Tuesday, October 23, 2007

Why is this man working? (UPDATED)

Dr. Andrew Agwunobi took over at Atlanta area hospital South Fulton, a fairly small hospital specializing in providing services to poor folks. in mid 2001. The Joint Commission on Accreditation of Healthcare Organizations (JCOHA) issued its first report toward the beginning of his tenure. This report was critical of South Fulton however they did give the hospital a passing grade though with conditions. The JCOHA issued the final report of his tenure a few months after he left in mid 2003 and this report did not just find South Fulton to be sub par in some areas but in fact no longer in compliance with their standards. Here is a list of the policies and procedures that South Fulton was no longer in compliance with.

1)Competence to perform job responsibilities is assessed, demonstrated, and maintained.

2)The leaders develop and implement policies and procedures for care, treatment, and services.Informed consent is obtained.

3)The organized medical staff oversees the quality of patient care, treatment, and services provided by practitioners privileged through the medical staff process.

4)Medications are properly and safely stored throughout the organization.

5)Emergency medications and/or supplies, if any, are consistently available, controlled, and secure in the organization’s patient care areas.

6)Medication orders are written clearly and transcribed accurately.

7)There is a process for granting, renewing, or revising setting-specific clinical privilege

8)Medications are safely and accurately administered.

9)Patients are reassessed as needed.

10)The organization fulfills the expectations set forth in the Universal Protocol for Preventing Wrong site, Wrong procedure, Wrong person surgery and associated implementation guidelines

In layman's terms, he took over a fairly subpar hospital and by the time he left the sub par hospital had turned into a hospital that could no longer meet governing body standards for compliance.

As a result of his performance at South Fulton, he was rewarded with the CEO position at Grady Hospital, the largest hospital hospital in Atlanta, one of the largest hospitals in the country, and also a hospital that specialized in providing health care to the indigent. His tenure ended as a result of the conclusions of yet another government report. I have no doubt that medical professionals will look to pick apart my analysis of his tenure at South Fulton and try and spin his performance in a more favorable light. That is fine, however there is no spinning the conclusions of the report of the Center of Medicaid and Medicare Services (CMS) of the Department of Health and Human Services leaves absolutely no doubt. (I couldn't find the report online though I have one in hard copy) Here is the conclusion of this report.

Based on the findings, we believe that the conditions at your hospital (Grady Hospital) pose an immediate and serious threat to the health and safety of your patients.

The specifics were broken down into four different categories.

#1) Serious medical errors and complications resulting in deaths or adverse outcomes were not investigated and the Chief Medical Officer, William Casarella
ignored them
#2) The Governing Body of the hospital was ineffective and ignored quality assurance standards mandated by law.
#3) There was a lack of accountability and required supervision of medical staff that resulted in deaths and serious adverse outcomes.
#4) There were violations of medical note/record keeping rules and standards.

In other words, the leadership Agwunabi, was totally absent in fulfilling any of the responsibilities of being a leader. If we are keeping score, Dr. Agwunobi took over one hospital that was sub par and left when the hospital failed to meets its requirements for even being in compliance. After that he took over a hospital that was deemed to pose an immediate and serious threat to its patients.

Now, the details of the report are of course more complicated. For instance, the report laid most of the blame on this man, William Casarella, who was Chief Medical Officer at Grady and in charge of all of the clinical departments. (as you can see from the link not only was Casarella not reprimanded but in fact he has since been promoted) Of course, ultimately, as the head person, which Dr. Agwonabi was, he takes the responsibility for everything anyway. That also gets into semantics and speculation. The bottom line is that this report was scathing. The hospital wasn't merely run poorly. It wasn't just below average or even failing to meet requirements for being in compliance with standards set by a governing body, but rather it was in such bad shape that

the conditions at your hospital pose an immediate and serious threat to the health and safety of the patients.

