To the UT Southwestern Campus Community:
On Sunday, May 30, the Dallas Morning News published as a front page
story a lengthy - but misleading and incomplete - article about UT
Southwestern.
Most of the article focused on a case from 1998 involving a former
employee, Jack Mooney, who had contacted federal authorities to raise
questions about UT Southwestern’s billing practices. Sunday’s
article offered no new information and repeated a number of false and
unsubstantiated claims.
A governmental review at that time of UT Southwestern’s billing
practices found nothing to support an assessment of liability against UT
Southwestern. There were no findings of wrongdoing, no charges, no
fines, no penalties, and no settlements that resulted from the Mooney
claims - which came at a time when the federal government was
aggressively pursuing such cases against other academic medical centers
and when some of these investigations resulted in significant fines and
penalties elsewhere.
Additional allegations about residency supervision and billing now date
back three years and have been thoroughly investigated multiple times,
again with nothing found that would be the basis for wrongdoing or
liability against UT Southwestern. The basis for the Dallas Morning
News' specific assertion that a "probe has identified millions of
dollars in potential fraud" resulting from UT Southwestern's billing for
unsupervised resident services is unknown to us and lacks credibility.
Such claims are an unjustified affront to the nearly 2,000 physicians
who are here every day providing outstanding patient care and teaching
those who will provide patient care in the future.
UT Southwestern has a long-standing and significant institutional
commitment to ensuring that its practices - including but not limited to
professional billing - are conducted in full accord with applicable law
and regulations. We regularly conduct reviews across all areas of the
university, as well as provide training via meetings and written
materials to staff because the regulatory requirements governing the
practice of medicine - and billing for its costs - are complex and
continually changing. Our focus is to ensure that our compliance
programs evolve with the ever-changing regulatory landscape so that
institutional risk is reduced, and institutional resources are available
to support our mission.
The Dallas Morning News article selectively excerpted phrases from
internal billing compliance memos. By both omission and innuendo, they
implied that our professional billings were in some way fraudulent,
without any proof or documentation. The specific internal audits they
cited related to billing processes, not actual billings.
In contrast to the article’s implications, UT Southwestern's
professional billing compliance program is well-developed and consistent
with federal guidelines. In actuality, the 2010 audit states that the
professional billing compliance program has "well-designed processes
which are consistent with Office of Inspector General (OIG) Compliance
Guidance for Physician Practices.”
The audits and memos cited offer strong evidence of our aggressive
commitment and approach to compliance, not the wrongdoing that was
implied. In addition to other strict compliance controls, we have in
place our Compliance Hotline - 877-507-7319 - for all employees to
report any concerns related to our business practices, our research, or
our patient care.
Our faculty is committed to delivering the very best care to all the
patients they serve. I believe that the UT Southwestern community should
also be proud of the role it has played in training approximately half
of the physicians currently practicing in North Texas and of our world
class research, which informs the patient care delivered by our
committed professionals.
Residents learn by doing. At every major academic medical center in
the nation, physician training is accomplished by allowing residents
gradually to assume increasing responsibility in all areas of patient
care, under supervisory guidelines that meet the strict standards of the
Accreditation Council for Graduate Medical Education (ACGME). This
organization regularly monitors and examines our residency supervision
to ensure compliance, and we are proud that our surgical residency
program meets the ACGME’s highest level of review.
While we all regret having our reputation unfairly tarnished by our
hometown newspaper, I trust you will respond by doing all you can to
continue to support our mission of delivering excellence in patient
care, training the physicians that will provide the patient care of the
future, and conducting the scientific discovery and research that will
save lives in decades to come.
Daniel K. Podolsky, M.D.
President
UT Southwestern Medical Center
My opinion of this letter is as follows.
1. Dr. Podolsky stated in the first paragraph that the article was misleading and incomplete. The reporter asked to meet Dr. Podolsky so that he could contest any portions of the article that he felt were misleading. Podolsky refused.
If Dr. Podolsky thinks the article is incomplete he has only himself to blame for not taking the time to meet with the reporter to fill in the blanks.
2. The next paragraph is the part I am most concerned. It raises concerns about whether Dr. Podolsky making false statements to the faculty.
He wrote, "Most of the article focused on a case from 1998 involving a former employee, Jack Mooney, who had contacted federal authorities to raise questions about UT Southwestern’s billing practices. Sunday’s article offered no new information and repeated a number of false and unsubstantiated claims."
That is not true. Mr. Mooney filed a qui tam lawsuit alleging that UT Southwestern was engaging in widespread billing fraud.
A qui tam lawsuit is one where a private individual notifies the federal government that someone is stealing from them (over-billing, over-charging, charging for services not rendered).
They originated around the time of the civil war, when Abraham Lincoln noted that dishonest contractors were charging the government exorbitant amounts of money for items such as boots that were supposed to be made of leather but were made of cardboard, and ammunition that did not contain gunpowder. People were using various means of stealing from the government.
When a qui tam lawsuit is filed the government goes after the entity that stole from them. They get their money back, and some of the recovered money goes to the person who informed the government. According to the Dallas Morning News story Mr. Mooney informed the federal government that UT Southwestern was engaged in billing fraud by filing false claims to Medicare and Medicaid.
