UT Southwestern and Parkland Hospital Stories

UT Southwestern and Parkland: Whoops, Another Lie! Why Can't They Stop Lying?

2011-10-16T08:32:00.000-06:00

We know that after the U.S. Department of Justice and after the Texas Attorney General found UT Southwestern and Parkland guilty of bilking and defrauding the Medicare and Medicaid programs, both Parkland and UT Southwestern said that by paying the seven figure fine (their biggest one yet), that brings their legal problems to a close. See the last sentence on this one.

And, then there is Parkland making the same claim that their legal problems are over, as stated by their media person, April Foran:

We know from News articles that the U.S. Attorney thereafter heightened their interest after the billing fraud findings, and is now conducting a more widespread inquiry. And as far as them being in the clear in regards to billing fraud, see the following, filed three days ago in Federal Court. Note, this another lawsuit about the United States of America as the plaintiff, going against UTSW:

UT Southwestern and Parkland: The Unique to Parkland Service Improvement Agreement

2011-10-04T03:47:00.005-06:00

This document is pretty technical and in legalese, but it is the only thing keeping Parkland's doors open right now. It may not reveal any new scandals, but there are numerous hits on this website from organizations around the country that are writing about Parkland. This helps them to find what they need here. It contains the agreement between Parkland and CMS that basically constitutes a federal takeover of the hospital for the next 19 months. This is the first and only such agreement between a university-associated acute care hospital and the federal government. It memorializes how far Parkland has fallen under current leadership.

It is interesting that CMS is ordering Parkland to, "Acquire Expertise in the Development and Implementation of an Effective Quality Assessment and Performance Improvement (QAPI) Program." That pretty much clinches that Parkland does not have one now. Despite all of the highly paid executives there are not with the expertise to implement an effective quality control program. The report goes on to say that Parkland must have an, "On-Site Expert" in compliance. That's another group of executives not doing their jobs within the existing Parkland Office of Billing Compliance, none of whom were fired when the U.S. Attorney found Parkland guilty of Medicare and Medicaid fraud.

Click on images below to enlarge.

UT Southwestern and Parkland: Heartbreaking Findings by CMS

2011-09-03T20:59:00.001-06:00

The CMS and Texas Department of Health inspection said that Parkland patients, under the care of UT Southwestern Faculty, are placed in "imminent danger." The report was 600 pages long, so not too many people are likely to have read it. It's technical, and can take a few days. Below are a couple of pages that highlight the whole problem.

But the first part of page 109 indicates that Medical Residents are not Qualified Medical Professionals, are not appointed to the medical staff through the hospital credentialing committee, yet, they were the ones performing screening exams in the emergency department. Every single time such a patient is evaluated and discharged it is an EMTALA violation punishable by up to a $50,000 fine. What is sad is that both Parkland and UT Southwestern knew that the U.S. Attorney, Inspector General, Texas Attorney General, Health and Human Services, and others were investigating them for allowing residents to work without supervision for the past four years. They didn't care. Maybe the $1,400,000.00 fine will catch their attention. But starting on the bottom of page 109 is the sad story of Patient #3.

Per below, the inspectors found a patient sitting in agony for over an hour. No Qualified Medical Professional (attending) had seen the patient. She was improperly sent to sit in a chair in the hallway, despite her severe distress. Then their is the story of patient #13, stumbling in the hallways, practically blind, in severe distress with an acute eye problem after being inappropriately being sent out of the ED without an exam by a Qualified Medical Professional. The Inspector sent the Parkland Executive that was "escorting" him/her back to the ED to get a wheelchair, put down the clipboard and took the patient back to the ED to get her properly cared for.

Poor patient #14, was sent out of the ED without an examination by a Qualified Medical Professional and told to walk to clinic, even though she could hardly walk. This time the Parkland Executive "escort" had to render medical aid to patient #14 in the hallway while the Inspector took patient #13 back to the ED. A fiasco of problems right outside the ED doors. And this was in the morning when it wasn't busy, and the ED Director was staffing the triage desk.....

Poor patient #6 below, a three year old child. Notice the Plan of Correction was for Parkland to admit that it will stop breaking the EMTALA Law.

Per below, it can be seen that Non-Qualified Medical Providers are providing care without attending coverage.

The report is 600 pages of case, after case of UT Southwestern and Parkland violating the Conditions of Participation for Medicare and Medicaid funding. That is why they were given two weeks to fix it, or be dropped from the program.

UT Southwestern and Parkland: The Criminal Charges Filed by the U.S. Attorneys Medicare Fraud Unit, and the Texas Medicaid Fraud Unit

2011-09-02T12:27:00.004-06:00

The term “qui tam” is derived from the Latin adage qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning “he who pursues this action on our Lord the King’s behalf as well as his own.” Qui tam lawsuits extend back to 695 A.D. The reasoning behind it is, “each man is to be judged by his peers of the same neighborhood.”

Around the time of the Civil War the United States Congress passed a qui tam act and referred to it as the, “Lincoln Act.”

The law was designed to prevent government contractors from supplying faulty equipment to the Union Army in the Civil War. Sometimes the army would pay a high price, only to receive a shipment of fake bullets that wouldn’t fire, or boots made out of cardboard. Abraham Lincoln believed this should be punished, and requested a qui tam statute, saying, “Worse than traitors in arms are the men who pretend loyalty to the flag, feast and fatten on the misfortunes of the nation while patriotic blood is crimsoning the plains of the south and their countrymen are moldering in the dust.”

The 1863 Congress created the original False Claims Act by combining “Lincoln’s Law” with the already existing concept that citizens are obligated to discover and expose fraud. When a fraud report is made to the government, they evaluate it. If they find enough evidence the government takes over the qui tam case. The citizen, known as the “Relator,” becomes a bystander, and the government then prosecutes the criminals.

How does this relate to health care? In 1965 President Lyndon Johnson established Medicare and Medicaid to provide insurance coverage for the elderly, the disabled, and the poor. Prior to that, these patients had no option but to go to a “charity hospital.”

At a charity hospital it was understood that care would be provided by residents and students, or by doctors-in-training. Patients assumed the risk of receiving care by "not yet qualified doctors" because it was free, and because they had no other option.

Once Medicare and Medicaid were established the care was no longer being provided for free. The government was paying for it. Soon, the government became the nation’s largest payer for health care. Congress then declared that it is illegal to provide a different standard of care to a Medicare or Medicaid beneficiary, and a patient with private insurance.

