Thursday, July 25, 2013

Hospital slumlord

Miles Moffeit @milesmoffeit in the Dallas Morning News has published an astounding story about a doctor who operated a chain of dangerous Texas hospitals for the last four years despite repeated warnings he was engaging in fraud and putting patients at risk.  Here's the lede:

The physician swept into Terrell as a savior, rescuing its only hospital from bankruptcy. It was the summer of 2008, and Dr. Tariq Mahmood, a specialist in buying financially ailing hospitals, maneuvered swiftly to lay down the favored bid. Not everyone was swooning, however. As Mahmood took over Renaissance Hospital Terrell, employees grew alarmed by his practices. At least one hospital official alerted authorities. But her complaints went nowhere. It took regulators more than four years to rein in Mahmood. Before they acted, he allegedly submitted more than $1 million in fraudulent billings to the government, and substandard care at his chain of small-town Texas hospitals led to multiple patient deaths.

It is not that things went unnoticed:

In those initial days at Renaissance Terrell, patient quality director Edwina Henry says, she witnessed several threats to patient safety. Physicians whose backgrounds had not been vetted were treating patients. An ER doctor forced to work 24-hour shifts kept falling asleep. Unsupervised nurses retrieved patient medications from the unattended pharmacy. Henry also watched Mahmood thumbing through other doctors’ patient charts and writing in them — making what she feared were fraudulent entries aimed at boosting insurance billing revenue, she said. “He was adding conditions to the patients’ charts — things that were supposedly wrong with them,” Henry said. “He wrote whatever he pleased.” Henry secretly alerted authorities to the potential fraud and to the safety threats. But her warnings generated no effective response. 

I'll leave the rest for you to read. To provide an tease, I include Miles' final listing of issues in these hospitals:

AT A GLANCE: Four years of trouble
Since 2008, Dr. Tariq Mahmood’s hospital chain has regularly run afoul of dozens of regulations.
Summer 2008: Mahmood takes control of bankrupt Renaissance Hospital Terrell. The patient quality director alerts health care regulators and criminal investigative agencies to potential billing fraud and patient safety threats. No agency follows up with her.
April 2009: Regulators with the U.S. Centers for Medicare & Medicaid Services and the state health department cite Renaissance for turning away patients, an alleged violation of the federal Emergency Medical Treatment and Active Labor Act, or EMTALA. That month, authorities cite Lake Whitney Medical Center for the same problems.
July 2009: Regulators again hit Lake Whitney with an EMTALA violation.
December 2009: Regulators cite Shelby Regional Medical Center for violating EMTALA.
January 2010: Inspectors find rusty “over-the-bed tables” in patient rooms at Lake Whitney and other substandard building conditions that put patients at risk.
February 2010: Regulators cite Renaissance again with an EMTALA violation.
July 2010: At Cozby-Germany Hospital, inspectors flag failures to vet credentials of doctors and nurses. Over the next three years, several of Mahmood’s hospitals are repeatedly cited for similar violations.
September 2011: At Renaissance, inspectors document that a bungled blood transfusion procedure was performed without supervision of a registered nurse.
October 2011: At Shelby, inspectors document broken air conditioning and failures to prevent ceiling plaster from falling into the patient food service line.
June 2012: The Texas secretary of state revokes Renaissance’s business charter for failure to pay taxes.
September 2012: The state health department notifies Renaissance that it is proposing a $35,050 fine for 13 care violations such as nursing supervision failures dating as far back as 2010.
December 2012: As surveyors inspect Shelby, the power goes off to the complex’s buildings, except for the main hospital. The electric bill and other debts amounting to nearly $200,000 haven’t been paid, they report.
January 2013: Inspectors respond to complaints at Renaissance and document three ER patient deaths they say resulted from nursing supervision breakdowns.
February 2013: The state health department is in the process of revoking Renaissance’s operating license. The Centers for Medicare & Medicaid Services terminates funding to Renaissance. It takes local governments to force the immediate closure of the hospital because of unpaid taxes.
July 2013: CMS moves to terminate Shelby’s funding following the death of an ER patient. The death is blamed on nurses’ inability to get the ER doctor to leave the “sleep room.”


akhan13 said...

I would be interested in the details on the regulatory side here. What restrained regulators in the face of clear violations? Were there unnecessary legal limits to their authority to act or to gather sufficient evidence? Was there political pressure to refrain due to any relationships between Mahmood and local officials? Or is this just pure bureaucratic malaise resulting in unthinkable (but all too common) consequences?

Linda Galindo said...

An "astounding" story? As you continue to point out, healthcare is critically ill. What went on in this situation is disgusting but it fails to astound me. A sad commentary in and of itself. The massive, dare I say "too big to fail" healthcare monster with all its tentacles continues to hide behind complexity. Healthcare is tedious for sure, but to give up its complexity of charting, coding, billing, specializing, monetizing, regulating, mandating, human capital management systems and bureaucratizing you would have to insert personal accountability at the top. The whistle blowers did not and still do not stand a chance. My current weapon of choice to combat and potentially prevent bad things from happening if and when I or a family member have to go into any healthcare facility for treatment is a pen and notebook. Write everything down. Names, dates, who told you what and how much they said it would cost. If you are afraid to do it, ask someone to go with you. Change in healthcare is not going to happen from the inside out.

David Joyce MD said...

So you have a hero quality administrator blowing the whistle and then list several incidents. So where are the quality metrics that tell the real story. What was the quality administrator doing? Were there quality metrics and what were those numbers and how did they compare to benchmarks. Sounds like a non-quality administrator to me.

Richard said...

Paul – I agree with Linda Galindo’s comment, this is not an astounding story. Reprehensible, for sure. Preventable, absolutely! Terribly sad, as much for the lives lost, as for the fact that people knew and nothing was done, which is tantamount to reward. But not really that "astounding". While I don’t see our healthcare system fixing itself, it won’t be because it’s complicated, it will be because the fix is difficult. The fix is culture, culture is people, we are by definition the problem, and the solution.

It’s time to be leading with more clarity, more personal accountability and zero tolerance for consistent failure to deliver on expectations, from the board to the bedside. The hospital CEO’s that I meet, that run the safe, patient centered hospitals where I want to receive care are leading with clear expectations, they coach and retain their high performers, they manage and exit the low performers, and they are open to feedback and focused on data-driven outcomes, not history.

Anonymous said...

Yes, after seeing the horrible care my brother got in his last stay in a Tenet-owned hospital before he died (and where we could not get him decent care no matter how hard we tried), I don't find this at all astounding. It's really frightening, but it's not astounding.