Dr. Podolsky stated in the third paragraph of his letter, "A governmental review at that time of UT Southwestern’s billing practices found nothing to support an assessment of liability against UT Southwestern. There were no findings of wrongdoing, no charges, no fines, no penalties, and no settlements that resulted from the Mooney claims."
The facts are that on May 22, 2000, before the Mooney lawsuit had been heard, the United States Supreme Court rendered a decision in a case called, "Vermont Agency of Natural Resources v. United States ex rel. Stevens. "
Mr. Stevens informed the U.S government that the Vermont Agency of Natural Resources was stealing The government sued the Vermont Agency, and won the case. The Vermont Agency appealed to the Supreme Court. The court reversed the decision, ruling that "A private individual may not bring suit in federal court on behalf of the United States against a State (or state agency) under the False Claims Act."
In other words, private individuals like Mr. Mooney could not file a qui tam lawsuit against a state agency such as UT Southwestern. UT Southwestern enjoys, "immunity" from such lawsuits.
Mr. Mooney's lawsuit was dismissed before it had even been heard.
Those are the facts, and they are not in accordance with Podolsky's statement that, "A governmental review at that time of UT Southwestern’s billing practices found nothing to support an assessment of liability against UT Southwestern. There were no findings of wrongdoing, no charges, no fines, no penalties, and no settlements that resulted from the Mooney claims."
There were similar inaccuracies in the letter he issued concerning the May 24th case that found UT Southwestern guilty of racial and religious discrimination.
3. Dr. Podolsky stated that the article contained, "no new information." The statement that UT Southwestern "is currently under federal and state investigation for billing fraud" is new information to 99% of the citizens of Dallas County.
4. Next, Dr. Podolsky states that claims of inadequate resident supervision have been investigated numerous times, and were not substantiated. As proven elsewhere on this blog, faculty surgeons were repeatedly telling Dean Gilman that residents were taking their patients to the OR without notifying them, and performing complex surgery.
These investigations were conducted by the departments responsible for the infractions, who exonerated themselves. The surgeons swore under oath that lack of supervision at Parkland Memorial Hospital is routine.
5. I did not see any affront to the 2,000 physicians who work at UT Southwestern in the Dallas Morning News article. The article reported on billing fraud and inadequate supervision. I and most others believe that the people who show up to UT Southwestern are decent, honest, hard-working and caring, and that includes the residents. They deserve a management that is beyond reproach, and not one that is perpetually involved in scandals.
6. Next, Dr. Podolsky goes on to state, "UT Southwestern has a long-standing and significant institutional commitment to ensuring that its practices - including but not limited to
professional billing - are conducted in full accord with applicable law and regulations."
An internal audit of UTSW audit on billing rule compliance that was concluded on January 31, 2010 identified five specific concerns.
One concern was, "Our audit scores for the first quarter of 2009 identified systemic failure rates for certain departments. We determined that systemic departmental failure rates for the same departments continued into the second, third, and fourth quarters without being identified and addressed at the departmental level. These recurring failure rates indicated that current departmental billing practices are in need of immediate improvement."
In medicine, "systemic" is a term that is used to describe a disease that affects the entire body. In business, it is a term used to describe an entire organization or department. Dr. Podolsky told the UTSW community that the audit, that was never supposed to see the light of day, showed that everything was fine. Actually, recurring "systemic" billing practice failures affecting entire departments that need immediate improvement is a failed audit.
7. Dr. Podolsky's letter stated, "In actuality, the 2010 audit states that the professional billing compliance program has "well-designed processes which are consistent with Office of Inspector General (OIG) Compliance Guidance for Physician Practices.”
This is misleading. There are two elements to billing compliance; physician billing, and hospital billing. The audit said there is "systemic billing compliance failure" at the Departmental level, and by 46 individual practitioners. With respect to billing for services provided by the hospital the audit found, "Hospital Billing Compliance has not established a framework to apply key elements of the Office of the Inspector General Guidance for Hospitals."
8. Next, Dr. Podolsky mentions that UTSW's firm commitment to compliance is evidenced by the existence of a "Hotline" for complaints. That hotline goes to Mr. Dieter Lehnorrtt's office. Mr. Lehnorrtt is responsible for setting up a framework to apply the Inspector General Guidance for Hospitals that was published in 2005, and that is not yet in place in 2010, and for preventing the "systemic" billing compliance failures at the departmental level.
He was asked to attend a Burns, Trauma, and Critical Care Division Meeting on June 13, 2007, to clear up concerns about billing fraud. Here are the key excerpts.
BTCC Divisional Meeting
Wednesday, June 13th, 2007
10 am in E 5.514D
NOTES
Attending: Drs. Rege, Minei, Hunt, Purdue, Frankel, Shafi, Friese, O’Keeffe, Nirula; Belinda Weston
Dieter advised his office is performing a focused audit, and they will return to a division meeting when completed to present their findings.
Dieter discussed a previous Whistle Blower case against the University in the 1990’s that the Federal Government withdrew from for lack of evidence and no monetary settlement – please see Dieter for specifics on this and all audits.
