pipeline of primary care providers to our region.”
The federal Health Resources and Services Administration projects a nationwide shortage of 35,260 primary care physicians by 2035, mostly in rural areas. State Sen. June Robinson, D-Everett, said Washington has made “significant progress” to increase family medicine residencies over the past decade, but most are in King and Pierce counties.
“Losing family residency slots in Marysville is painful,” Robinson said. “I hope both Sea Mar and the ACGME can work to correct any deficiencies and restore the residency program as soon as possible.”
Lewis said stopping Sea Mar’s program could increase demand for the county’s STI clinic, and limit primary care providers for refugee and immigrant referrals.
In February, two representatives from the council met virtually with Sea Mar residents and staff following poor annual survey results, according to court documents. One representative, Dr. Pamela Royston, left the visit “shocked and appalled,” according to court papers. Residents and faculty told Royston that the program’s director, Dr. Ricardo Jimenez, led a “hostile” working environment where residents worked more than 80 hours per week and were not properly trained.
In her 34 years doing this work, Royston had visited 235 sites. Sea Mar’s was “‘the worst program’ she had seen,” court documents read.
In court documents, Sea Mar called the 47 citations “a hodgepodge of vague, manifestly erroneous, trivial or insubstantial claims.”
In late April, a review committee voted unanimously to withdraw Sea Mar’s accreditation for the program, effective June 30.
The ruling sent a shockwave through Sea Mar. At least 30 out of the 34 physicians-in-training left to finish their residencies elsewhere. Longtime partners such as Providence Everett threatened to terminate their affiliation with the program.
“The unfortunate loss of Sea Mar accreditation has forced our valued Sea Mar physician residents to complete their training outside our community,” Providence spokesperson Erika Hermanson said in an email. “Providence worked with each affected resident to secure placement elsewhere.”
‘Inflexible, harsh, and detached’
In response to a growing need for local doctors, especially those who can serve Spanish-speaking families, Sea Mar developed its Marysville-based residency program in 2015.
In 2022, the accreditation council flagged the program based on annual resident and faculty survey results, according to court documents. Residents rated the program low for patient safety, professionalism and resources.
In February 2023, the council shared the survey results with Sea Mar but overall found the program was in “substantial compliance” with program requirements, according to court documents.
But the next survey results were worse, court documents say, with “very low” scores in multiple categories. More than half of residents said the program was not in compliance with health and safety requirements, while some faculty said they often witnessed abuse, harassment, mistreatment, discrimination or coercion.
The council notified Sea Mar of the survey results last October. At the site visit in February, representatives randomly selected 21 residents for confidential interviews lasting about five minutes each. According to court documents, “several faculty members and almost all residents” said Jimenez, the program director, was “inflexible, harsh, and detached from the program.”
Listed among Sea Mar’s 47 citations, the council found residents only made rounds once or twice a week, meaning they may have guided treatment for patients they’d never met. The program also scheduled all patients for 15-minute visits, regardless of their medical issue. Overworked residents often did not report their hours out of fear of retribution. And some faculty members said they were supervising residents in settings they felt “incompetent” in, according to court papers.
“They feared Dr. Jimenez, and were not comfortable voicing concerns about the program to him, because he had engaged in retribution,” court documents read, “for example by firing the program’s previous coordinator after the coordinator repeatedly raised concerns that the program was out of compliance with ACGME requirements.”
The residents also felt limited in what they could say because two of the program advisors were Jimenez’s brothers, according to court documents.
‘Too little, too late’
Sea Mar appealed the accreditation withdrawal, but the council will not rule on the matter until the end of September. If the council denies the appeal, Sea Mar can reapply for accreditation within two years.
In June, Sea Mar filed a lawsuit against the council, arguing the group made a rash decision based on limited and incorrect information. Sea Mar alleged the council refused to provide documents — including surveys, inspections or other meeting notes — or any detailed explanation about its decision, and has been tight-lipped about the appeals process. Sea Mar also claimed it had reason to believe council representatives destroyed notes from their visit.
“Sea Mar’s administration was granted only a few minutes with the field representatives for discussion,” the lawsuit reads, “with no opportunity to learn of, respond to, or disabuse them of any inaccuracies of their impressions and findings or otherwise address their concerns.”
Sea Mar alleged that because the withdrawal would take effect before the appeal process, and because the council denied Sea Mar proper explanation or a “meaningful opportunity to be heard,” the council violated common-law due process rights, fair procedure, good faith and fair dealing, as well as the Washington Consumer Protection Act.
Sea Mar employees and Dave Robbins, its lawyer with Perkins Coie, declined to comment on the case. The accreditation council also declined to comment. A lawyer with Stoel Rives, the firm representing the council, could not be reached for comment.
The clinic asked a judge to suspend the council’s decision until after the 2024–2025 academic year. Sea Mar argued the accreditation council, responsible for more than 13,000 residency and fellowship programs, has too much power. Since federal and state funding, as well as crucial partnerships, are contingent on accreditation, Sea Mar said the withdrawal would decimate the program.
“Even if Sea Mar prevails in its appeal and the Family Medicine Residency Program’s accreditation is restored by the ACGME board in late September, substantial damage will have already been done, as the program will have effectively and permanently ended on June 30,” the lawsuit reads. “Given the realities of the situation, the appeal ACGME has offered Sea Mar is illusory; at best, it is too little, too late.”
In its opposition, the council claimed working conditions at the residency threatened patient safety.
“Sea Mar’s program—in its current state—is not equipped to provide adequate patient care or resident training,” the council’s opposition read. “Providing substandard medical care and substandard training for residents does not serve the public interest.”
While Sea Mar fights for accreditation, Providence Everett is working with Washington State University’s residency program, Hermanson said.
After a hearing on June 27, a judge denied Sea Mar’s request to suspend the withdrawal. But on July 10, the court granted Sea Mar expedited access to some accreditation council documents deemed necessary for the lawsuit.
On Aug. 5, the council filed a motion to dismiss Sea Mar’s case. Sea Mar’s response is due Aug. 26.
Sydney Jackson: 425-339-3430; sydney.jackson@heraldnet.com; Twitter: @_sydneyajackson.
Talk to us
> Give us your news tips.
> Send us a letter to the editor.
> More Herald contact information.
