The Battle Between Parkland and Dallas News Rages On In Missive From Hospital CEO

Categories: Media, News
Anderson-Big.jpg
Ron Anderson
Last week, Dallas Morning News Deputy Managing Editor Maud Beelman penned a piece for Harvard's Nieman Watchdog in which she explained the paper's yearlong investigation into the University of Texas Southwestern Medical Center and Parkland Memorial Hospital -- two heretofore "sacred cows" in Dallas. Wrote Beelman, both institutions received nothing but positive press for years. "But after receiving a few insider tips and learning of the allegations in a whistleblower lawsuit, the newspaper decided it was time to investigate," she explained. "What we found was a system that for decades had deceived virtually all of its patients, put many at risk and, by the hospital's own estimate, seriously and often needlessly harmed on average two people a day."

A few days later, the paper published its latest installment in the series, which began: "Parkland Memorial Hospital repeatedly violated the rights of people who complained about medical treatment." That's based on a report from the U.S. Centers for Medicare & Medicaid Services, whose inspection of six other patients' records was based on the complaint of another patient that was later determined to be "unsubstantiated."

Parkland president and CEO Ron Anderson can take it no longer: Moments ago, a missive from the doctor hit the Unfair Park in-box, and in it he attempts to fend off the latest story -- by offering a letter to the editor The News refused to run for reasons explained on the other side. Writes Anderson:
Last Sunday, The Dallas Morning News published an article that said Parkland violated the rights of complaining patients. Here are the facts:

Based upon a single patient complaint, CMS came to Parkland in June 2010 for an unscheduled survey as they are required to do. This original complaint was deemed unsubstantiated by CMS. Copies of letters to the patients could not be produced to document that the patients had been contacted within 10 days according to Parkland policy.

Parkland leadership took immediate action to improve this situation for patients. Parkland staff reviewed our policy to ensure its compliance with CMS guidelines. The Patient Relations department, which is responsible for resolving patient issues, is now 100 percent compliant with regulatory guidelines, requirements and our own policies.

The care and safety of our patients is our number one priority. As always, we thank you for your continued commitment to Parkland and its mission.

Clinicians around the country have studied the patient care we provide every day. We want to share with you the thoughts and research of Mark A. Keroack, MD, MPH, the senior vice president and chief medical officer of the University Health System Consortium, an organization representing approximately 90 percent of the nation's non-profit academic medical centers. He provides a clear and compelling argument about the quality of care offered at Parkland. He provided this article to The Dallas Morning News, but they declined to publish it in the newspaper. We think this article contains important information about the high standards of Parkland and the enormous care we take in extending health care to the people of our community.
Now, before we get to Keroack's letter, keep in mind: On December 29, Dallas News Managing Editor George Rodrigue wrote an Ask the Editor in which he explained why the paper refused to publish the missive, which came in response to the paper's November 14 story about Jessie Mae Ned, the former Parkland employee who, wrote Brooks Egerton, was "left a destitute amputee after 24 surgeries in 16 months and $1 million in billings to Medicaid" because of surgery performed by a medical student without proper supervision.

Wrote Rodrigue, "Because Dr. Keroack was unable to share the full details of Parkland's performance, we do not believe that it would be appropriate for us to base a news story on his letter." He also said that the doctor's missive had "become entwined with public-relations efforts at Parkland and UT Southwestern Medical School" intended to show the paper had only told half the story.

With that in mind, here is Keroack's letter, as forwarded by Anderson:
December 10, 2010
Dallas Morning News
To the editor:

Since the publication of the landmark report "To Err is Human" by the national Institute of Medicine, the American healthcare system has focused on improving patient safety. Policymakers, patient advocates and journalists have joined healthcare professionals in shining the bright spotlight on this issue. It is a problem we all take very seriously.

Complications of care are an unfortunate reality at all major medical centers, and statistics provide small comfort to an individual patient who has experienced such an event. However, it is important to keep a single tragic event in perspective. The best hospitals achieve low rates of these complications and have systems and processes in place to achieve continuous improvement. Based on data the University HealthSystem Consortium collects from 110 major academic medical centers across the country, as well as years of working with their quality and safety professionals, I know Parkland to be one of these hospitals.

The recent series of articles in The Dallas Morning News overlooked the broad-based superior performance of Parkland in standard measures of quality and safety, as well as their significant accomplishments in innovating to improve quality and safety. Furthermore, the culture of open reporting required to make improvements in patient safety risks being damped by a public airing of every adverse event.

Consider the following facts not mentioned in the stories:

- In a comprehensive annual ranking of quality and safety across all patient types, including measures of safety, mortality, effectiveness, patient centeredness and disparities of care, Parkland ranked in the top third of 98 university hospitals across the country in 2010 and was the second highest performing safety net hospital.

- Among over 100 university hospitals submitting data to UHC from across the country, including the majority of those on the US News Honor roll, Parkland ranks at or above the top quartile in outcomes related to cardiology, cardiac surgery, medical and surgical oncology, neurosurgery, trauma care and overall surgical care.