Plus, he made the same false statement about the Mooney case that Dr. Podolsky did. The government did not withdraw from the Mooney lawsuit due to lack of evidence: the Steven's decision made it go away.
I asked Dieter for "specifics on this and all audits," as he suggested. He denied me every single time. I have plenty of emails to prove it. Is Dieter the guy you want on the other end of the hotline at an institution known for retaliating against people who make complaints against it?
Back to Dr. Podolsky's letter.
9. The ACGME does not monitor billing compliance, or supervision. They look at work hours, lectures given, case loads, and they meet with residents in conference rooms and in private interviews. They give them surveys to answer about their program. When I last checked, the survey given to residents contained two questions about OR supervision. They were questions such as, "do you think you receive adequate supervision and support in the operating room."
The ACGME does not look at charts, records, or times when surgeons signed in and out of the OR. The ACGME has absolutely NOTHING to do with billing compliance. Residents learn by doing. But the ACGME requires that it happens under appropriate supervision.
A faculty member cannot provide adequate supervision when they are sitting in their office two buildings away while major surgery is being performed on their patients, and they wait to see if the residents are going to "consult" them during key and critical portions of the case.
10. I have to disagree with the last paragraph about patient care excellence. Look at Parkland's own resident supervision policies. It says that a second year resident can perform a radical mastectomy on a patient, as long as they are supervised by a third year resident, and there is someone more senior resident on campus whom they can call for a consultation, if they get into trouble. And once a resident reaches their fourth year, they can do a radical mastectomy on their own, with no faculty supervision. Compared to today's supervision requirements, these policies are medieval.
May I make a suggestion? Let the UTSW community read the news and watch television coverage, and formulate opinions on their own.
They don't really need the University President telling them what they should think.
Like everything that comes from the desk of Daniel K. Podolsky, M.D., President UT Southwestern Medical Center these days, facts are now being blurred or outright distorted.
ReplyDeleteHe now resides over many morally challenged faculty executives at UT Southwestern where the culture is based on “infectious greed” where the primary criterion of success in academic medicine is now how much money the faculty brings in from hospital/clinical practice or external grants, not the quality of teaching or academic work.
Facts, truth and integrity are now missing. He has taken a position that UT Southwestern is above the law. This is based on the fact the government withdrew from the Jack Mooney qui tam lawsuit due to lack of evidence or vindication of the billing process. This is an outright false statement.
The Steven's decision state the Federal Government can not sue the State. The result of this is the federal government can not sue a state entity like UT Southwestern. Therefore Dr. Podolsky stance has sanctioned the concepts to maximize the Medicaid and Medicare billing fraud because the Federal Government can not enforce or stop it.
One thing about the filthy rich … they are different. It is not just that they’re rich but that there’s something about being extremely rich that blurs ordinary perspective in all but the most exceptional people. Where power may corrupt, extreme wealth blinds and deafens. And Dr. Podolsky no longer hears the warnings.
Both Bernie Madoff and Alan Stanford thought they were right and above the law. So did the leadership of AIG, Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers, Merrill Lynch, etc.
Dr. Podolsky is now relying on a highly skilled PR team to spin a positive tail. But to this Texas county boy, spinning spin is nothing but a lie. And Dr. Podolsky’s letters are now nothing but spin.
The entire audit was printed in the online version of the DMN. It was a failed audit. Podolsky sliced out one positive sentence and left out the key finding that ther are multiple department where compliance failure is systemic. This is just outright misleading.
ReplyDeleteI don't know who he is answerable to, but the Dallas Morning News told the facts as they were. The Mooney case was withdrawn after the supreme court made s decision that said the federal government cannot sue a state entity.
Podolsky wrote a fiction to make it sound as if there was a trial in the Mooney case, and UTSW was found completely innocent. I don't see how anyone can believe what he says anymore.
It is very condescending for Dr. Podolsky to send out these letters. We are all educated people. We can read the newspaper and decide to believe or not. We do not need a nanny telling us what to believe.
ReplyDeleteI you read the audit it is clear that Podolsky is just trying to hide and mislead readers about the results. One would someone being paid $1,212,000 per year to do a better job.
ReplyDeleteBut do you know what I find completely strange? Kern Wildenthal retired in 2008. Yet, is he still on the UT Southwestern payroll with an annual salary of $950,000.
Why is UTSW paying the ex-president almost one million per year? He no longer works at UTSW. This is tax payer rip off.
Is there a UT system wide problem? http://www.mysanantonio.com/news/state/Commuting_from_Houston_to_Philly_on_Texas_dime.html
ReplyDeleteYou may be right. I am stunned to read the post right above yours, saying that Kern Wildenthal retired and barely took a pay cut. He still gets paid nearly a million per year, and his title is something like, "assistant to the president for community affairs." We have Governor Perry talking about a $15 billion dollar budget shortfall, with cuts in schools, health care, and increases in tuition. On the other hand, they hand out a million per year to a person who is retired.
ReplyDeleteWhen citizens see corruption by the leaders it makes them feels that they shouldn't have to obey the rules either.
This doesn't happen at Baylor because it is a Christian institution not like the podolsky and levine run it southwestern.