If an attending surgeon scrubs in and performs a two-hour operation on a patient’s gall bladder at a private hospital on a patient with commercial insurance, it is expected that a doctor operating on a Medicaid patient with a gall bladder problem at the county hospital will provide the same two hours of work when operating on his or her patient.

Why should a doctor collect $1,000 for two hours of work at the private hospital, while a doctor in the county hospital collects the same $1,000 for two minutes of work when all that they did was rouse themselves from the call room to go to the OR for two minutes, just to sign the billing paperwork?

The hospital's food, TV’s and other amenities may be different, but there cannot not be two separate standards of medical care, one for county hospital patients, and one for private patients.

Also, the federal government pays the salary for almost all medical residents in the United States. Hospitals receive roughly $90,000 per year from Medicare for every resident they employ. This pays for the residents’ salary, benefits, and other expenses.

It is illegal to submit a bill to Medicare for work performed by a resident. The reason is because Medicare is already paying the resident’s salary. If the resident does the two-hour gall bladder operation and also submits a bill asking the government to pay him or her for doing the operation, that’s double billing because the government has already paid them.

This also means that an attending cannot bill for work that a resident did. During surgery an attending must be standing, “elbow-to-elbow, shoulder-to-shoulder,” during all critical phases of the operation in order to be considered as participating enough to bill for it. The critical phase of an operation is described as, "any part of an operation during which, if a deviation in care occurs, it could cause harm to the patient." That’s almost all parts of almost all operations.

Also, if a faculty member wants to bill for an admission, for seeing a patient on the wards, for seeing a consult, or for a clinic visit, they must be physically standing in the room with the resident while the resident is obtaining a history, and performing the physical exam. If the attending was not standing in the room providing direct supervision of the resident, then attending must do their own, independent history and physical in order to bill for it.

When President Johnson started Medicare and Medicaid and it became the predominant form of medical insurance in the country, his Surgeon General advised him that this gave them great leverage to reform health care. They decided to establish, “Conditions of Participation” in Medicare and Medicaid. One of the first conditions was that in order to qualify for government funding, a hospital couldn’t practice racial discrimination. This Condition is widely credited with desegregating hospitals in the South in very short order.

There are a number of Conditions of Participation, but a very important one is that surgery cannot be performed on a patient without their consent. There are specific elements of informed consent, including that the patient must know who his or her doctor is, and their doctor can never be a resident.

Hospitals across the country had trouble making adjustments to some of the resident supervision rules. It wasn’t until the 1990’s that the government began to crack down. A number of universities were fined because they billed Medicare and Medicaid for operations and medical care that was largely provided by residents. This includes the University of Texas at Galveston, UT San Antonio, Texas Tech, and over 20 other medical schools across the country. Typical fines were in the $15 to $30 million-dollar range. This caught everyone’s attention, and caused hospitals to reform their resident supervision practices by the end of the 1990’s.

Around that time, UT Southwestern’s own Chief Billing Compliance Officer, after failing to get UTSW to reform, used the qui tam provision and reported to the federal government that UTSW was not complying with Medicare and Medicaid billing rules in almost all services at Parkland Hospital.

Then, in the year 2000, the Supreme Court passed a new, “Steven’s rule,” that made it almost impossible for the federal government to take an action against a state government entity. In other words, if a state entity like UTSW defrauds Medicare and Medicaid, it is now very difficult for the federal government to get the money back. Very shortly after the Supreme Court decision, the U.S. Department of Justice dropped the UTSW Billing Compliance officer's qui tam fraud case against UT Southwestern, after it decided that the new rule made it too hard to collect.

Now it appears that despite the difficulties, this doctor prevailed in a qui tam lawsuit against UT Southwestern, despite the odds. The size of the settlement does not reflect the amount of the fraud, which the Texas Medicaid Fraud Unit estimated was approximately $45,000,000.00. It reflects the difficulty inherent in prosecuting qui tam claims against state agencies such as UT Southwestern.

The government began investigating in 2007. Finally, on August 31, 2011 the U.S and Texas Government notified Parkland and UT Southwestern that they were filing charges of Medicare and Medicaid Fraud against both of them, in what is called a Notice of Intervention.

The following day on September 1, 2011, UT Southwestern and Parkland settled the case by paying a $1.4 million dollar fine. The government reserved the right to pursue them for tax fraud, criminal fraud, to expel both of them from the Medicare and Medicaid programs, and to pursue them for various other infractions.

The document below is quite long, and some parts should be skimmed. However, it contains many chilling moments about what goes on in the care of typical Parkland patients. After reading this you’ll realize why the Government decided to intervene. Remember, the document below is the Federal and State Governments case. It is not the doctor's case. It is about crimes that the Government is charging UTSW and Parkland with committing. That is why it says, “United States of America, ex Relator Larry Gentilello, M.D, v. UT Southwestern, Parkland, et al.”

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UT Southwestern and Parkland: More Lawsuits, As Far As the Eye Can See

2011-08-28T17:33:00.023-06:00

Someone left a comment on the previous post, asking if this blog has been retired, "now that the lawsuits are over." It is my understanding that UT Southwestern and Parkland are facing lawsuits for years to come, from multiple parties. Some are known, others will soon be known, others have been filed under various types of seals to protect the parties from retaliation by UT Southwestern and Parkland. Also, the Federal and State Government are certainly not finished with either of them yet.

This was predicted several years ago. A group of new faculty members were recruited to try to restore Parkland's national reputation as a trauma center, but were deeply disturbed by UT Southwestern's tradition of treating patients that go to their private hospital as VIP's, while treating Parkland patients as, "guinea pigs." Yes, that term is in sworn testimony in official court proceedings.

The CMS fiasco and current potential closure of Parkland is now well known nationally. Most of the Dallas Morning News stories have been picked up by various news wires, and have been carried in newspapers and shown on television around the country. There are now over 1.3 million websites about Parkland's problems with hygiene, lack of resident supervision, and its numerous deficiencies as a hospital. And this is a big black eye for UT Southwestern. Everyone knows that Parkland is where its residents go for the majority of their training. Residents do not prefer learning how to do sub-standard care at sub-standard hospitals.

This was unavoidable. Newly arrived faculty members told the "old guard" UT Southwestern and Parkland managers and officials that allowing residents to provide unsupervised patient care might have been the norm through the 1960s and 1980's, but could now get an institution into a lot of trouble.

