Interesting Article

[HoustonDreaming]

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I'm sure some of you have seen this week's Propublica report on THI's heart transplant program (search "At St. Luke’s in Houston, Patients Suffer as a Renowned Heart Transplant Program Loses Its Luster" sorry I'm unable to post links). It has certainly caused quite a stir here in the Houston area, but what was surprising to me was the range of people's reactions: anything from "Oh that's an overblown hit piece from the guys next door at Methodist," to "That's unconscionable and the program is doomed to failure." Figured some sort of discussion would have popped up on here by now, but since there's none yet I'm happy to start. What are your thoughts? Word is that a second part will be released by Propublica next Tuesday or Wednesday.

 

[deleted697127]

At St. Luke’s in Houston, Patients Suffer as a Renowned Heart Transplant Program Loses Its Luster — ProPublica


That article is uncomfortable and toxic. Barring criminal activity, no health care provider should be named and blamed publicly for bad outcomes. Hospital leadership should probably be held more accountable for fraudulent marketing and the poor planning that lead to rapid over expansion, high turnover among staff, and undoubted systems failures. I guess it’s easier for the suits to have a scapegoat.

 

[coffeebythelake]

At St. Luke’s in Houston, Patients Suffer as a Renowned Heart Transplant Program Loses Its Luster — ProPublica


That article is uncomfortable and toxic. Barring criminal activity, no health care provider should be named and blamed publicly for bad outcomes. Hospital leadership should probably be held more accountable for fraudulent marketing and the poor planning that lead to rapid over expansion, high turnover among staff, and undoubted systems failures. I guess it’s easier for the suits to have a scapegoat.

Yes I blame the hospital administration and the suits for this more than anyone else.

 

[Orin]

I have no knowledge of this situation. Reading the article and trying to decipher what happened makes me think this is similar to what occurs at any number of places when critical linchpin people move on. As physicians it's easy for us to blame the suits and pass the buck, but at the end of the day, everyone involved from physician to nursing assistants to valets needs to step up and stop the line if this **** isn't working.

Obviously that article drops the surgeon's names and suggests their ownership of the blame, but as we've all been taught, it's a system. The surgeon, the anesthesiologist, the ICU attending, the transplant coordinator are just the stars that get all the attention and all the blame. The system was coasting on reputation, much like many big name places.

The suits failed for recognizing it and buying into the idea that people are just cogs in a machine and not special individuals that make a messed up system work.
The replacements failed for thinking they were good enough to make it work.
The system failed for not realizing there was a problem sooner.

Sucky situation, but it's happening around the country I'm sure as every medical system tries to expand rapidly and providers turn over/burn out/retire/etc. This isn't a widget you're building. You've got to have people that know more than just their role and the usual standard operating protocols, and that only comes with time, experience, and clear communication among passionate people.

I have no problem in naming names. We've got to accept our failures and learn from them. Let's all make new mistakes rather than repeating this dumb stuff.

 

[Robotic Wis-Hipple]

Why is every physician named but none of the administrators are? They even provide vague meaningless quotes from unnamed administrators, why the double standard?

I agree with others though, this is happening all over the country, big hospital groups buying up facilities and contracting staffing, cutting funding, and pushing out established physician leaders that don’t fall in line. I think this story is great for telling that tale. We aren’t cogs, the working relationships and experience matters and we’ve let the business people take control. I’m jumping to conclusion here but it sounds like they hired some inexperienced academic hotshot surgeon for his NIH funding or publication prowess while also likely being able to pay him a lower salary than a more seasoned surgeon with more experience running a transplant program would command. This serves two purposes, they save some money on the accounting side as well as getting a guy who wants the job enough for the opportunity that he doesn’t fight admin. I’m a young dude, and I’ve seen this story myself.

Honestly, the future requirement for all hospitals to provide their outcome data on an easily found website is exactly what we need despite the understanding that it will impact patient selection and involve some fancy statistical manipulations. With all that said, it’s a bit of a scapegoat piece and without knowing actual details it’s hard to say how blatant the surgical errors were (though a stenotic PV or SVC is a pretty blatant error). But it’s clear that even in heart surgery, patients expect perfection, and it’s not fathomable to them that things like a CABG may not go perfectly everytime.

 

[coffeebythelake]

if you are going to punish the physicians and other healthcare members involved in this, you should also take out the CEO and executives who were tracking the data and felt it was fine to advertise themselves as being a premier health system with low complication rates. you think they didn't know? it's laughable if the CEO didn't know... and either way means he/she is incompetent in their role

You know what's worse than having high complication rates? Having high complication rates and trying to cover it up.

 

[HoustonDreaming]

There is a new article on Propublica this morning focusing on Dr. Frazier's history with THI. Again, very weak on the role of hospital administrators. And, since he's no longer operating (really just hangs around the hospital and runs teaching rounds these days), the article is really just beating a dead horse. I feel his methods were already well known throughout the field, even outside the institution. What's the agenda now?

 

[nimbus]

There is a new article on Propublica this morning focusing on Dr. Frazier's history with THI. Again, very weak on the role of hospital administrators. And, since he's no longer operating (really just hangs around the hospital and runs teaching rounds these days), the article is really just beating a dead horse. I feel his methods were already well known throughout the field, even outside the institution. What's the agenda now?

His methods may have been known within the medical community but probably not to the general public. Boundary pushers tend to push boundaries in every regard. I’ve also witnessed smart academic surgeons with agendas do dubious things. For example, proceeding with their pet procedure on a patient who randomizes to the control group of a study they are conducting because they felt like it.

 

[coffeebythelake]

Why is every physician named but none of the administrators are? They even provide vague meaningless quotes from unnamed administrators, why the double standard.

They should list the administrator names followed by their compensation in dollars. Perhaps some outrage needs to be directed there

 

[HoustonDreaming]

Looks like Texas Heart has suspended all heart transplants indefinitely pending internal review of outcomes. Propublica has updated their site with an article confirming this, and finally directs a little more blame (via former THI cardiologist Deborah Myers) towards CHI management. Hopefully a chance to start moving in the right direction. After their last story dragging Bud Frazier through the mud, would be nice to see something positive come from this series.

 

[mxg67]

I'm familiar with the med center and some of the people mentioned. I felt it was rather sensationalized, they've written multiple articles now and it seems like a hit job. Anyone who reads it carefully can see that, lots of fluff but no smoking gun really. They use stats and stories (from unhappy patients and former employees) to weave a grand picture, nitpicking relatively minor things. Their rebuttal piece after receiving negative feedback from patients and doctors speaks volumes. If you've read propublica (surgeon scorecard, provider compensation info, etc.), it seems they have their own agenda with MD's. While the stats don't lie, we all know in medicine it's not the whole story. The wait times are skewed by large wait list. Bad outcomes=less surgeries=lower denominator=worse percentage. Bad things go down in the hospital, stuff we keep internal for m&m so I'm not shocked to hear the stories, but maybe the writers are. Basically a dept/surgeon with presumed success of over 30+ years sees an abnormal string of bad outcomes over 6months (a few patients die than expected), they make changes while going thru 3 dept chiefs (who were doing transplants as well). So who knows who/what was the problem. The new hire supposedly has above average outcomes so far (it would be dumb for the hospital to lie) but they only write of his bad outcomes. There was no independent review of wrongdoing and apparently the patients are not suing for malpractice. They're are many transplant programs that have had dips in their outcomes over the years, it's nothing new, look at duke. It is concerning how public data can be interpreted and used, and we ultimately don't know the full story about each case, circumstances, etc. The med center always has drama though and there are certainly some who are relishing this.