ReplyDeleteThe previous post had multiple comments about Dieterr Lehnorrt. He
ReplyDeletewas telling the surgeons that since they get to decide what are the key pre-op visits, post-op visits, and critical parts of an operation, there is really no way to get caught on billing fraud. And the on this post Dieter the same mistatement that Podolsky did 3 years later- say the Feds did an investigation and found no evidence of fraud, whereas the record indicates that the Stevens issue nullified the Mooney case. I don't see why anyone would use that hotline and feel secure about it.
Anyone dumb enough to use that hotline after all of this shouldn't be working there anyway.
ReplyDeleteThe author of a “Stories” blog post dated 04/09/10 reported concerns about properly executed informed consent.
ReplyDeleteIs a copy of the consent form for the study entitled “Delayed Versus Early Enoxaparin Prophylaxis After Traumatic Brain Injury” available for review? See
http://clinicaltrials.gov/show/NCT01014403
Are Medicare and Medicaid-eligible participants billed for all medical care provided during the course of the study, including care for adverse events that occur as a result of the experimental treatment?
This Dieterr is just another person in a long line of people that don't have to tell the truth. He finds loop holes, plays word games and has no care about the safty of the patients. It's just make the bucks no matter how many people get upset.
ReplyDeleteI alway thought UT Southwestern was a great school, but this is eyeopening.
At Parkland, everyone and anything is billed for. Even when the Faculty isn't there, Parkland will bill you for their services.
ReplyDeleteBut if I read the other posts, wasn't it this Rege guy that came up with that policy?
ReplyDeleteGood question. If you mean about billing for procedures even if no faculty is present, that is not something that originated with Rege. It's the way medicine and surgery had been practiced for a long time. As the costs of health care began to sky rocket, the government realized that a lot of it was due ti fraud.
ReplyDeleteThe rules said the surgeon has to be present. Surgeons would bill if they were present anywhere in the hospital. Finally, in 1995, the Feds realized that Medicare and Medicaid were going to go broke, and that they had to clamp down on fraud. They made it clear that the surgeon has to be in the OR, directing the surgery, if they expect to get paid for it. And they kept making the laws more and more strict, so that quality would improve, and costs would go down.
Rege, as Department Chair, just decided to ignore the rules. dieter Lehnorrt, in charge of enforcing them, merely looked for the loopholes, and developed ways of getting around them.
The results speak for themselves. A two year audit that concluded on January 31, 2010 found "systemic" failure of compliance with billing rules, not just by individual physicians, but by entire departments. So, Rege didn't start the system. He just decided to disobey the laws, with Dieter generating reports and paperwork to make it all look legimate.
And now, to the disappointment of many, we have the new President Podolsky, who instead of facing up to failures, seems to be trying to cover it all up.
It's a tangled web, and I wish outside authorities would step in and fix things.
Given the resources, the generosity of the community, with people willing to donate endless amounts of money, UTSW should not be ranked the 28th best med school out of 129 med schools in the country. Many of those schools are small, designed to just meet the needs of the state.
Dallas is the 8th largest city in the country, and doesn't have significant financial problems. It should at least be in the top 15, if not in the top 10 giving the best a run for it's money. That won't happen until the move forward, and adopt philosophies that place patient care first, at the head of the mission statement list. Everything then will take care of itself.
Looks like things are bad all around. http://www.mysanantonio.com/news/local_news/layoffs_and_pay_cutsare_ahead_at_uthsc_95671119.html
ReplyDelete“According to the eight-count indictment in their case, Beltre and Alana violated several of the health care programs’ rules, including regulations that the billing doctor be on site for all medical procedures....”
ReplyDeleteRoebuck J. “Podiatrist, assistant sentenced to prison for health care fraud” The Monitor May 28, 2010 7:05 PM
http://www.themonitor.com/news/podiatrist-39229-assistant-prison.html
What important to know about the Beltre case is that it was two people, Beltre (the Attending) and Alana (the Resident) billing for the services that Beltre was not there to do. Notice that it took only ONE incident to obtain the conviction.
ReplyDeleteBut at UT Southwestern / Parkland, they were told this was happening and they covered it up. When the indictments come, they will have a conspiracy charge as well. Every Attending Doctor that signed for services that he/she wasn’t their to perform, is guilty just like Beltre.
True, but look, the got Alana in the resident scenario. They went after the Resident!
ReplyDeleteAnd notice that the Funds obtained were to paid back by the Doctors not the Company.
“The former chief executive officer of an Alvin [Texas] nonprofit medical organization was arrested at her residence Wednesday after being charged with two Medicaid fraud-related felonies...According to investigators, Benefield diverted Medicaid funds for her personal benefit, awarded jobs and contracts to family members, directed employees to falsify Centers for Medicaid Services billing statements and failed to comply with federal guidelines governing the administration of the facility....”
ReplyDeletehttp://www.kiiitv.com/news/txstatenews/90359029.html
KIII TV3 - News, Sports, Weather April 9, 2010
Tillos, according to the article on the Beltre case, "Alana graduated from the New York College of Podiatric Medicine in 1996 but failed to pass state licensing examinations at least five times from 1995 to 1998. She still does not hold a license according to the Texas State Board of Podiatric Medical Examiners."