Parkland and UT Southwestern were intransigent and refused to even consider allowing Parkland patients the right to be treated by a fully trained doctor. They had always let doctors-in-training and students practice on them, said that's the way it has always been, and that's the way it always will be for the poor and indigent of Dallas County.

Discussions were held with several members of the legal community, and documented proof was offered. Faculty members stated that residents were providing unsupervised medical care at Parkland, and UT Southwestern Medical School was billing Medicare and Medicaid for the services, even though the faculty members were not present or involved in the procedures. This is felony billing fraud.

Members of the legal community informed us about the legal reputation of Parkland and UT Southwestern. They said it would not matter how much we complained, or how much proof we provided.

They said the reputation of UT Southwestern and Parkland in the legal community is that based on the personalities of Kern Wildenthal and Ron Anderson they were arrogant to the point of considering themselves to be god-like creatures who could do no wrong.

They said that UT Southwestern and Parkland would never admit to committing any fault. They would rather spend tens of millions of dollars in legal and court costs out of taxpayers money denying wrongdoing, and would even bring the institutions themselves down in flames rather than admit to fault, or that that changing their way of doing things was needed.

These legal opinion turned out to be true.

Here is what one witness, a new faculty member at UTSW assigned to Parkland had to say.

18 Q. Doctor, you were explaining to me earlier about
19 the fact that at the time you were in your own training
20 as a resident and a fellow, and then subsequent to that
21 when you were teaching faculty, you became familiar with
22 the system by which a physician would -- or say a
23 resident in training would evaluate a patient, then
24 consult with faculty, make a decision about whether or
25 not surgery in this circumstance was indicated, and then

1 how you would be present at most of the surgery that was
2 done on a patient if a resident was in charge and you
3 were faculty do you recall that conversation?
4 A. Yes.
5 Q. Once you arrived at UT Southwestern, did
6 Parkland routinely handle it the same way you had seen it
7 handled at the various institutions where you had either
8 trained or been faculty in regards to faculty involvement
9 in the preoperative assessment of patients and having a
10 say in what should be done with that patient before
12 A. No.
13 Q. Was it a completely different culture than what
14 you had been exposed to in the past?
15 A. Yes.
16 Q. Could you explain for us, sir what the
17 differences were in that regard?
18 A. Sure. The glaring difference was that the
19 patients were at Parkland routinely taken to the
20 operating room without the knowledge of the patient
21 actually undergoing the beginning of the operation by the
22 attend -- without the attending's knowledge of the
23 patient undergoing surgery.
24 Frequently patients were being taken to the
25 operating room without the attending having never seen

1 the patient.
2 Q. ?
3 Q. Does that mean, sir that a resident or a doctor
4 in training would assess the patient, come up with a plan
5 of care, and then at times go forward with that plan of
6 care and take the patient to an operating room for
7 surgery without that patient having been examined and
8 personally evaluated by an attending?
9 A. Yes.
10 Q. Okay. Did that concern you?
11 A. Yes.
12 Q. Why did that concern you?
13 A. Because the level of experience of the resident
14 may not be adequate to make that decision and it may put
15 the patient at risk.
16 Q. Did you have any experience with a surgery
17 actually proceeding, that is incision made into the
18 patient and some part of that surgical procedure
19 beginning, before you were paged to come to the O.R.?
20 A. Frequently.

That conversation from four years ago sounds similar to what Parkland was told three weeks ago on August 9th in the 600 page CMS Statement of Deficiencies at Parkland.

Ron Anderson and John Shannon keep referring to the report as mainly being concerned about hand washing and changing of surgical gowns. If you read the report you will see that was just a diversionary excuse. The primary findings were that, "emergency patients were not being seen by a QMP," or Qualified Medical Provider.

QMP also stands for an attending UTSW faculty member who is part of the Parkland Medical Staff. Residents are not part of the Parkland medical staff, and they are not Qualified Medical Providers. As such, they are not allowed to perform surgery or emergency evaluations of patients except under the direct supervision of an actual QMP, or attending faculty member.

I suspect not many people read the entire 600 page report. It took me four days to get through it. The predominant finding was that at Parkland patient care is rendered by a resident rather than by a Qualified Medical Provider.

A second major finding was that Parkland has innumerable violations of the anti-dumping EMTALA Law. EMTALA requires that any patient with an emergency medical condition or who appears to be in active labor must not be discharged from the ER until a Qualified Medical Provider has evaluated and stabilized the patient.

It was the routine practice of Parkland to a resident, but not a Qualified Medical Provider, evaluate the patient and send them away. That was the routine, daily practice at Parkland. The EMTALA Law was being violated day after day at Parkland, and was embedded into Parkland emergency care policies, procedures, and routines.

This problem of residents "practicing" on poor and minority patients without supervision has been discussed for years at Parkland, and any protests raised by newcomers have been squelched.

Surgeon Witness:

Q. So if something unexpected happens in a surgery
3 that has begun without yours or another attending's
4 knowledge, that could be devastating and potentially
5 life-threatening for a patient?
6 A. Yes.
7 Q. But that is a practice that has gone on at

Bob Rege, MD

8 Parkland to your observation?
9 A. Yes.
10 Q. Was that frustrating to you?
11 A. Yes.

24 Q. Were you told by Dr. XXXXXX, whether he was
25 making progress in that regard with Dr. Rege, as far as

1 changing the policies and procedures?
2 A. He felt that what he told me was that he was
3 meeting opposition to making those changes.
4 Q. Let me ask you about how the residents reacted
5 to concerns raised by you, Dr. GXXXX and others,
6 about their supervision in the operating room?
7 A. They -- they wanted to dismiss it. They didn't
8 agree that things should change.
9 Q. Did you get pushback from them?
10 A. Yes.
11 Q. Did some of your colleagues get pushback from
12 them?
13 A. Yes.
14 Q. Could you tell us what happened to Dr. XXXXX
15 when he first arrived, early in his arrival when he tried
16 to assist in a surgery on one of his patients that was
17 being done by a resident?
18 A. When he attempted to put his hand in the
19 abdomen to perform a portion of the procedure, the
20 resident slapped his hand.
---
20 Q. So would it be fair to say that Dr. Rege as
21 chairman of the department was well aware of the fact
22 that several members within the department of the BTCC
23 faculty members were expressing concerns that residents
24 had inadequate supervision in the operating room?
25 A. Yes.

