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.
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.
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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.
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.