ReplyDeleteA Weslaco ambulance company owner was sentenced to two years in prison Monday for defrauding government health care programs out of more than $1 million. He scammed the Medicare and Medicaid programs by paying people to take unnecessary ambulance trips to and from local clinics and then submitting fake claims for reimbursement.
ReplyDeleteIn addition to the prison term, he was also ordered to pay more than $650,000 in restitution to the Center for Medicare and Medicaid Services more and serve a three-year term of court supervision upon his release.
Read about how to stop Medicare fraud, here:
ReplyDeletehttp://www.stopmedicarefraud.gov./
These case are a small blip compares to what happens at Parkland. Parkland sent as proof that they supervise cases by showing them the records of a brain tumor removal case. They said, "see, we supervise. The case last a little of four hours, and neurosurgeon didn't leave until two hours into the case. The number of charts without documentation of pre- and post notes notes is staggering. I can only imagine that the federal investigation mentioned in last sunday's Dallas Morning News means that this same type of probe is now happening at UTSW and Parkland
ReplyDeleteHow to stop Medicare fraud is a good article. It's mainly directed at telling patients how to detect when their doctor is committing fraud. But the website makes it clear that due to looming bankruptcy of the program the Obama administration is going to really crack down. If as the DMN article stated, the investigation into fraud at UT Southwestern and Parkland was initiated two years ago, that may explain the delay.
ReplyDeleteDave, this blog and the topic is not about Obama and Medicare going bankrupt, it's about greed, self serving retaliation and violations of the law. This took place during the Obama administration, Bush (2) Administration, Clinton Administration and Bush (1) Administration.
ReplyDeleteIt's about people at UT Southwestern / Parkland Hospital that think they are above the law of the land. Untouchable! This is what makes left wing and right wing get pissed equally. It’s a disgrace to have this taking place in Dallas. The people doing it are a disgrace and it disgraceful the health care to the People of Dallas must suffer.
So stay on topic – UT Southwestern / Parkland Hospital Billing Fraud.
To Anonymous 11:43
ReplyDeleteHow does UT Southwestern / Parkland Hospital justify to the Federal Inverstigation the Resident operating solo that has been documented manytimes.
I wish I knew. Perhaps they are relying on the Centers for Medicare and Medicare Services. This blog contains copies of altered documents where they were found to be out of compliance, and then the documents were changed. I suspect that they have a small staff, and they ask Parkland for documents, and Parkland says they can't find them, or they take months to find them. If you look at most of the investigations, it seems that they take several years to play out. You can see how frequent this is at:
ReplyDeletehttp://stopmedicarefraud.gov/innews/texas.html
Many have asked us how they can report additional incidents of fraud at UT Southwestern / Parkland Hospital.
ReplyDeleteCurrently the Government wants everyone to start at
http://stopmedicarefraud.gov/reportfraud.html.
There are phone numbers there, but the best location for a smoking gun document is at:
http://oig.hhs.gov/fraud/hotline/
and specifically
http://oig.hhs.gov/report_fraud/OIGFraudForm.asp
Or contact an attorney using the topic "Federal Whistleblower Claim and Protections" and have them file for you.
As more and more people move forward on this, we will keep you informed as to the successful methods or defense's used by UT Southwestern / Parkland Hospital.
Thank you BOB. This is a battle we can win with persistence and the truth. Its a battle we have to fight for the patients, the tax payers and ourselves. There is power in numbers and we need to keep moving forward. The internet makes it more difficult for upper managment to divide and conquer employees
ReplyDeleteLarry-
ReplyDeleteConsidering how you've been portraying yourself as the pied-piper of antiracism and all else that is sacred and holy, I'm truly suprised that you allowed the 6/5/10 at 12:02 pm post to survive on this blog.
Clearly, one of your multiple personalities that writes all these comments to each other is an anti-semite.
Why dont you try practicing what you preach????
To Anonymous 8:16 pm
ReplyDeleteYour comment to bring racism into this discussion is a new low for you Joseph Pxxx Mxxxx, M.D., M.B.A., F.A.C.S., F.C.C.M.
If you don't have the skills or the intelligence to discuss a topic then maybe you shouldn't be in the position you are in at UT Southwestern.
To the other Readers, it is very difficult to write a blog and not get the negative comments injected into the blog. People are people and they have their opinions.
When the DMN posted a comment about a Hispanic patient who died, it brought out all the anti immigration/healthcare political comments. But the man was a US citizen who paid his taxes. These comments that were off topic and was a clear example of how to use comments to moves the article off topic. Now, the DMN heavily edits or sensors their comments in an attempt to keep the comments “on-topic”. I disagree with this, its censorship.
For us, we decided to leave all comments up to let the Readers make up their own minds on a comment or allow anyone to respond to a comment if they feel strongly.
Here is an example. One night, we discussed whether we should pull down a senior UTSW team member who was posting comments while drunk (a blogging no-no). We know this man very well but his grammar, point of view and emotion would have be an embracement to him in the morning. We left it up but decided not to respond to it.
And as with this comment from Anonymous 8:16, we’ve just decided to point out how certain members of UT Southwestern use a racism comment to deflect the blog off topic.