- Parkland achieved low rates of post-operative complications relative to a comparison group of 15 large academic public hospitals performing more than 100 total knee joint replacements over the last year.

Parkland also has an active and effective quality and safety program, whose innovations have been highlighted in our collaborative quality improvement projects and annual meetings. These include successful projects to recognize patients whose condition is deteriorating, to reduce emergency room waiting times and to reduce unplanned readmissions.

Parkland's use of UHC's patient safety reporting system referenced in the articles was highlighted at our annual quality and safety meeting this past fall, attended by representatives of 93 university hospitals. The safety team at Parkland showed outstanding results in acting on safety reports to make systematic improvements. At the time of their presentation, they had gone 69 days without a serious safety event as defined by the National Quality Forum.

The picture we at UHC hold of Parkland, based on extensive data and years of collaborative work, is of an organization achieving superior results and committed to continuous improvement in the care of some of the most challenging patients in the nation.

Can America's healthcare system do better? Yes it can. And the road to improvement will be to follow the lead of hospitals like Parkland.

Sincerely yours,
Mark A. Keroack, MD,

Mark A. Keroack, MD, MPH is Senior Vice President and Chief Medical Officer of University HealthSystem Consortium, an alliance of 112 major academic medical centers and 254 of their affiliated hospitals representing more than 90 percent of the nation's non-profit academic medical centers.

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8 comments
BC
BC

Hey Keroack - do you think Jessie Mae Ned, who is now an amputee and broke due to the incompetence of your hospital staff - feels mcuh better about her situation now that she has read your public relations B.S.?

See one, do one, kill one
See one, do one, kill one

This is not news. The DMN already published Mr. Keroack’s missive (which should be “DISmissed” for being incomplete, one-sided, and not transparent) in their Ask the Editor article (in bold print.) (See http://www.dallasnews.com/shar.... That letter reeks of cronyism and conflicts of interests. The DMN managing editor, George Rodrigue, already dealt with these issues very openly, honestly, and effectively with very compelling arguments.

And this new investigation by the feds only reinforces what everyone already knows, especially patients that go to Parkland. (See http://www.dallasnews.com/shar.... There is a pervasive attitude there of neglect, lack of respect, indignity, arrogance, incompetence, and out right contempt for patients and their concerns in that hospital. Those randomly small sampled cases showed that Parkland had ZERO-compliance in even listening to patients’ complaints, as required by federal rules and guidelines.

They only acted now to comply with the law because they were caught by CMS and exposed by the DMN. That’s the only to get Parkland and UTSW to comply with the law—threaten them with fines, penalties, lawsuits, and expose their violations to the public. That’s why we need the press as a watchdog because Parkland can’t be trusted to do what’s right on their own accord.

Daretocare
Daretocare

Clearly a case of more cover-ups!

The UHC will always be biased, fearing to bite the hands that feed. That's understandable - - and should be definitively pointed out so individuals who read UHC statements will more fully understand the source and reason for the bias (and, thus, evaluate their writings appropriately).

Parkland, this "protected" institution, seems to go on and on - - its leaders just get larger obscene bonuses and the much-needed reckoning keeps getting overlooked by both the city leaders and the feds.

Be assured, the citizens of Dallas continue to depend on entities like the Dallas Morning News to strive for, and uncover, the truth.

Thank you for your efforts in reporting the great that UT Southwestern and Parkland do - - and thank you even more for working just as diligently to show us the opposite side of these institutions.

Perhaps, if enough daylight is shedded on the improprieties - - those who can make things better finally will do so!

The Parkland Stooges
The Parkland Stooges

Here is a repost of another blogger’s comments from the DMN on 1/4/11 on the missive written by UHC’s Dr. Mark Keroak:

6:11 PM on January 4, 2011

I think it’s clear why Dr. Keroack and the UHC were reluctant to release the data they have compiled about Parkland Hospital to the DMN. We all know they have the data in question; however, we also know that the UHC has a cozy relationship with Parkland that raises some suspicions about Dr. Keroack’s ulterior motives in writing such a disingenuously glowing and highly defensive letter on behalf of Parkland Hospital.

Parkland Hospital and other hospitals like it financially support the UHC. The UHC [and Dr. Keroak] is therefore not an independent and unbiased source that the public can trust at its word. Parkland’s President and CEO, Ron Anderson, also sits on the Board of the UHC. Clearly, this questionable relationship points to serious conflicts of interests for Dr. Keroack to be open, honest, and transparent about his motives in writing a letter on behalf of Parkland and releasing a one-sided report of only “selected and hand-picked” data about Parkland’s safety record and performance measures. Anyone who is reasonable and rational can see through this guise as a serious affront to objectivity and transparency and an insult to one’s intelligence.