1 Q. To your knowledge did he do anything to change
2 that?
3 A. No.
4 Q. To your perception did he think it needed to
5 change?
6 A. No.

It also seems to us that the lack of supervision at Parkland, compared to UT Southwestern Medical Center Hospitals, has racism as its basis.

Witness:

17 Q. Doctor, there has been some discussion within

Jim Valentine, MD

18 your division where you and/or some of your other faculty
19 members complained to Dr. Valentine about being labeled
20 the pus service or the junk service; are you aware of
21 that?
22 A. Yes.
23 Q. Tell me about that situation.
24 A. The perception is is that because we're dealing
25 with indigent patients and patients with poor insurance

1 that they frequently will not seek out medical care in a
2 timely fashion and so their needs are different from an
3 insured patient population. Their disease processes have
4 allowed to progress and frequently it involves
5 infections, surgical infections and not necessarily the
6 glamorous surgery that is viewed as occurring in some
7 other private hospitals.
8 Q. And is this -- this description of the service
9 as a pus or junk service, it's derogatory in nature isn't
10 it?
11 A. Yes.
12 Q. And offensive to you?
13 A. Yes.
14 Q. And offensive to other faculty members in your
15 division?
16 A. Yes.
17 Q. And extremely offensive to Dr. GXXX?
18 A. Yes.
19 Q. And when you say patients have often progressed
20 when their disease diseases have progressed because
21 they're indigent it's not because they don't want care
22 it's because they can't afford it?
23 A. Correct.
24 Q. You're not at any way critical to patients that
25 can't present?

1 A. No.
2 Q. It's just a fact of their life that they don't
3 have available medical care that other people do?
4 A. Correct.
5 Q. Did Dr. GXXX to your knowledge complain
6 about that characterization of his patient population to
7 Dr. Rege and/or Dr. Valentine?
8 A. Yes.
9 Q. Did they try and take any action to try and
10 correct that that you're aware of?
11 A. No.
12 Q. The residents felt free to sort of use this
13 derogatory tone in your presence or around others without
14 any kind of retribution?
15 A. Yes.
16 Q. Doctor, have you heard the term two tiered
17 system as it would apply to Parkland Hospital versus
18 Zale-Lipshy hospital versus St. Paul Hospital?
19 A. Yes.
20 Q. Was that a topic that was discussed within the
21 department of the Burns, Trauma and Critical Care unit?
22 A. Yes.
23 Q. Was that a concern to you?
24 A. Yes. ?
25 Q. To your knowledge were the concerns that a two

1 tiered medical system existed ever made known to Dr.
2 Rege?
3 A. Yes.
4 Q. And/or Dr. Valentine?
5 A. Yes.
6 Q. To your knowledge was Dr. GXXX concerned
7 about that fact?
8 A. Yes.
9 Q. Could you tell us, please, sir, what you mean
10 when you say that there's concerns about a two tiered
11 medical system existing for, A, the patients at Parkland,
12 and B, the patients at the other two hospitals that are
13 associated with UT Southwestern?
14 A. Well, what our concern is and what we mean by
15 that is that patients at Parkland it was accepted that
16 the residents would be at the forefront of their care,
17 guiding their care, instituting their care with little or
18 no attending involvement but that this would never occur
19 in patients that were seen at the other two UT
20 Southwestern hospitals where the attending always met the
21 patient preoperatively, was an active participant in the
22 surgical procedure and in the post-operative care.
23 Q. And these are the same residents who are
24 rotating through Parkland?
25 A. Correct.

1 Q. So these residents felt free to treat their
2 patients in one way at Parkland, that is the indigent
3 patient population, but met the expectations of the
4 attendings at St. Paul and Zale-Lipshy that the
5 attendings be involved all the way, correct?
6 A. Correct.
7 Q. They disregarded in large part your demands,
8 requests, and desire for it to be the same at both
9 institutions?
10 A. Correct.
11 Q. And did Dr. GXXXo express that same
12 desire, that it be the same patient care at both
13 institutions?
14 A. Yes.
15 Q. And is that when you were advised, either
16 directly or indirectly, that this is the way we do it at
17 Parkland and we don't think we're going to change?
18 A. Yes.

The original question that led to this post was, "now that the lawsuits have ended, is this blog dead?" The answer is, NO. It is just starting.

It is illegal for a health care worker to bill Medicare or Medicaid for a service that they did not provide. Several years were spent trying to convince UT Southwestern and Parkland that there was a lack of attending participation in patient evaluations, bedside rounds, involvement in clinics, and performance of operations. Yet, Parkland (taxpayers, actually) were paying UT Southwestern over $120,000,000 per year for the faculty to supervise patient care at Parkland. However, the residents were providing the care while those faculty members remained seated in their office, or were asleep in bed.

And in addition to the $130,000,000 that UT Southwestern receives from Parkland each year for providing patient care, if the patient has insurance UTSW also bills the insurance company and keeps the money. If the patient had Medicare coverage UTSW would bill Medicare and keep the money. If the patient had Medicaid, UTSW would bill Medicaid and keep the money.

On top of that, even if the patient had no insurance, no Medicare, or no Medicaid, UT Southwestern had worked out a sweetheart deal with Parkland where they would pay them much as if the patient had insurance! UT Southwestern had a no-lose, sweetheart deal, and still, according to the August 9, 2011 CMS investigation, it could NOT get UT Southwestern to send Qualified Medical Providers, or QMF's, to take care of Parkland patients.

Parkland patients were left, as stated in court, to be treated as "guinea pigs" as learning material for students and residents.

It is a federal crime if the attending did not provide the care, and was in bed or in their office, because residents are not Qualified Medical Providers, and are not allowed to bill for their services. When residents provide the service but the faculty bill for it as if they were the providers, it is punishable by up to five years in the federal penitentiary.

After continued complaints from newer faculty members who were uncomfortable with the expectation that they were not supposed to actually participate in the surgical care of their patients, but were supposed to, "let the residents learn by their mistakes," the Chair of the Division of Burns, Trauma and Critical Care was demoted to quell the opposition.

However: The Texas Whistleblower Act prohibits taking an adverse employment action against an employee who “in good faith reports a violation of law by the employing [city] or another public employee to an appropriate law enforcement authority.”