What the Readers should also know, Anonymous 8:16 pm took the place of the Doctor when he was attacked by UT Southwestern and was instrumental in undermining him with the Residents.
To this old Texas country boy, we call this underhanded New York politics not racism.
Larry-
ReplyDeleteHow dare you accuse ANYONE else of bringing racism into this discussion?
Was that not you on Univision, speaking in Spanish, calling everyone that works at UTSW a racist becuase of your imaginary two-tiered system of care? Was it not you parading the poor Herrera family in front of the cameras when his case had absolutlely nothing to do with the salient points of your case??? You're the racist, and YOU and ONLY you have tried to bring race into this discussion.
While you sit at home blogging all day and night (like most impaired zealots), the UTSW/Parkland surgeons are standing by, ready to take care of anyone that walks in the door without regard to race, creed, color, sexual orientation or religion, just to name a few.
And...please don't think a one minute trip to the office each day fools anyone into thinking you're doing one single thing to earn any of the >$300,000 taxpayer dollars you're stealing every year.
Someone ought to put you in jail for being a low-down, dirty thief!
on May 24th didn't the court rule that at the highest level of UTSW, the level of the Dean, they WERE found guilty of practicing discrimination on the basis of race, color, and creed? I'm confused.
ReplyDeleteAmazing how you can tell who is writing these post there is not reason you doctors/administrators have to hide we all really know the real you and now it is time that the public know I wish anyone who has had problems with UTSW take them to court no matter how long it takes and CYA because they will throw you under the bus so fast!
ReplyDeleteTo Anonymous 12:18, you said "...the UTSW/Parkland surgeons are standing by, ready to take care of anyone that walks in the door without regard to race, creed, color, sexual orientation or religion, just to name a few."
ReplyDeleteI'm glad you said this because that means your name will be there as the Attending Surgeons when the "Residents Are Training The Residents" are investigated. We know the Residents and Nurses are there doing the real work and are putting in the 30 hour workdays. We just could find out where you were in all of this. When we walk the corridors, we can never see the UT Southwestern Attending Faculty (the body) making rounds or in OR. Is this that new UT Southwestern Stealth Supervising that everyone at UTSW keeps talking about?
Or are you now announcing that UT Southwestern is quitting the concept of Residents Training Residents finally? No…
Then maybe you are playing your word games again and “standing by” means somewhere on campus or at home “on call”. We know it is not scrubbed and ready to step in when the Residents need it.
Again Joey, this is just more New York hot air and the temperature in Dallas hit 100 today so we know you are doing real good at talking.
He is very good at standing by. He lets everyone else do the work and then bills for it.
ReplyDeleteNow be fair, he is standing by to let the other better surgeons do the work.
ReplyDeleteTo the person who posted at 12:18, accused the doctor running this blog of being a racist, and accusing him of calling all 2,000 people who work at UTSW of being racists, may I offer you some advice? Find someone who speaks Spanish, ask them to listen to the interview, and to translate it for you.
ReplyDeleteHe did say what he and others have been saying for years. There is a two-tiered system of medical care used and endorsed by UTSW leadership. Which tier you are on falls along race, ethnicity, and monetary lines.
About the 12:02 post - not even worth a debate. It is so out-of-left-field and absurd it made me "lol". Hopefully that idiot works at baylor which would make one less idiot to worry about on harry hines.
ReplyDeleteSee "When Residents Are Not Supervised-Part 2" by Maggie Mahar (www.healthbeatblog.org), here:
ReplyDeletehttp://tinyurl.com/2cemcv7
To 7:20 - agree with you. The very high ranking UTSW and Parkland official made a big feign of outrage because the system administrator didn't delete that comment.
ReplyDeleteAs stated earlier, threats and obscenity do not have a place on a blog. But if someone makes a statement like the 12:02 one from yesterday, the readers don't need a censor to protect them from seeing it for what it is.
The same utsw department of surgery executive also gave us a show of mock outrage about an interview a doctor gave on the Spanish TV show Univision. The UTSW accuses the doctor behind this blog of being a racist, and of saying that all 2,000 people who work at UTSW are racists.
I have not actually seen the interview. I do know that the doctor said there is a two-tiered system of treatment at UTSW. This is not news.
There are minutes of faculty meetings where the two-tiered system was debated. Some of these minutes have already been posted on this blog.
What you are seeing now are the temper tantrums of utsw managers, who are not used to having people not bow down to them
The post at 7:51 is a sad, but true one.
ReplyDeletehttp://tinyurl.com/2cemcv7
Ishows what happens at teaching hospitals when residents are not adequately supervised. Any experienced physician would agree that the care in this instance was horrible. As one of the faculty said, "a boy scout could have done better."
The residents made poor choices, and incorrect decisions. This is not a criticism of these specific residents. Lecturing or giving a poor evaluation to these residents will not prevent such incidents from happening again. Anyone who has been paying attention to patient safety issues knows, if you want to change the results, you have to change the system.
In this system, the residents did not feel "compelled" to notify the attending when a patient was deteriorating. The nurses did not feel "empowered" to call the attending surgeon on their own.
It is clear to any clinician that the residents were in over their heads, and didn't realize it. And the system did not compel them to notify the attending when a significant change in the patients condition occurred.