If you are in charge of a hospital, as Agwonabi was, it doesn't get any worse than that indictment. Since he was the only one that faced any punishment as a result of this report, some could speculate that he took the fall or fell on the sword if you will. That may or may not be true, but at this point it doesn't matter. If he took the fall and he was the only one, then his employer, through their actions, said that he was the one responsible for

the conditions at your hospital pose an immediate and serious threat to the health and safety of the patients.

Thus, an honest observer would expect that after such a finding that Dr. Agwunobi's career could and should be over. One could say that for Dr. Agwunobi, his future career path could be describe by these famous words from A Few Good Men

teaching typewriter maintenance at the Rocko Clubbo School for Women

One would be wrong. Agwonabi then resurfaced as the COO of St. Joseph's Hospital System a fourteen unit conglomerate of hospitals in California. That's right everyone after being ultimately responsible for the scathing findings of two separate government inquiries, this man was essentially given a promotion. He moved from a small hospital in South Fulton, to a large hospital in Grady, to a group of hospitals at St. Joseph's. In other words, whoever was in charge of hiring either read this

the conditions at your hospital pose an immidiate and serious threat to the health and safety of the patients

and was impressed, or just simply didn't bother to find out how the hospital was run when Agwunobi was there.

While I still haven't gotten the whole story here, his career path takes another curious route. He left this conglomerate after about a year or so and is now in charge of the AHCA in Florida. The reason this is curious is because he moved cross country from Atlanta to California to a job that paid well. It seems odd that after only a bit more than a year he would uproot his family again and move back across the country one more time.

Now, what is the AHCA you might be wondering? Well, the AHCA is a Florida bureau part of the Department of health whose goal is to provide quality health care to poor folks. That's right, all you Floridians, the man in charge of the government bureau who's purpose is to provide quality health care for the poor has run two separate hospital's that specialized in providing such health care, and both of those hospitals were the subject of scathing government reports relating to his tenure there. How did he get this job? Only the powerful know, however this is interesting. It turns out Dr. Agwunobi's ran Florida's department of Health under Governor Jeb Bush.

I know what some of you cynics are thinking right now. That is just how the game works, Volpe. True, however, it doesn't have to. Things don't have to work out so that someone fails and fails and constantly has that failure rewarded. It doesn't have to work out like this and we can start here.

Is this the best we can do? Is this how things work among the powerful? Perform your job in a totally incompetent manner and you eventually get rewarded with promotions? I don't know, but I would like to find out. If the good people of Florida are happy to have someone running the department that provides quality health care to the poor despite failing to do it when ran two hospitals for the poor, then don't read any further. If you are happy having your tax payer money go to this incompetent don't read any further. If you aren't then please make your voice heard. Here is a link to the Florida Department of Health, and here is another one to the Governor of Florida, Charlie Crist. Please ask them how running two hospitals into the ground qualifies anyone to run a department dedicated to providing quality health services to the poor.

UPDATE: For the most part the story behind the mess that now engulfs Grady is extremely confusing and complicated. Thus, if you were to find your way to any of the many stories I have written on it, and it was your first exposure, you would likely get confused. I don't believe this is one of those stories. You should be able to follow this one regardless of your exposure to the mess in general. If not, let me know. That said, I have put together a summary of the entire fiasco that tries to put all of its moving parts together in one piece. Please read it for guidance.
That way, you can see how Dr. Agwunobi fits into the entire nightmare. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.


Snooper said...

This is cross-posted and posted at our Group.


Anonymous said...

Why is it that any Liberal tghinking group like Academia, Left of center party groups, ACLU, MORON.org, Media matters . Reid and 41 mental migets can Never " COME CLEAN" even though they proclaim to want trasparency.... Redhawk

mike volpe said...

I never miss an opportunity to take a pot shot at liberals and especially at academics however this is about specific corruption at one school and two hospitals, Grady and the VA. Let's worry about indicting the system later and make sure that Emory answers for ALL of their sins now. Besides he was hired by a Republican admin in Florida.

Anonymous said...

Excellent post ... we cross posted at FLAPolitics.com (yes, Redhawk, one of those "liberal" blogs).

Keep up the great work Mike.