A person cannot be fired, demoted, harassed, have their pay reduced, receive a poor evaluation, or experience any adverse personnel action if in good faith they report that someone is breaking the law in their workplace. Billing Medicare and Medicaid for surgical services performed by residents, and misrepresenting that the services were performed by faculty, is a felony.

A series of disputes about this UT Southwestern conduct, performed in collusion with Parkland Memorial Hospital, led to a demotion despite the protection accorded by the statute..

In Criminal Court in June 2007 UT Southwestern, defended by the Texas State Attorney General, pleaded Sovereign Immunity. They claimed that a citizen is not allowed to sue the State of Texas, and the University of Texas is considered part of the State. The judge denied their motion for dismissal, stating that immunity is lost when the conduct committed by the state is considered a crime. In other words, just because you are the Dean of the Medical School if you are embezzling funds or sexually harassing someone, you cannot fall back on an immunity defense. The judge noted that Medicare fraud is a criminal offense.

UT Southwestern then claimed that to be afforded whistleblower protections the employee must in good faith report to, "an appropriate law enforcement authority." UT Southwestern claimed that Bob Rege, the Department Chairman, was not an appropriate law enforcement authority.

The Whistleblower Act says that a report is made to an appropriate law enforcement authority if the authority is a part of a state or local governmental entity, or of the federal government, that the employee in good faith believes is authorized to: (1) regulate under or enforce the law alleged to be violated in the report; or (2) investigate or prosecute a violation of criminal law.

There was no doubt in Criminal Court that as the Chairman of the Department of Surgery, and as Chairman of the Surgical Billing Compliance Committee, Dr. Bob Rege had the ability to regulate and enforce compliance with federal and state billing rules. All other Chairman do so, using simple measures such as passing a policy that patients are not allowed into the operating room without an attending surgeon being present.

Dr. Rege was also considered by the Criminal Court to be the best person to meet the second prong, being able to investigate that billing fraud was occurring. It was ruled that Rege can speak to the faculty, the OR nurses, examine the time that the nurses document that the faculty walked into and out of the operating room, and compare that with the time that the anesthesiologist recorded the operation as beginning and ending. As Department Chairman, and also as the Chairman of Billing Compliance, it was ruled that he would be the person that most surgeons who were concerned about immediately stopping illegal billing fraud would report to, as did the whistleblower.

Joe Minei, MD

For example, to prove, and then subsequently take definitive steps to stop billing fraud, in his position as Department Chairman and Chair of Surgical Billing Compliance Bob Rege could have looked at random cases, and found most of them to be non-compliant. For example, on X/Y/20ZZ a patient of Dr. Joseph Minei, Surgeon-in-Chief at Parkland, and temporary Chair of the Division of Burns, Trauma, and Critical Care, and Vice-Chair of the Parkland Medical Advisory Council had a patient who went to the operating room for an exploratory laparotomy, sigmoid colectomy, lysis of adhesions, and formation of a colostomy.

According to anesthesiologist's record the operation began at 10:54 PM, and ended at 12:45 AM. Dr. Minei entered the OR at 10:50 AM, four minutes before the operation started. He left at 10:56, two minutes after the operation began. This is extremely complex surgery for which the attending was present for only the first two minutes of the operation.

It wouldn't be very hard for Dr. Rege to investigate, determine a pattern, and properly regulate the billing practices. He wouldn't have had to look beyond the same day. That same day, earlier than Minei's case, a Dr. John Hunt had a patient who went to the operating room for a laparoscopic cholecystectomy. The operation began at 1:00 PM, and ended at 2:50 PM. Dr. Hunt entered the OR to operate on his patient at 1:15 PM, and thought he had enough, leaving the case to the residents at 1:17 PM. You could just throw a dart at the list of cases from that day, and you would find that two attending surgeons didn't even show up for their cases at all!

Some new faculty didn't have much of a problem. Again, we were just picking randomly around that time, and found a patient of Dr. Herb Phelan taken to the OR for an appendectomy that started at 3:50 AM, and ended at 5:01 AM. Dr. Phelan entered the operating room at 3:46, four minutes before the operation began, and left at 3:52, just two minutes after it started, but enough time to sign the billing sheet attesting to having supervised the operation.

Minei then had a patient who underwent a skin graft procedure that started at 5:11 PM and ended at 6:18 PM. Minei entered the operating room at 4:50, well before the procedure started - but, it probably didn't take him too long to fill out the billing paperwork because the nursing notes documenting him as logging out of the OR at 5:05 PM, six minutes before the operation started.

UT Southwestern lost in Dallas County Criminal Court. (click on partial transcript to enlarge).

In Dallas County Criminal Court UT Southwestern lost its claim that it is immune from accountability when they break the law, and they also lost their motion that Bob Rege was the wrong person to whom billing fraud should be reported to, as he was the Chairman of the Department of Surgery, and also was the Chairman of the UT Southwestern Surgical Billing Compliance Committee. Indeed, UT Southwestern's own Billing Compliance website instructed surgeons to report billing fraud to Dr. Bob Rege.

UT Southwestern appealed to the Texas State Court of Appeals on the same issues: they claimed that as a state entity, they enjoyed sovereign immunity and were exempt from lawsuits, and claimed that Bob Rege was not the right person to whom UT Southwestern faculty should report crimes. (As will be subsequently noted by the Court, UTSW never claimed that they weren't committing fraud; they were trying to escape by technicality.) UT Southwestern lost its case its case on both grounds in the Texas State Appeals Court in 2008.

Next, UT Southwestern filed an appeal against the whistleblower to the Texas State Supreme Court.

The Supreme Court ruled also against UT Southwestern, in 2009.

It refused to dismiss the case based on their claim of sovereign immunity. However, the Supreme Court had made a recent ruling (State v. Lueck) that it said it had a bearing on the UT Southwestern Whistleblower lawsuit. It sent the case back to the State Appeals Court and asked it to consider solely whether the Lueck decision had any bearing on whether Bob Rege was, "an appropriate law enforcement authority," that surgeons concerned about billing fraud should report to.

The State Court of Appeals heard that case in July 2010. Again, UT Southwestern was on the losing side. What is significant here is that the wording of the Opinion by the Appellate Court portended and mirrored the wording that would be issued one year later by CMS and the Texas State Department of Health in its 600 page Statement of Parkland Hospital Deficiencies.

If Podolsky and Anderson had read and accepted the Appellate Court decision they would have been able to rectify and prevent the CMS notice to Parkland of their potential termination from Medicare and Medicare, which in effect, means hospital closure. Both were tone deaf, or too arrogant to listen.