In this case it seems that the 15 year old patient died because the attendings did not make rounds on the weekend. Residents were allowed to make rounds, unsupervised.
This blog already contains multiple documents and letters written by surgeons at UTSW who were concerned about the lack of post-operative supervision of patients who underwent surgery care at Parkland hospital.
Those who complained included Professors, the chiefs of trauma, critical care, emergency surgery, and others, saying that it is routine for attending surgeons to NOT make post op rounds on Parkland patients. Not just on weekends, but any time.
I have seen this same scenario of residents providing care without appropriate supervision over and over, often resulting in suffering, complications, and in some cases, deaths.
Specific cases have been provided to the Chair of the Department of Surgery, The Chair of the Parkland Board of Managers, and the Dean of the Medical School, none of which have resulted in any changes in practices.
The website: http://tinyurl.com/2cemcv7 makes it very clear why the standards for resident supervision have evolved and changed over the past few years.
What's very funny about this very high ranking UT Southwestern / Parkland Hospital official is he doesn't speak Spanish. So how does he know what was said on Univision that is broadcast in Spanish? But the Doctor was able to speak fluent Spanish during the interview. Is married to a Hispanic and does lectures in both Central and South America. And if you are Hispanic and sick, he can talk with you directly and not go thru a translator like the others.
ReplyDeleteOh, did I say the Doctor is also a better doctor than this very high ranking UT Southwestern New Yorker that only speaks in your face New York affluent slang.
And for the two-tiered system of treatment at UTSW, meeting notes from UT Southwestern already have document this. It is where the statement – the rich and insured go to the other two hospitals and the “leftover junk goes to Parkland”. Not one of UT Southwestern’s finest days. Their staff needs sensitivity training and a roll of duct tape to keep their mouths shut.
Meanwhile enjoy the New York temper tantrums and understand, this is where the vindictive retaliation comes from.
Night night Joey... If you are at work, sleep tight.
It is very clear from the posts at 12:18 PM today, and at 12:02 PM yesterday, made by a person who is in a high managerial position in both the Department of Surgery, and at Parkland, are sandbox level temper tantrums.
ReplyDeleteClearly, these institutions have lost their ability to hide their problems from the public by using their usual intimidation and fear tactics.
The credibility of these institutions has taken a real hit by the series of articles that have been published in the news, and by the publication of of documents on this website that these institutions thought would never see the light of day.
The new UTSW president Dr. Daniel Podolsky makes the situation worse by trying to tell the UTSW community what they should think by sending out letters that are childish fibs.
Anonymous said "The nurses did not feel "empowered" to call the attending surgeon on their own."
ReplyDeleteIf we did, we would be on the street within a hour.
Doesn't anyone at UTSW tell the truth. My god look at all the games that a played. No wonder nothing gets done.
ReplyDeleteVery true. Now you know why it take so long to get into Parkland. All the politics and BS games.
ReplyDeleteDoes anyone know of a nurse that has been retaliated against?
ReplyDeleteI have had calls from a number of nurses who were retaliated against. A few were too scared to tell me their names, but wanted my advice. Others have given me their names, but have asked me not to give it out due to fear of retaliation.
ReplyDeleteYou would have to indicate the reason why you want this information.
I wonder if the new UT Southwestern Public Relations Team has people on it that speak Spanish.
ReplyDeleteThey now have another scandal on their hands, this time it is in Spanish and on TV.
When will this ever end...
To the nurse who said at 9:48 PM that a nurse who complained would be on the street within an hour, your comment is very important.
ReplyDeleteAll of the recently published documents, articles, and position papers on improving patient safety state that the system will only be safe when a nurse feels empowered to question the decisions of the Chairman of the Department of Surgery without fear of retaliation.
In fact, exactly that statement was made by Dr. Peter Pronovost, perhaps the nation's leading authority on reducing medical errors in his testimony to congress.
Hospitals where nurses do not feel supported to that extent will never be first rate. I read a very interesting article about this recently, and will try to post it when I get back to town next week.
To 9:50 who asked, "Doesn't anyone at UTSW speak the truth?" The two letters that Dr. Podolsky sent out to members of the campus were either misleading, or flat out misstatements.
ReplyDeleteParkland CEO Dr. Ron Anderson did the same thing in his comment on the story. Parkland has a policy stating what operations a resident can do, based upon their level of training. It also describes the level of supervision and faculty involvement that is necessary. You can see it at:
http://www.scribd.com/doc/32332493/Chart-of-Clinical-Privileges
You’ll have to download it, or find the zoom button to see it properly.
It's extremely embarrassing. On the top of the first page, Level 1 supervision means the attending has to be in the OR. Level 2 says the attending or a senior resident has to be somewhere on campus and available for consultation.
Every general surgery case, no matter how big, from removing a lung, to doing a kidney transplant can be done by the residents with "Level 2 Supervision." A faculty member just has to be somewhere on campus, available for consultation. The campus is so large that if something went wrong in the OR they may need to take a bus to get there.
Page 4 says a 2nd year resident can perform a radical mastectomy if they have a 4th year resident supervising them. An intern (1st year resident) can take out your appendix if there is 2nd year resident supervising them.
