Monday, August 29, 2011

What's going on at Parkland Memorial Hospital?

A series of stories at the Dallas Morning News raised some serious questions about the quality of care at Parkland Memorial Hospital.  I draw no judgments about those issues.  But what comes across in these stories is something equally interesting:  A hospital that has chosen to take a hard line, dare I say stonewall, with the local press on issues of community concern.  In an era of increasing transparency, this approach is an anachronism.

Those of us a certain generation remember Parkland Memorial as the site of President Kennedy's trauma treatment and death in 1963, providing it an important symbol of high level care in our national consciousness.  But it is also a major teaching facility of the UT Southwestern Medical Center and is prominent in its own right for many reasons.

When a hospital with this kind of affection and reputation faces difficulties in the delivery of care, there are two possible approaches.  One is to be open and transparent about the nature of the problems, their causes, and the solutions being tried.  That approach is consistent with the high level of trust granted by the community.  The other approach is to hunker down and draw on powerful interests in the community to put pressure on journalists to back off from the story.  That may work for a while, but eventually fails, with an even greater loss of trust that would have been thought possible at the start.

It looks like Parkland has engaged in the latter kind of campaign.  The phases are disturbingly familiar.  After some highly visible cases, including stories of a patient care system heavily dependent on residents who sometimes work with little or no faculty supervision, federal regulators warned that failures in care at Parkland Memorial Hospital posed “an immediate and serious threat to patient health and safety,” and ordered it to submit a plan to remedy the problems within two weeks or lose federal funding.  The hospital administration described the report "as a collection of mainly 'technical violations.'"(Full story here.)

Meanwhile, conflicting explanations to the press emerge.  Here is an excerpt on a medical student issue:

Newly obtained records contradict UT Southwestern Medical Center's claims about unlicensed med students who were paid to work in Parkland Memorial Hospital's psychiatric ER -- and why the 30-year cost-saving practice ended this summer.

UTSW spokesman Tim Doke previously told me that the students were "administrative assistants" who "do absolutely no clinical, patient-care work" and had no formal job description. He also insisted I was misinterpreting a 2009 letter from four UTSW psychiatry professors that repeatedly called the students "clinicians" and never "administrative assistants."

But now a Texas Public Information Act request, filed right after we brought the unusual employment practice to light in June, has forced UTSW to release the students' job description. It says the students "provide experienced help" in Parkland's psychiatric ER -- they obtain the patient's history, perform a "brief neurologic exam" and "periodically assess patients."
Think about this.  The press was forced to file a freedom on information request to obtain job descriptions of students.  In fact, the hospital sued the Attorney General to challenge rulings that required this and other kinds of information to be provided. This is clearly a situation that has spun out of control.

Prominent members of the community have publicly come to the defense of the hospital.  Staff from UT Southwestern Medical Center asserted that the newspaper has a "vendetta" against the school and its teaching partner, Parkland.  Also, the hospital has retaliated against the newspaper by removing its advertisements. This is the kind of nasty local politics that eventually backfires.

I don't know where this is all headed, but given Parkland Memorial's place in the country's consciousness, the next stage has to be the national media.  What a shame that the hospital's return to the national scene will be about these kinds of issues.  Wouldn't it be marvelous if it adopted a truly transparent approach to the problems and instead became a national example of that philosophy?


Anonymous said...

Mr. Levy, you are so ahead of your time. Everyone knows that transparency is the key to quality health care. UT Southwestern and Parkland are like death traps. They insist that anyone who gives out any information is a detriment to the system and should be fired.

Paul Levy said...

I have allowed this comment -- even though I believe that such nasty aspersions about clinical care ANYWHERE are overstated, inaccurate, and unfair -- because I have now heard from several sources that people are being threatened with being fired for saying negative things about the hospital. Perhaps someone can confirm or deny that, providing some substantive backup.

That people believe such disciplinary actions would be the case, even if not true, is an unfortunate side effect of the kind of approach I discuss in my post.

In any event, please do not submit more comments about clinical matters here. Those are not the point of this blog post, and they would too complicated to evaluate in this kind of forum. Those issues require prudent and careful peer review, not offhand characterizations.

Anonymous said...

I preface this comment with the caveat that I have not read the allegations. However, having worked in a hospital which, over 10 years ago, was the subject of a similar threat from Medicare and much adverse publicity in the press, I can attest that any and all attempts to suppress information inevitably backfire in a way 10x worse.
Yes, sometimes allegations are exaggerated. Yes, the threat of being excluded from Medicare is a standard threat given to all hospitals in which these problems are found (although 2 weeks is a short time frame for a response and is a better indication of the perceived severity). Yes, yes, yes.
But - my hospital is still trying to live down that publicity 10 years later, despite a fairly sterling record since. It behooves Parkland to get the entire story out there for everyone to see, so there are no more rumors. Anything less, and certainly any of the reported behavior, will reverberate for years to come. It is a shame.

nonlocal MD

Anonymous said...

