Dallas: UT Southwestern faculty let unsupervised resident doctors operate at Parkland

[rainbow4321]

http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/080110dnprosupervisionmain.2914f7a.html


UT Southwestern and Parkland deny that they have put the training needs of their residents ahead of care for their patients. Such accusations, they say, originate with one demoted faculty surgeon who has sued to get his job back. But The Dallas Morning News found at least a dozen other doctors and staff who also expressed concerns about resident supervision and patient care internally over the years. So did independent consultants hired by Dallas County commissioners to study Parkland.

(snip)

But the institutions refused repeated requests to release statistics on resident performance and patient outcome. "We want it dealt with among peers," said Dr. Ron Anderson, Parkland's chief executive.

Nonetheless, The News obtained information on patient death rates at Parkland, where residents serve as "house staff." Data that compare teaching hospitals across the country show that Parkland's performance is average. In some key measures of patient mortality, however, data show the hospital was near the bottom of its peer ranking



(snip)
The two taxpayer-funded institutions also could face millions of dollars in fines, if federal investigators probing allegations of Medicare fraud conclude that the government was falsely billed for services, such as resident supervision, that faculty physicians did not actually provide. An inquiry into similar allegations several years ago identified overcharges, but stalled in 2002 because of a U.S. Supreme Court ruling that shielded state entities from federal civil fraud action

[KT2000]

1. "dealt with among peers"

this is something unique to doctors. It is also why their objections to malpractice suits ring hollow with me.

[rainbow4321]

7. He appears to be using that excuse

so he won't have to answer to the patients or the tax paying community.
He went onto say that any stats about the provided care and patient outcomes should be kept confidential so workers will be comfortable reporting mistakes and that management can take steps to correct the process without "worrying about litigation"

[w8liftinglady]

2. ok... Had my brain surgery at Parkland.They saved my life

They have the busiest ER in the nation...I know,because I was the Asst head nurse of the MICU for 5 years(15 years ago)They see 12,000/month...many critically ill.They get dumped on regardless of their divert status with uninsured pt's who arrive there by ambulance from surrounding cities.They have some of the best neurologists and neurosurgeons in the US.They are THE burn center for North Texas.....and I have been fortunate to have the residents and fellows follow me.Their operating room runs hard 24 hr/day.
Incidentally,Ron Anderson is a member of physicians for a National Health Plan...
Just wanted to give a little insight into a crappy situation.
:)

[rainbow4321]

3. It's more about how the care differs

between the indigent at the county hospital and it's sister hospitals that have primarily insured patients
Being investigated at county are:
No surgical consents
Incorrect consents given to patients to sign (including who the surgeon will be)
Faculty attendings not being told that residents are taking their patients to surgery--yet it is the attending who is supposed to sign off on it in the end
Parkland and UTSW billing third parties for surgeries done by student doctors when federal and state law only allow billing when faculty does it.

The list goes on and on.

The links within the OP article go into detail on other problems being looked at.
Medicare and Medicaid were some of those third parties who were billed when they possibly should not have been..both facilities could end up paying back a lot of that money in fines.

But again, it's a lot about how the local indigent are being treated so differently.

[w8liftinglady]

4. that could very well be happening by inexperienced doctors.Again-I honestly think in their case

it is not so much dumping the baby docs on the poor folks as a huge patient population with some really bad crap going on.
You have Zale Lipshy-144 beds,no ER-specialized patients either recommend because they are interesting neurologically,psychiatrically, and rehab .St Paul hospitals has 279 beds and a 29 bed ER.They focus on organ transplants,pre-and post -op,as well as cancer.few if any med students go there(Maybe fellows in specialties)
Parkland has the following info:
Operating beds 672 - to be increased to 1200 beds sometime-many inpatients are stuck in the ER until a bed opens up-I know,because with my GREAT insurance,I was down there with a blood clot for 48 hours.
Annual Admissions 55,079 which is 150/day-which occupies a lot of time the Attendings are all teachers,too as well as reseachers.2 of my docs are working with the VA on PTSD and Gulf War syndrome...in their spare time.
Average Patient Stay Adult - 4.8 days
Neonatal - 22.6 days
Annual Emergency Room Visits 108,707 (which equals about 1000/day)
Annual Clinic Visits 983,820 2500/day in clinics in neighborhoods
Uncompensated care provided annually $523.4 million PLUS-they also have a pharmacy there that fills indigent pts meds.

[w8liftinglady]

5. I'll give you an example...

One night,I was the charge nurse of the MICU.me and 9 news grads of our programs to teach nurses ICU.We each took 2 patients.We had a Fellow,resident and an OB intern(they also rounded in MICU to care for sick mamas when they graduated)there at night.
The fellow was in ICU-2 coding patients needed intubating/care.They resident was on the pulmonary and medicine floors,dealing with three patients...running three codes.
The OB intern was in charge of the ICU.I had 3 patients code-he had to intubate,insert central lines,and placed a chest tube in one.sometimes consents are difficult to obtain at night because many patients didn't have phones,so 2 docs sign consent.He did a great job and saved 3 lives...never slept.Resident came back up-my patient coded,developed huge fluid acculation around heart and lungs which had to be tapped,required special line inserted into heart to remove pressure...then going to surgery for emergency surgery.the attending physician arrived by this time,and took up some of the slack.This is the reality of a hospital set up as a county hospital.
these are their "Centers of Excellence"-and,yes-med students and baby docs care for these patients...how else will they learn?
Trauma
Burns
Spinal Cord Injuries
Cancer
Endocrinology
Women & Infants
Epilepsy
Gastroenterology
Cardiology
Orthopedics

again-there needs to be a shift where every patient has some type of insurance.Otherwise,you will continue to see this getting more prevalent as more people have no insurance or ways to pay for meds.

[rainbow4321]

6. Unfortunately for the hospital and the school

all their stats won't mean much when it comes down to "did you take money from federal agencies when you should not have?".
UTSW own internal audit showed "systemic" fraud and violations and it was signed by their school administrator. Yet he made no changes in their system and such activity was still going on as late as this past Spring.
And if those patients had their care done at the county hospital...well, their billing practices may be called into question, also.
Their stats or patient acuity level won't change what those laws say. The law is the law.
It is believed that Medicare and Medicaid have already begun an investigation.