These policies are not in accordance with legal rules. Billing rules require that the faculty member be physically present in the OR, supervising, and in direct control of the case.
Anderson was questioned about this in the May 30th DMN article that stated “feds are probing alleged fraud at UTSW and Parkland.”
According to the DMN, "Parkland's president and chief executive, Dr. Ron Anderson, said the chart was simply a "guide" for nurses who monitor operating room procedures."
Everyone who works or has worked in the Parkland OR, including faculty members, nurses, and residents, knows that was not a truthful statement. I doubt if any of them had ever seen the “guide” before.
That 29 page document was NOT something that was just left lying around in the OR for nurses to use to check if it was OK for a 4th year resident to take out someone's lung without faculty supervision (the chart says that is OK at Parkland).
It took filing a Freedom of Information Act request and an 8-month wait before I was able to pry that 29 page document out of Parkland's hands.
That untrue statement just rolled right off of Anderson's tongue.
If the top of UT Southwestern can not tell the turth or understand why it's so important, then how do they expect us to believe them about the Medicaid Billing Fraud issue?
ReplyDeleteAs serious as the Medicaid billing fraud issue is, it’s not what concerns me. When the senior Resident trains a junior Resident, mistakes will happen. The Supervision Surgeon or Attending UT Southwestern Faculty is supposed to be there in the OR as the backup. But they are not. How many mistakes are covered up or not fixed because of lack of supervision?
ReplyDeleteThis is the real issue. This is not top of the line medicine and it’s what I now call scary as hell medicine. Residents must be trained I know, but by trial and error?
Would you let a student pilot teach a student pilot on a commercial flight? The Supervising Surgeon is there to help guide the Resident thru the procedure not as one Resident said, “Oh, I read up on the procedure last night.”
You know with all the lying that is taking place in this story by the UT Southwestern / Parkland Hospital Faculty and Management, how can anyone trust the results and integrity of UT Southwestern research and testing being done.
ReplyDeleteIt seems that lying is second nature to them.
You don't think they would cook the results or fudge on the grand hours work do you?
ReplyDeleteSomeone really made a great comment, but they sent it in response to a much earlier comment. I am reposting it up here with the latest response so that hopefully more people will see it. It is a newspaper story that covered the Federal Investigation of the University of Washington, and how similar it is to the current federal investigation of UTSW and Parkland.
ReplyDeleteNoted faculty members wrote letters to the Dean who found all of the allegations unfounded. He hired a law firm and medical experts to investigate. All had obvious conflicts of interest, and they all said the billing fraud allegations were untrue.
Uncannily similar to what Gilman did. He actually put UTSW Department Chairman in charge of investigating whether the billing fraud allegations were true. The article below is very interesting:
http://seattletimes.nwsource.com/html/localnews/2001950792_ramsey08m.html
The most important part of Podolsky's response to the Dallas Morning News story that announced that UTSW and and Parkland are being investigated for fraud by the feds is that Podolsky NEVER DENIED IT!
ReplyDeleteHe took the readers on a long, diverting discussion about a qui tam billing fraud case that was filed in the 1990's, and that was dismissed on a technicality in 2002. He never mentioned, denied, or even discussed the headline allegation: That UTSW and Parkland are being investigated for fraud RIGHT NOW, not just in the 1990's.
Finally, the Feds have arrived.
ReplyDeleteHay, do you think the reason UT Southwestern / Parkland Hospital is getting so pissed is because people are now being talked to?
ReplyDeleteThis may sound silly, but I hear there is a run on attorneys which bring us the question, does Dallas even have 2,000 attorneys to cover the 2,000 doctors at UT Southwestern?
Robert 7:13 good find. It's the same thing that UT Southwestern has done.
ReplyDeleteBut it also brings up a question. How did the Fed sue the State of Washington where the UW and UW Faculty were considered the “People”. This is the same scenario that UT Southwestern / Parkland Hospital used in their Stevens v. Vermont defense to the False Claims Act (FCA). UT Southwestern claimed that they were part of the State of Texas and therefore the Fed’s could not sue the State.
Not sure of the details, but the two departments at UW that the Feds took down were Neurosurgery and Nephrology. These Departments set themselves up as contractors who provided theIr services to UTSW, and thus exposed themselves.
ReplyDeleteWell, I'm the confused. Are you saying that the Feds can not enforce the Medicaid / Medical rules on UT Southwestern / Parkland Hospital because they are part of the State Of Texas?
ReplyDeleteTest
ReplyDeleteI is confusing. The feds can stop a governmental agency from stealing from them. There is a particular type of lawsuit where a private citizen notifies the government that someone is stealing from them. This would be in a situation where the government would have no way of knowing that they were being charged $500 for a hammer, or $800 for a toilet seat, except for the "relator" giving them this information. The government can then sue to get this money back. As I understand it, the Stevens's case decided that private citizens cannot do this anymore. The feds can still enforce the rules, but private citizens, who were encouraged to report wrongdoing, not longer have any incentive to do so, unless they want to get beat up and retaliated against by their employer. Nevertheless, some creative ways filing successful cases against the government have been made, despite the Steven's case.
ReplyDelete