The Appellate Judges specifically cautioned UT Southwestern about the criminal nature of allowing unsupervised residents who are not Qualified Medical Professionals to render medical care without direct supervision.

(click on image to enlarge)

Note Footnote 2: it's nice to know UT Southwestern did not contest that the whistleblower reported a crime! Having failed in getting the case tossed out once in Criminal Court, twice in State Appeals Court, and once in the State Supreme Court, UT Southwestern and Parkland found itself back in Dallas County Criminal Court in July 2010, now charged with Contempt of Court!

At the original date of trial in Dallas County Criminal Court in 2007, where UT Southwestern lost its case but said it would file an Appeal, the trial court judge ordered that the status quo be maintained during the time period of the Appeal.

As the whistleblower had been demoted from being the Chair of the Division of Burns, Trauma, and Critical Care, and the Holder of the C. James Carrico Distinguished Chair in Trauma and Surgical Critical Care as a result of reporting a violation of the law, victory at trial would require his reinstatement.

Therefore, the trial court judge ruled that the Division Chair and Carrico Chair must be held vacant, and could only be filled by an interim chair who would then be barred from being considered as the permanent chair after all appeals have been heard.

There were multiple contempt of court issues heard in the July, 2010 Contempt of Court hearing. The three most notable were;

1. Endowment/Appointment of Joseph Minei, M.D. as C. James Carrico, M.D. Distinguished Chair in Surgery for Trauma and Critical Care

UTSW violated the status quo by appointing/endowing Joseph Minei, M.D. with the C. James Carrico, M.D. Distinguished Chair in Surgery for Trauma and Critical Care, the chair position held by Dr. GXXX until his demotion subject of the filing of this lawsuit. This blatant violation of the agreement to maintain the status quo is further example of the obvious retaliation and disregard UTSW holds for Dr. GXXXXX and this Court’s authority to impact its relationship with Dr. GXXX during the pendency of its appeal.

(The second, described below, was retaliation with a frivolous, "incompetence" charge that was made up by Bob Rege and Ron Anderson, and sent to Parkland peer-review. The peer-review committee was so incensed that they spoke to the whistleblower and informed him that it was an, "obvious attempt to abuse the peer-review processes for malignant purposes," and they made sure that Bob Rege and Michael Silhol, both of whom were insistent that the committee find some charge with which to sanction the whistleblower, left with "egg all over their faces." Despite being exonerated, Ron Anderson decided that Parkland has the right to determine who can take call at Parkland, and therefore without any legal or peer-review basis, decided that the whistleblower could not longer take trauma call at Parkland. Since a trauma surgeon obtains all of his or her operative cases by being on call, this effectively ended the possibility of him performing any further surgery, or pursuing justice in court.)

2. Removal from Trauma Call

Ron J. Anderson, M.D., CEO of Parkland, has testified in his deposition that he was aware of the present suit and the issues in the present suit. He has also testified that he was aware of the temporary restraining order that had been entered by this Court. On July 25, 2008, in furtherance of this conspiracy, Michael Silhol wrote to UTSW and asked that XXXX be removed from the trauma call list. A copy of this letter is attached as Exhibit “F.”

The conduct which was the subject of Exhibit F had been referred to the Patient Care Review Committee, i.e., Parkland’s peer review committee by this time. By this date, both Parkland and UTSW knew that objective members of the peer review committee, who were not members of the cabal, had found no wrongdoing on the part of Plaintiff.

The lifting of the stay by the court of appeals was apparently not anticipated by either Parkland or UTSW. Despite this knowledge and despite the fact that Parkland was aware of this Court’s temporary injunction, Parkland nevertheless agreed to assist UTSW in violating the terms of this Court’s injunction. Plaintiff contends that both Parkland and UTSW believed that because of the stay imposed by UTSW’s appeal, that nothing could be done about their conspiracy to violate this Court’s order.

On July 29, 2008, after meeting with Parkland and in furtherance of it conspiracy with Parkland, Robert V. Rege, M.D., chairman of the Department of Surgery of UTSW wrote to Plaintiff and informed him that he was being taken off the trauma call list at Parkland. A copy of this letter is attached as Exhibit “G”.

The purpose of this letter was two-fold. First it was an attempt to defame and discredit Plaintiff in hopes that Plaintiff’s accusations in this suit would have less weight when UTSW completes what will be shown to be a frivolous appeal. UTSW’s assertion of immunity has already been rejected by this Court and twice by the Dallas Court of Appeals. The second purpose of this letter was to damage Plaintiff financially. Plaintiff has already had his income affected by his being removed from the two Chairs referenced in paragraph 2 of the letter. Parkland and UTSW know the removal of Plaintiff from trauma call will further injure Plaintiff economically in hopes that Plaintiff will be unable to continue with this lawsuit due to economic duress.

(As confirmed one year later in August 2011 by CMS, Parkland management placed the lives of patients in serious jeopardy by refusing to take heed of the recklessness and carelessness of allowing non-Qualified Professionals to be in charge of patient care. All of the trauma surgeons who were concerned about the lack of attending supervision of patient care and the legal issues surrounding Medicare and Medicaid fraud were pushed out by Drs. Ron Anderson, John Shannon, and Robert Rege, to the point that there were only a few trauma surgeons left. Trauma surgeons that covered the Level 3 trauma center in Plano became the mainstay of the Parkland trauma service. The remaining coverage was provided by moonlighting thyroid surgeons, breast cancer surgeons, GI surgeons, or by moonlighting residents.)

3. Lives of Dallas Residents at Risk

In order to retaliate against Plaintiff in violation of this court’s injunction, UTSW and Parkland have decided to place the lives of the citizens of Dallas County at risk. Parkland CEO Dr. Ron Anderson testified that trauma coverage was inadequate, and a serious concern. Nearly half of all trauma call was assigned to surgeons from other specialties within the department who had no trauma training, or by residents who were still in-training who functioned as residents during the day, and were “deemed” to be the trauma “attending” while on call at night. Despite the fact that Plaintiff is one of the most qualified trauma surgeons available, Parkland and UTSW have placed their personal vendetta against Plaintiff above the welfare of the citizens of Dallas County.