If anything, the reluctance to be open, honest, and transparent about Parkland’s safety and performance data shows UHC, Parkland, and UTSW have, if anything, something seriously damaging to hide from the public. Obviously, it has data to support the claims that Parkland is underperforming in many critical area which Parkland and UHC themselves deem to be harmful and damaging to their reputation of Parkland and UTSW if that data were disclosed to the public. This, therefore, only demonstrates an inherent dishonesty, lack of trustworthiness, and lack of transparency by the UHC and Parkland to address serious concerns over their own safety records.

I strongly disagree with Parkland about one key point about this public institution’s responsibility to the public, and that’s honesty. This inability and deliberate unwillingness to be open and transparent about its patient health care operations by sharing even the most basic data about its patient safety record and performance measures with the public will more swiftly bring about Parkland’s and UTSW’s demise than anything that their critics can argue on their own. The cat’s already out of the bag about the lack of patient safety at Parkland, so what is preventing the UHC and these so called “trusted” public, tax-payer funded institutions from coming clean about even the most basic patient data? That kind of honesty and openness at this point can only help the beleaguered institution in regaining some of the public’s trust that they have so pitifully whittled away.

This reluctance to be open and transparent about their governmental mandated reporting of its public affairs again poses the same question in the public’s mind: What ELSE are you really hiding that you don’t want the public to know, Parkland and UTSW?

The Parkland Stooges
The Parkland Stooges

Dear Mr. Wilonsky,

Although we appreciate the efforts you have made to report Ron Anderson’s side of the story, there is much distortion in his less than honest and completely untransparent statements that I want to address. I am one of the many key informants at Parkland and UTSW who has personal knowledge of the improprieties going on there, and if you want, I can discuss the evidence I have and the charges, for years, that many of us at Parkland and UTSW, have levied against Parkland and UTSW for gross negligence, incompetence, corruption, and serious patient endangerment. I think you as a reporter have to know the complete picture with all the available evidence to report fairly and accurately on this growing scandal. I hope that will help you in your efforts to get to the truth in subsequent articles.

Now, although the original complaint to the CMS was later determined to be “unsubstantiated”, the subsequent small randomly sampled complaints (6 of them) that the CMS looked into from the original complaint were far worse than the original complaint and revealed substantial violations of federal law. In just a small sampling of 6 cases from the CMS investigation, Parkland had zero-compliance with federal regulations and guidelines, which suggests that virtually all of Parkland patients’ complaints were going unheard, possibly for decades.

And it’s not just within the required 10 days that Parkland didn’t respond. According to Parkland spokeswoman, April Foran, Parkland had no proof that they ever wrote back to the patients in question. She embarrassingly admitted in her own words: “We couldn’t produce the letter.”

They show patients’ complaints who alleged that Parkland discharge them home “with needles in her arm” (possibly a peripheral IV catheter, which is far worse to go home with than a needle) and performed “experimental procedures on her without consent”, a pregnant patient who was given 2 doses of a swine flu shot who was seriously concerned about the safety of her pregnancy afterward, another patient who was given a medication that possibly caused a heart attack, no interpreter provided for a tubal ligation in obtaining informed consent from a patient (therefore an improper consent again by Parkland, leaving this patient in the dark about what they would do to her), inadequate treatment of pain and vomiting in another patient after repeated readmissions to Parkland, and a patient on life support who was urged to have his life support pulled against the wishes of the mother in order to “save money.” All these cases need to be investigated by the Texas Medical Board because the improprieties all suggest gross negligence and substantial violations of patients’ rights.

Clearly, the statements made by Ron Anderson stating: “Parkland leadership took immediate action to improve this situation for patients,” is disingenuous. They only took action after they were cited by CMS and the DMN found out about the investigation. They did nothing but ignore their patients’ complaints for decades. They wouldn’t care to do a thing to address any of their patients’ concerns until they were caught red-handed by the CMS and the DMN. To state that: “The Patient Relations department, which is responsible for resolving patient issues, is now 100 percent compliant with regulatory guidelines, requirements and our own policies,” is absurd because (as the CMS report suggests) they were ZERO percent compliant before this was revealed to the public.

As the CMS stated to Parkland: "The deficiencies are so serious that they constitute an immediate threat to the health and safety of any individual who comes to your hospital with an emergency medical condition." There is nothing to show that this statement has changed at all since, week after week, more and more improprieties are being revealed to the public. Let’s find out the whole truth about Parkland and UTSW.

GWC145
GWC145

The Morning News made up its mind about Parkland and UT Southwestern some time ago. Since then it has systematically excluded anything that counters their view and puts a roadblock on their way to what they hope is another Pulitzer Prize. For their part, Parkland and UT Southwestern have failed to utilize the resources they had in place to defend themselves. The cost to taxpayers of the Dallas Morning News witch hunt has been astounding.

Dallas Diner
Dallas Diner

So, what piece of property does Parkland own that it refused to sell and that Belo wants to buy?

Carolyn Strom Lindeman
Carolyn Strom Lindeman

One of the few truly independent, unemotional and balanced things I've read about the issue. Thank you.

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