First posted 8/29/11 on Not Running a Hospital
A series of stories at the Dallas Morning News raised some serious questions about the quality of care at Parkland Memorial Hospital. I draw no judgments about those issues. But what comes across in these stories is something equally interesting: A hospital that has chosen to take a hard line, dare I say stonewall, with the local press on issues of community concern. In an era of increasing transparency, this approach is an anachronism.
Those of us a certain generation remember Parkland Memorial as the site of President Kennedy’s trauma treatment and death in 1963, providing it an important symbol of high level care in our national consciousness. But it is also a major teaching facility of the UT Southwestern Medical Center and is prominent in its own right for many reasons.
When a hospital with this kind of affection and reputation faces difficulties in the delivery of care, there are two possible approaches. One is to be open and transparent about the nature of the problems, their causes, and the solutions being tried. That approach is consistent with the high level of trust granted by the community. The other approach is to hide to hunker down and draw on powerful interests in the community to put pressure on journalists to back off from the story They may work for a while, but eventually fails, with an even greater loss of trust that would have been thought possible at the start.
It looks like Parkland has engaged in the latter kind of campaign. The phases are disturbingly familiar. After some highly visible cases, including stories of a patient care system heavily dependent on residents who sometimes work with little or no faculty supervision, federal regulators warned that failures in care at Parkland Memorial Hospital posed “an immediate and serious threat to patient health and safety,” and ordered it to submit a plan to remedy the problems within two weeks or lose federal funding. The hospital administration described the report “as a collection of mainly ‘technical violations.'”(Full story here.)
Meanwhile, conflicting explanations to the press emerge. Here is an excerpt on a medical student issue:
Newly obtained records contradict UT Southwestern Medical Center’s claims about unlicensed med students who were paid to work in Parkland Memorial Hospital’s psychiatric ER — and why the 30-year cost-saving practice ended this summer.
UTSW spokesman Tim Doke previously told me that the students were “administrative assistants” who “do absolutely no clinical, patient-care work” and had no formal job description. He also insisted I was misinterpreting a 2009 letter from four UTSW psychiatry professors that repeatedly called the students “clinicians” and never “administrative assistants.”
But now a Texas Public Information Act request, filed right after we brought the unusual employment practice to light in June, has forced UTSW to release the students’ job description. It says the students “provide experienced help” in Parkland’s psychiatric ER — they obtain the patient’s history, perform a “brief neurologic exam” and “periodically assess patients.”
Think about this. The press was forced to file a freedom on information request to obtain job descriptions of students. In fact, the hospital sued the Attorney General to challenge rulings that required this and other kinds of information to be provided. This is clearly a situation that has spun out of control.
Prominent members of the community have publicly come to the defense of the hospital. Staff from UT Southwestern Medical Center asserted that the newspaper has a “vendetta” against the school and its teaching partner, Parkland. Also, the hospital has retaliated against the newspaper by removing its advertisements. This is the kind of nasty local politics that eventually backfires.
I don’t know where this is all headed, but given Parkland Memorial’s place in the country’s consciousness, the next stage has to be the national media. What a shame that the hospital’s return to the national scene will be about these kinds of issues. Wouldn’t it be marvelous if it adopted a truly transparent approach to the problems and instead became a national example of that philosophy?
Paul Levy is the former CEO of Beth Israel Deaconess Hospital in Boston, now working as an advocate for patient-centered medicine and efficient process. He writes at Not Running A Hospital.