UT Southwestern and Parkland both claimed that the contempt of court trial could not go forward because they were going to make another appeal. They believed that this prevented any action by the Criminal Court on the Contempt of Court charges. The Criminal Court disagreed and held them liable to Contempt. Both Parkland and UT Southwestern then appealed to the State Appeals Court (again), asking them to place a "Stay" on the Contempt proceedings until other appeals were exhausted.
-----

On August 4, 2010, the State Appeals Court refused their requests. On August 6, 2010, UT Southwestern and Parkland then filed an "Emergency Plea" for relief to the State Supreme Court to stop the Contempt of Court hearing, and all other trial matters until they have had a chance to exhaust all of their remaining possible appeals.

The Supreme Court works very slowly. In fact, UT Southwestern just submitted their written plea to the Supreme Court for emergency relief relative to their August 6th 2010 on May 24, 2011. They are asking the Supreme Court, for the third time, to dismiss the case based on sovereign immunity, and by claiming that Rege cannot enforce Medicare and Medicaid compliance at UT Southwestern Hospitals.

A hearing date in the Supreme Court has not yet been scheduled. UT Southwestern and Parkland have hired multiple legal firms located in Washington DC in anticipation of possible federal criminal fraud defenses, they have hired legal firms that are national experts on white collar crime, and when last I heard, their legal bills on this case are approaching or have already exceeded $12,000,000 in taxpayer money.

The last communication with the Attorney General concerning the amount of billing fraud indicated that the amount exceeds $45,000,000, payable by triple penalties, or over one hundred and thirty five million dollars. And those are just state charges. Federal charges are likely to exceed that amount, as they include the total amount of fines, and up to $11,000 in fines per patient.

Are there lawsuits as far as the eye can see? I don't think claims of Medicare and Medicaid fraud can be bantered about in court for four years, and posted all over the internet, without certain authorities beginning to notice. Let's just say that there are multiple, active lawsuits and inquiries into Parkland and UT Southwestern's patient care and billing practices.

People outside of the Department of Surgery have noticed that the residents in their areas are also practicing medicine without them being Qualified Medical Professionals. UT Southwestern and Parkland were forewarned years ago. The recent CMS inspection confirms that non-Qualified Medical Professionals provide health care at Parkland.

It may take UT Southwestern, Parkland, the Parkland Board of Managers, and the County Commissioners years to sort this all out.

Meanwhile, make sure that if you go to UT Southwestern, be it Parkland, or anywhere else, that you know who your doctor is.

Some that they know about, many of which they don't, but soon will. But we are aware of at least six recent subpoenas.

UT Southwestern and Parkland: Are They Going to Be Shut Down?

2011-08-10T23:05:00.001-06:00

Ron Anderson sent a letter to all employees, saying that they were ready and prepared for the "Make or Break" Centers for Medicare and Medicaid (CMS) inspection. He said that "as always, Parkland welcomes the inspection."

Little did he know that that as usual, Parkland was going to fail.

Anderson said it was a surprise inspection. Anyone who reads the paper or has received the email warnings from him now that they were notified of the upcoming "make or break" inspection months earlier, giving them time plenty of time to prepare. Ron, "three swipes of the blade" said that the inspection would be based on Parkland's most important principles: transparency and servant leadership, and he would let everyone know what the inspection found.

Almost immediately after the inspection he wrote to all, something that could only be described as a layer cake of b#ll Sh^>t, saying that CMS inspectors found only a few minor things, "and Parkland remains accredited, and passed inspection."

Actually, CMS echoed what the Joint Commission said about Parkland two and one-half years ago: "Anyone who steps foot in the ER door at Parkland puts their life in danger.

The federal inspectors ruled that patient care at Parkland is so bad that, "it poses an immediate threat to patient health and safety."

Parkland didn't pass with flying colors as Ronnie "three swipes of the blade" Anderson suggested. Anyone who wants to know why he has this nick name should look here:

http://www.youtube.com/watch?v=LirGs9dWYOM

The first paragraph is pretty densely written legalese, but from there on it's clear. (click to enlarge)

Readers of this blog are familiar with Ms. Ginger Odle. She conducted an inspection of Parkland when it was revealed that Parkland's in-house attorney Michael Silhol, in collaboration with Ron Anderson, Bob Rege, Joe Minei, and Jim Valentine decided that Parkland could be shielded from lawsuits by not completing consent for operation forms until after the operation was complete, and the patient could no longer protest (although there have now been lawsuits and penalties where Parkland surgery was found guilty of operating without informed consent by the Texas Licensing Board.

As readers may recall, Ms. Ginger Odle told Parkland to clean up their act three years ago. Instead, Bob Rege, Joe Minei, Kern Wildenthal, Al Gilman, and their cronies thought that squashing the faculty who complained about billing fraud was a better strategy. (click on report to enlarge).

Perhaps CMS has had enough?

One thing you cannot do is say as Ron Anderson has said, that this most recent inspection was a surprise inspection. It was announced in the Dallas News about two months ago, and Ron "three swipes of the blade" Anderson sent memos to employees about it months ago.

The simple facts are that Parkland has been under the gun for three years now, as the above letters attest. Yet, with all of that time it couldn't get its act together. There is no reason to give a person like Ron "three swipes" Anderson, who personifies poor managerial skills, anymore time in a leadership position.

How did Ron "three swipes" respond to this fifth recent notice about his failed leadership? With his usual defensiveness, excuses, and servant leadership talk.

What does he mean when he says, "we've taken public hits." When a pilot makes a mistake the plane lands nose first into the ground, and the pilot dies. At Parkland, when the intern doing the surgery makes a mistake while the attending is on the other side of the campus, nothing happens to either one of them. He doesn't take any hits. The patients do.

If Ron Anderson and Daniel Podolsky were honest men, none of this would be happening. Forget about the excuse that the Parkland building is old. Bellevue hospital in New York City was founded in 1736. Massachusetts General Hospital was founded in 1811, and is so old they invented anesthesia there. So stop making excuses and lies, then calling yourself "transparent."

If you think that criticism of your leadership is a "hit," your ego has become so massive that you think you represent the hospital. People who want a different solution are not, "nay-sayers." We are just fed up with the fact that you can't lead Parkland anywhere except into more trouble.

UT Southwestern and Parkland: Are Federal Charges About to Come Down?

2011-08-08T14:24:00.008-06:00

Important new documents below. Almost 100% of the doctors practicing at Parkland are employed by UT Southwestern. The Bills for patient care are submitted by UT Southwestern. The bills for use of the Parkland facilities are separate, and are submitted by Parkland.

