Saturday, May 18, 2013

When public values compete

An intriguing story has developed in Kentucky.  Several months ago, the UK's Kentucky Children's Hospital announced that it had suspended its pediatric cardiothoracic program, pending an internal review.

Read more here:
A local public radio reporter from WUKY-FM (which is owned by UK) filed a freedom-of-information request asking for:

1. The number of surgeries Dr. Mark Plunkett, chief of cardiothoracic surgery, performed in the previous three years.
2. The date of Plunkett's last surgery.
3. Payments received for surgeries performed by Plunkett in 2010 and 2011.
4. The mortality rate of pediatric cardiothoracic surgery cases in the previous three years.
5. Documentation related to any evaluations/accreditations of the program in those three years.

She did not request the names of, or any other identifying information about, the patients. UK answered questions 1 and 3 but declined on the rest, citing patient confidentiality. UK said Plunkett performed so few surgeries that it might be possible to identify individual patients.

The reporter appealed to the state's Attorney General, who ruled in her favor.  The University has now appealed that ruling in state court.  UK's general counsel said:

The open records requests impact three competing values — the right of the public to know what transpires at a public institution, the right of individual patients to privacy and the obligation of the health-care providers to engage in critical self-examination so as to improve patient quality and safety.

Read more here:

Read more here:
The University is taking some heat in the matter from a local newspaper:

In a really sad day for both open inquiry and freedom of information, the University of Kentucky last week sued a reporter for its public radio station.

If UK is trying to manage its image, it has made a huge blunder.

Stonewalling on this request only makes it appear that the university is more interested in keeping under wraps whatever has gone wrong in Plunkett's department rather than protecting the confidentiality of its patients — living or dead. 

When the story began back in December, questions were raised.  The radio station reported:

Kentucky Children’s Hospital treats some of the sickest and smallest patients from across central and eastern Kentucky. But for the past several weeks, pediatric heart surgeries have been referred to other hospitals. ...UK Healthcare is reviewing its program, but the reasons why are unclear.

UK Healthcare officials have not identified what prompted the review, but they say it is limited to the pediatric cardiothoracic surgery program, not any other pediatric areas or the adult heart program. “We’re looking at what can we do best and how do we best deliver the services and the care that kids need,” said Dr. Carmel Wallace, Chair of UK's Department of Pediatrics.

UK’s head of surgery, the chief medical officer, and Dr. Michael Karpf, the Executive Vice President for Health Affairs, all would not comment for this story.  Dr. Mark Plunkett, the surgeon at the center of the review, also declined to be interviewed.

One of the trustees said that he thought UK should consolidate its pediatric heart program with the University of Louisville because of high operational costs.

So are there economic reasons?  Are there reasons related to sustaining a high quality clinical environment?

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UK's position is understandable if we take as a given the hospital's obligation to preserve patient confidentiality under HIPAA and also the need to protect the peer review process as applied to clinical decision-making.

But it is giving the impression of stonewalling by not explaining much about the reason for the program's suspension. That kind of image is usually not good for a public institution.

I wonder if there is a middle ground that might be negotiated here between the university and itself.

Read more here:


Neville Sarkari MD, FACP said...

As a UK Medical School/Residency graduate, I am sad to see this story. I hope they move toward more transparency soon.

a concerned momma said...

My 6 1/2 month old son passed away at UK, he had two opened heart surgeries done, and to read this and knowing they can't give us that peace of mind, and and tell us they're reasoning for closing this program, just runs all over me. What are they hiding?!?!

Granny Jayne said...

I am so sorry for your loss of your precious son. My granddaughter had her two surgeries by Dr Mark Plunkett and his associate. She was born a very sick baby and it was touch and go for quite sometime. We lived minute by minute and hour by hour sometimes. I lived at the hospital for about a month the last time and never left her side, except to go to the bathroom. Dr Mark Plunkett is an excellent physican that tried to help many critically ill babies hope. Even with all we know today in Medicine, at the end of the day we will never have all the answers. Medicine is not an exact science. For example, women don't surive open heart surgery as well as men.In babies, little boy's don't do as well as little girl's. I did a lot of research and return to college myself in search of answers as to why my Mom didn't make it. Each person's reasons are as unique as their personality. My mother had open heart surgery and never"came off the table", which means she had the surgery but her heart couldn't function even after repairs. Mom's surgeon a very good doctor was haunted by the fact that she didn't make it even though her odds were good. However,my Mom didn't want to be alive anymore. She couldn't deal with the illness or the fear of the unknown and the pain. She had been depressed for years and Marched to the beat of her own drum.She chose her own destiny by not taking care of herself and working with the doctors.Lastly,I don't believe hiding behind anything except that this program is very expensive and dealing with babies this critically ill there will be losses of our precious lil one's. Perhaps U.K just isn't ready to be the leader it should be.