The coming split of North County’s Graybill and Palomar Health medical groups will force about 45,000 patients to make a decision: Follow their doctors to different medical offices or stay put and be seen by someone new.

This conundrum is prompted by Graybill, a respected provider of primary care since 1932, notifying Palomar in August that it would terminate a management services agreement with the public health care district, citing “inadequate support and response to the aftermath of the May 2024 cyber attack directed against Palomar Health Medical Group.”

The attack shut down both organization’s computer systems, including digital phone services, making electronic medical records inaccessible for months and forcing staff to document everything from appointments to prescriptions with pen and paper.

“The breach and the inability to have all critical functions restored has hindered our group’s ability to deliver essential medical services to our patients,” said Dr. Kelly Boyatt, a Graybill family medicine specialist in a statement issued by the organization.

The two sides disagree on the extent to which the aftermath of the data incursion was resolved, with Graybill saying “critical functions (are) still not fully restored,” and Palomar saying that “operations have been fully and safely restored.”

Palomar Health responded in its own statement late Wednesday afternoon, denying sole responsibility for the response to the data breach incident.

“Graybill attempts to distance itself from the consequences of the data security incident, despite one of Graybill’s key leaders serving as the Chief Medical Information Officer of Palomar Health Medical Group,” the statement said.

Dr. Vanessa Peters, Graybill’s chief physician officer, said the organization has tried to keep the split amicable. Graybill’s 100 doctors and affiliated medical providers, she said, will continue to refer patients to Palomar specialists and hospitals in Escondido and Poway.

But those assurances apparently were not enough.

“They notified us on September 10 with a memo to all employees and Graybill providers that Graybill was terminating (and) therefore needed to be out of the building on November 11,” Peters said.

The group currently operates medical offices on Second Avenue and El Norte Parkway in Escondido, Fallbrook, Vista, Murietta, Oceanside, San Marcos, Temecula and Valley Center.

All but two of Graybill’s nine sites are affected, Peters said. Locations in Vista and Oceanside will not have to move. Overall, the group estimates that somewhere between 91 percent and 93 percent of its 50,000 patients will have to follow their existing doctors to new locations, though it is clear that Palomar is offering a second option.

Palomar took exception to Graybill’s characterization of the situation as an “eviction,” indicating that physicians can choose to stay in their current buildings as part of Palomar Health Medical Group if they wish.

“We are offering every physician the opportunity to stay and continue practicing with PHMG,” said Russ Riehl, the Palomar group’s interim chief executive officer. “There has been no eviction of any doctors, and we remain hopeful that those considering leaving will reach out to explore how they can continue working together with us.”

Palomar’s statement adds that “many Graybill doctors have reached out to discuss staying with PHMG to ensure continued and seamless care.”

But Peters called that statement untrue, stating that only six specialists that are members of Graybill made such overtures to Palomar. She also stood by calling the situation an eviction, providing a copy of the Sept. 10 all-hands memo which states that Graybill members “will cease providing services at those locations on November 10, 2024,” adding that Palomar providers “will begin seeing patients at those locations commencing on November 11, 2024.”

How did the situation come to the point where Graybill finds itself being forced to vacate so many buildings, some of which it has occupied for decades? Peters said that the organization transferred its long-term leases to Palomar when the groups agreed to partner in 2020.

“Typically in a transaction where parties are separating, a commercial lease will be assigned back to the departing party in an amicable fashion, and that was what we anticipated occurring,” Peters said, adding that Graybill doctors are now searching for new locations.

Eric Goldy, a Valley Center resident who soldiered through the months-long cyber attack in order to have a previously-scheduled minor surgery, said Wednesday that he knows how he will make his decision. He has, he said, been with Graybill since before the Palomar merger, and does not see that changing anytime soon.

“I’ve already followed my guy to at least three different buildings (or) locations as Graybill expanded so, no question, I’m much more attached to my guy than my building,” Goldy said. “He’s been by doctor for probably 20 plus years now; he knows more about my health than my wife.

“I’m sticking with him.”