Dear Mr. Levy,

The death trap comment referred to the careers of employees, not to clinical care. Sorry for not being clear on that.

Both Parkland and UT Southwestern recently agreed to sign a settlement with the U.S. Attorneys Office, Medicare Fraud Division, and with the Texas Attorney Generals Medicaid Fraud Division.

The doctors who brought this to light have all been retaliated against, including falsified charges of incompetence. The Parkland Peer-Review Committee decided to break its confidentiality barrier to inform the maligned that the Chairman of the Department of Surgery and the Hospital's in-house attorney brought spurious charges that were referred to as, "an obvious attempt to abuse the peer-review process for malignant purposes."

They wrote an expository letter that was censored by hospital leaders that they wouldn't name, but referred to as, "the powers that be."

Quite a bit of this is in the public record as part of whistleblower lawsuits that Parkland and the University spend more than 10% of their annual profits to defend. They have lost twice in local criminal court (not including an additional lost Contempt of Court charge), twice in the Texas State Court of Appeals, twice in the Texas State Supreme Court, and are currently awaiting a date for oral arguments for their third appearance in front of the Texas Supreme Court.

It's all in the public record. Their argument is basically that they can retaliate against whistleblowers because as a state entity, they "enjoy sovereign immunity."

There are a few other technicalities in their various appeals, but even their chief of Billing Compliance turned them in to CMS for Billing fraud when he wasn't allowed to stop the practice of residents operating without supervision.

Anonymous said...

Dear Mr. Levy,
You asked for some evidence of proof. The Dallas Morning News is the only paper left in the metroplex, the 8th largest city in the world. They are deeply in the red after enlisting the city's leaders to boycott the paper. The paper has published over 75 articles as part of its investigative journalism series into Parkland and UT Southwestern. In every case where applicable, they have posted the source material on line, freely perusable on their website for all to see.

You can see all of the proof you need on the News website:

Nevertheless, this Dallas style has put the remaining city newspaper in jeopardy (note, I have no affiliation with the news. The financial jeopardy as a result of Parkland and UT Southwestern's press censorship attempts have been publicly reported.

Anonymous said...

The Harvard School of Journalism covered the media censorship currently being carried out by Parkland and by UT Southwestern in their January, 2011 issue. There are many "hard facts" here that prove the assertions to be true.

Gail Myers said...

Just had to comment - President Kennedy's death was in 1963 - Nov. 22. How soon they forget...

Paul Levy said...

I remember the day, the hour, and the minute, but blew the year! Thanks, Gail.

Paul Levy said...

Fixed now, thanks!

Anonymous said...

The strained relationship between the hospital and the media is very sad, but both sides share responsibility for it. Neither side trusts the other, and without that, there can be no transparency. All of the reasons the Dallas Morning News distrusts Parkland are well described above. On the flip side, consider this: responses from Parkland/UTSW are buried in an "Ask the Editor" section of the paper which is difficult to find online while the negative articles are prominently displayed in a special section, Parkland has invited the news team to come to the hospital to observe firsthand what things are like but they have declined, they have selectively taken quotes out of context from hospitalwide memos and completely distorted their meaning. Some of their criticism is quite legitimate, while others are completely blown out of proportion. Whether this is intentional or due to lack of information, I have no idea. With neither side trusting the other, both become more biased against and dismissive towards the other and reluctant to communicate, and the cycle continues in a downward spiral, and the whole community loses.

I think the press is one of the most important components of a free society, and I would love to see thoughtful reporting on the state of healthcare for the indigent, mentally ill, undocumented, and disenfranchised in our community - which included but was not limited to a critical appraisal of Parkland's services - along the lines of the DMN's own Kim Horner's award winning series on homelessness and mental illness. Unfortunately, that is not the kind of reporting going on here.

e-Patient Dave said...

For those who, like me, are just catching up on this post-vacation, here are links from this starter post to two subsequent ones.

9/1: Parkland's response a senior hospital official says "Think about the negative consequences of someone who needs care holding back instead of going to Parkland"!

Boy, is that a great example of chutzpah!

9/9: News that CMS is planning to disqualify Parkland because of "deficiencies that represent an immediate and serious threat to patient health and safety"; the hospital may accept outside systems improvement consultants.