Tuesday, December 4, 2007

JCAHO Threatens to Shut Down Grady Hospital

The Atlanta Journal Constitution (which I believe to be a suspect news organization) broke this this morning...

As if things weren't bad enough for the financially strapped Grady Health System, now the hospital faces a list of criticisms, including issues with patient care, that put its national accreditation at risk.

In a five-day inspection last week, the Joint Commission —- formerly the Joint Commission on Accreditation of Healthcare Organizations —- identified "numerous
requirements for improvement," according to a statement issued by Grady on Monday. Hospital officials gave no details about the kinds of shortcomings inspectors found.

Dr. Christopher Edwards, vice chairman of the Grady board, said the report cited "opportunities for improvement in various areas, including patient care."

Anyone who has been reading my work, knows that the tone of this article is wrong. It is frankly long past time that the powers that be, be held responsible for the mess at Grady. Keep in mind that about three years ago, the HHS conducted an investigation that concluded this about the patients at Grady Hospital...

there is an immediate and serious risk to the health and safety of the patients

Obviously, it can't get any worse than that for a hospital. Now, three years later the hospital needs an injection of half a billion dollars to stay solvent. Before that, Grady Hospital was convicted of Medicare fraud. State Senator Charles Walker committed so much criminality at Grady and beyond that he was ultimately convicted of 127 felonies. I am fond of the Latin phrase Res Ipsa Loquitur (the facts speak for themselves), and in the case of Grady Hospital, Res Ipsa Loquitur.

One only needs to do a Google search to discover that there are serious and systemic problems at Grady Hospital that frankly, in my opinion, warranted intervention from authorities long ago. Given the current crisis and latest report from JCOHA, it is clear that proper steps weren't taken in response to the report from HHS about three years ago. I hope that this latest episode winds up with a different result.

Here is the so called inside baseball on how this transpired. Much of the credit should end up going to Ron Marshall of the Grady Coalition. He sent letters for years to JCAHO complaining about stonewalling on the part of Grady staff as far as open records requests and in answering their many questions on a whole host of issues related to corruption, poor patient care, and effective hospital management. Here is an example of an email that he sent that I got a hold of...

Mr. Bressler,>> YOU often appear not to have the evidence we have presented to you> over the years. We hope you have protected all documents we have sent> to you from spoilage.>> NATIONAL WITNESSES: THE GRADY SYSTEM HAS FAILED> Because of the severe suffering at Grady, we cannot rest until JCAHO> violations are stopped. We are bringing on board new witnesses.

Dr.> Linda Peeno, formerly a top executive at Humana, has analyzed the> situation and finds that this is a breakdown of the medical system.> Peer review is an essential part of the system to protect patients.> Bad faith peer review effects the medical judgements of all doctors> in the system, and leads to systematic poor medical care. Testimony> demonstrates it is impossible to deliver minimal standard care when> peer review has been subverted.>> CONGRESSIONAL ALLIES> We will be meeting with Congressional allies next week, and we will> be holding a press conference. We hope we receive a statement from> you by noon, Tuesday that you will implement a plan to enforce JCAHO> regulations at Grady.>>

GOOD FAITH PEER REVIEW IS ESSENTIAL TO THE INTEGRITY OF THE SYSTEM> I know you do not want to enforce peer review standards. However, I> don't see how you can enforce any standard if bad-faith peer review> is being used to hide malfeasance at the hospital. Peer review is> part of a system to protect patient care. If peer review is> subverted, doctors and staff are unable to speak up for patients and> to enforce patient care standards. The whole system is stood on its> ear. I hope you will reconsider your position and enforce JCAHO's own> standards. Grady has violated each of the provisions you outlined in> your last letter.>> BAD FAITH PEER REVIEW HAS BEEN CORRUPTING THE MEDICAL SYSTEM FOR DECADES> This has been a horrible problem for years.

Verner Waite wrote to you> about widespread violations in peer review leading to patient harm> ten years ago, and you did not respond. It is our position that you> must enforce all standards, especially peer review standards, that> impact patient care. This is at the core of your function.>> BAD FAITH PEER REVIEW IS CORRUPTING POLITICS IN GEORGIA> We have presented extensive evidence, including evidence from an> assistant DA, that the huge amounts of money stolen from Grady has> perniciously influenced Georgia politics. The 142 felony count indictment against Senator Walker was based in large part of his corruption of Georgia's hospitals by corrupting its peer review system. Bad faith peer review is a cancer on the body politic of the> entire state. Bad faith peer review can only be
stopped by JCAHO.> JCAHOs failure to enforce its standards is harming the entire state.

HOWEVER, EVEN IF YOU WILL NOT ENFORCE YOUR OWN STANDARDS, PLEASE AT>LEAST MAKE GRADY CORRECT DEFICIENCIES IT HAS ADMITTED IN MORE THAN THIRTEEN AREAS. GRADY IS THE MOST IMPORTANT HOSPITAL IN THE SOUTHEAST THAT SERVES> MINORITY PATIENTS. PLEASE TELL US IF YOU WILL ENFORCE YOUR STANDARDS> AT GRADY.>> 1. For your convenience, we have created a database showing how> violations in JCAHO policy at Grady have resulted in severe patient harm over the last five years: http://www.geocities.com/ron_marshall21/

2. We also document how Grady has retaltiated against witnesses to> prevent you from getting evidence: http://www.geocities.com/ron_marshall21/

3. We summarize severe corruption and its impact on patients:

4. We summarize witnesses available and ethics violations:

5. Current staff document new retaliations, and JCAHO violations. The staff fear to
speak to you.

previously. This is but a portion of the documents> already in your possession.>> Ron Marshall> George Anderson> The New Grady Coalition

While many of the names are probably unfamiliar, please note this particular email is one of many over several years. Clearly, Grady refused to respond to good faith efforts to address issues that years later JCAHO has finally gotten around to forcing them to address.

I hope that everyone grabs the bull by the horn in this situation and takes steps to institute the sorts of institutional changes that are necessary to rid Grady of the culture of corruption that seems so apparent to me. Here is the plan as set by the Grady Task Force. If anyone can make sense of it, let me know because I can't. Here is the plan me and my allies have developed. I hope that everyone has a chance to read it. The time for Grady Hospital is critical, and it is time for real solutions.

For reference on how Grady Hospital got to such an extreme point you can go to this tag, or you can read this summary.

No comments: