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.

6. Patient care is greatly compromised.THE HARMS TO GRADY'S PATIENTS ARE STAGGERING. PLEASE RULE ON OUR> COMPLAINT IMMEDIATELY.> A BLUE RIBBON COMMISSION TO INVESTIGATE UNETHICAL PRACTICES IS NEEDED NOW.> ROBERT BROWN AND PAUL HOWARD MUST RESIGN.>> Thank you. We know this is a lot of information, but all of it has> been sent 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.

The Fox Guarding the Hen House

This is the final report filed by the Grady Task Force. Let me sum up for anyone that doesn't want to bother to click the link. This is a report that is about thirty pages that is full technical jargon that almost no one can understand.

So, what is the Grady Task Force and why should anyone care? If you have been following my work, you know that Grady Hospital has been in financial turmoil for years and it has now come to a head. Grady Hospital is one of the biggest hospitals, one of the biggest public hospitals, and one of the biggest hospitals for the indigent in the country. It needs a huge infusion of tax payer funds, up to nine digits, or it will close down.

The Grady Task Force is a sort of consulting group, created by the Metro Atlanta Chamber of Commerce, designed to make recommendations to "fix" Grady Hospital. The very fact that Grady Hospital needs this sort of consulting group is curious in and of itself.

This past spring Grady fired Alvarez and Marsals, a professional consulting firm it hired to recommend ways in which it could avert financial ruin. That was only after paying the firm a cool 300K plus, PER MONTH, and over 3 million dollars total. Consulting firms are nothing new for Grady Hospital. Frankly, Grady Hospital goes through consulting firms the way that Liz Taylor goes through husbands. They pay each of them handsomely and they are even thinking of hiring yet another despite having a "consulting firm" hand picked for them by the Chamber.

One would think that after spending roughly eight digits on consulting firm in about two years, Grady would finally figure out WHAT THE F$%K IS WRONG. That is if these consulting firms are being hired for their advice rather than other reasons. For instance, would it surprise anyone to learn that the principles of Alvarez and Marsals have close ties to Grady board member Michael Hollis? Would it surprise anyone to learn that all of the prior consulting firms were in one way or another hired for some reason other than their professional qualifications? It wouldn't surprise me, and my proof is in these Latin words, res ipsa loquitor. The facts speak for themselves, and the facts are that at least four consulting firms have produced a hospital on the brink of financial ruin. Again, Grady paid about ten million dollars for all of this consulting. If these relationships were on the level, this money would have produced something better than what we have.

Now, we have the Grady Task Force, an unpaid consulting firm. When, we examine the facts, I think that we will see that the Task Force has other financial considerations in Grady Hospital. The bulk of the members are community and business leaders and that gives the force a sort of rep. They are also individuals and entities with financial and professional interest in Grady, which makes me wonder if their advice is on the level.

For instance, there is Robert Brown. He is the former head of the Grady Board. He served on the board during a period in which Grady was convicted of Medicare fraud, State Senator Charles Walker was convicted of 127 felonies, many related to Grady, and an HHS report came out and concluded this,

there is a serious and immediate threat to the health and safety of the patients

Does it sound to anyone as though he has any business being on the board given his history of failure at Grady, and possibly obscene amounts of corruption. Did I mention that Robert Brown is also of RL Brown and Associates, an architecture firm? Would it surprise anyone if his own architecture firm was the recipient of several "sweetheart deals" for additions and upgrades to Grady during his tenure? The list is full of such names: Michael Johns, of Emory University, Michael B. Russell of H.J. Russell (also a recepient of several contracts), John E. Maupin, MD – ex-officio President & CEO Morehouse School of Medicine (another proprietor of Grady Hospital), Phil Humann CEO SunTrust Banks, Inc.(with significant financial ties to Emory University but who doesn't in Atlanta), etc. One would think that if a hospital is near financial ruin the last people that would be in charge of recommendations to fix it would be those who put it there in the first place. Not with Grady, in this case the very same people that were responsible for putting Grady in this position are now in charge of fixing it. That is why I call this piece: The Fox Guarding the Hen House.

Like I said earlier, most of the recommendations are quite technical and difficult for the layman to understand. One has caught my eye and it is a plan to make Grady Hospital run by a private corporation. Under this plan, Grady would still receive public funds so the only practical effect would be more secrecy when it came to public fund usage. Given Grady's history with corruption: State Senator Charles Walker, the Medicare fraud, so called double dipping and atrocious patient care, and all sorts of other unproven cases of malfeasance. Is going private and more secretive really the best way to "save Grady". It probably isn't however if I were looking to commit more corruption at Grady, I would certainly want to make it private.

I would love to hear what possible public benefit Grady going private would have. There appears to be none to me, though there is an obvious one if you wanted to commit more corruption. There is a vote coming soon in the Georgia legislature. My own read is that the folks of Georgia don't want the hospital to go private. There appears to be no public good in it. Thus, I can only see one reason for any politician to vote for that plan and by my estimation that vote disqualifies said politician from serving again.

Oh and finally, you want to add insult to injury. After Grady is done listening to the consulting recommendations of the unpaid Grady Task Force, they plan on hiring another paid consulting firm. Frankly, if the Grady Task Force is on the level one would think there would no longer be need for anymore consulting firm. If, that is, the Grady Task Force is on the level.

UPDATE:

While I tried to make this piece as comprehensive as possible, if this is your first exposure to the story behind the crisis at Grady Hospital you may very well be quite confused. Thus, 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. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.