Tuesday, February 07, 2012

Digging one's self into a Texas-sized hole

It has been some time since I have provided an update about the sad situation at Parkland Memorial Hospital in Dallas.  You may recall that after a hospital-wide inspection last summer, CMS issued a decision that Parkland no longer qualified for Medicare funding.  To stay open, an understanding was reached that the hospital would engage an external consultant to conduct an objective safety review.

As reported in the Dallas Morning News:

Parkland spent nearly $7 million hiring New York-based Alvarez & Marsal Healthcare Industry Group.

Parkland’s interim chief executive, Dr. Thomas Royer, said last month that the monitors’ report would be released. “After CMS approves the report, it will become public,” he wrote in the Jan. 23 issue of Parkland Now, an employee newsletter.

But the News reported today that the hospital's board has voted to keep the report under wraps, "citing a fear that it could be used against the embattled public facility in court."

I don't know what legal challenges might come out of the issuance of such a report.  Anybody who is pursuing a malpractice case already has full discovery rights to clinically relevant information, and I am guessing this report would be highly likely to be deemed "clinically relevant" by a judge.

Is the board worried that issuance of the report might prompt new malpractice case?  Given all of the adverse publicity to date, it is easy to imagine that the malpractice plaintiff bar has already scoured the city for likely cases.

The board's lawyer is quoted by the News as saying that it was his job “to make sure that we protect the institution, protect the taxpayers of Dallas, protect our patients by protecting our resources.”  Well, I guess so, but that horse seems already to have left the barn.  The only way to protect those three parties at this point is to be fully transparent with regard to the hospital's problems.  How else might you enable the doctors, nurses, and other staff to have the advantage of the consultant's report, to evaluate it and to use its most helpful conclusions to help direct future process improvement efforts?  If the report stays in the closet, the money paid for it will truly have been wasted.  Who is protected then?


Anonymous said...

Somewhere along the line, many hospitals have forgotten that lawyers are supposed to give advice - rather than make the decisions. We were told we could not include our central line checklists in the medical record for similar reasons. This was because someone might indicate on the checklist that the appropriate procedure was not followed. Obviously, the problem here is not the documentation but the fact that we still have a problem with performing the procedure appropriately.

Anonymous said...

What a ridiculous decision. Send them the case study of your experience at BIDMC.......

Anonymous said...

There is nothing like secret documents hidden behind lawyers to bring back confidence in the leadership and direction of an institution.

How embarrassing for the staff.

Andre Storey said...

It is interesting that Dr. Royer, the person you have brought in to try and make changes from the way business was done before his tenure was overruled regarding the release of this document. I understand the theory behind the lawyers judgment but as Jim Collins says, "You have to confront the brutal facts."