Now that the FBI has joined in they are being investigated by every state and federal law enforcement agency except border control and homeland security. Between the two of them they have broken every law and health care regulation that one can think about including racism, discrimination based on skin color and religion, perpetrated by UT Southwestern faculty right up to the level of Dean Gregory J. Fitz M.D.

In the last few months they were fined $50,000 for breaking the Health Insurance Portability and Accountability Act (HIPAA), then fined $80,000 for allowing the pharmacy to give millions of dollars worth of opiates and valium type drugs to narcotic traffickers so that they could sell them on the streets of Dallas.

They failed several Joint Commission Inspections, at least four inspections by the Center for Medicaid and Medicaid Services and by the Texas Department of Health, to name but a few.

But, the government moves very slowly, and so there are more. And, they seem to be more serious. The press has reported that both UT Southwestern and Parkland have been under investigation by the Department of Justice and the Texas Attorney General.

UTSW faculty receive specific instructions to run a two-tier, rich-poor, race-based system of care that originates in the highest levels of the administration, with the two Presidents Kern Wildenthal and Daniel Podolsky.

Former President Kern (Where's the Wine?) Wildenthal, MD

Current President Daniel ("For $600,000 per year, of course I'll push Glaxo Drugs at UT Southwestern") Podolsky, MD

Maintenance of the two-tier system where Parkland patients are treated as practice subjects for students, is reinforced by the former and current Deans, Alfred Gilman, and Gregory Fitz.

Alfred Gilman, MD, PhD

(While marketing drugs made by Eli Lilly on the side reportedly for $600,000/yr, multiple states sued for billions because of his lies about the deadly side effects. The Wall Street Journal reported, "Alfred Gilman, and Karen Horn are accountable for a weak stock price and bad corporate governance policies, according to Reuters. It was on their watch that Eli Lilly experienced severe stock underperformance, poor corporate governance practices, and was unresponsive to shareowners.” Investors demanded that Gilman be kicked off the Board.)

Gregory J. Fitz, MD

(Federal jury orders UT Southwestern to pay doctor $3.6 million for racial and ethnic discrimination within Department of Internal Medicine, Chaired by Gregory J. Fitz. UT Southwestern responded by promoting him to Dean of the racial and ethnically diverse UTSW medical school)

The specific message was is that it's OK to treat wealthy private paying patients at St. Paul one way, and to treat poor minority patients at Parkland according to a lesser standard. Specifically, the trio below who manage the Department of Surgery have said, at Parkland, patients are practice material for students and residents, and "it's OK if they have complications that could have been prevented with attending supervision." It was also said, "if we are not willing to tolerate more deaths and complications on the Parkland patients, how are the residents ever going to learn what works, and what doesn't work?" And the Chairman agreed because, "Parkland is a county hospital. It's OK because the expectations are different."

Vice Chair Joe Minei, MD

Rawson "Jim" Valentine, MD

Chairman Bob Rege, MD

The above trio also told faculty that Parkland patients won't know the difference between a surgeon and a student of surgery, so it's OK to let students do the operation. They also said don't worry, Parkland patients don't even know enough to sue. And they also said that you have to make mistakes in order to learn to be a surgeon, and that's what the Parkland patients are there for.

Those who felt differently brought their concerns not only to Podolsky, Wildenthal, and Gilman at UT Southwestern, but also to Parkland's Ron Anderson, John Shannon, and to the Chair of the Parkland Board of Managers, Lauren McDonald.

These faculty were all pushed out by the three above, who are often referred to as, "the EVIL trio," by residents, staff and faculty. On the Parkland side, Ron Anderson believes that only residents should be allowed to do surgery on Parkland patients. Attending surgeons aren't needed. He famously bragged that he used to do amputations on patients before he had a medical license back in the 1960's, so he doesn't understand why anyone would gripe about students doing surgery on Parkland patients today in the 21st century, even if they don't have surgical privileges at Parkland (as shown here: http://www.youtube.com/watch?v=LirGs9dWYOM).

Multiple legal firms based in Washington DC, Houston, Los Angeles, and Dallas have been hired by Parkland and UTSW to try to find loopholes to get them out of the noose that's gradually tightening around their necks. As of February of this year the total legal fees they spent to hide crimes and infractions just on the UT Southwestern side were over $9,000,000. Parkland probably spent a similar amount of taxpayer money.

It seems as if it's not working.

The Texas of Regents meets monthly. Their next scheduled meeting was August 24th. They just called a "SPECIAL" meeting for tomorrow. The meeting seems to be urgent because they don't even have time to fly to Austin to get together. It will be done by teleconference. Why the sudden emergency, are indictments about to come down?

See the notice of "Special Called Meeting" below. (click on page to enlarge).

Also just posted about the "special called telephone meeting,"

Normally, these Board of Regents meetings are open, and you can attend. They are also sent out as podcasts, and you can even listen to them live on the web, as they are public information. However, when something is damaging, even though it violates the principle of transparency, they call an "Executive Session." This bars the public and the media, and keeps it secret from the public, even though we have a right to know about any crimes that are being committed with the taxpayers' money.

See below, how they are going to go into secret session during the time while they discuss the Department of Justice and State of Texas investigations into UT Southwestern.

Here is the Agenda (click on it to enlarge)

Below, note that they say that they are having the meeting by telephone conference because it's too short a notice to get everybody together by tomorrow and the matter is, "of sufficient urgency" that they could not delay it until the regular Board of Regents meeting scheduled for August 24-25.

What could be this urgent that also involves the Department of Justice and the State of Texas? The State of Texas refers to the Attorney General. Is it a criminal matter?

And if this "behind the scenes action" is about UT Southwestern, you can BET that the Parkland Board of Managers and County Commissioners have had, or are having similar meetings. Even though UT Southwestern Hospitals St. Paul and Zale were found on a recent audit to be, "systematically violating federal billing regulations," Parkland is where the bulk of UT Southwestern patient abuses and illegal practices are carried out.

Parkland, however, always breaks the transparency in government and Public Information laws and hides its shady dealings in accordance with Ron Anderson's iron curtain philosophy of management.

UT Southwestern and Parkland Hospital: Here Are The Real Care Quality Reports.

2011-07-23T22:45:00.002-06:00

Parkland has some of the worst patient outcome statistics in the country.

Patient safety groups and agencies examine actual patient outcome data, adjusted for patient age, overall health, and extent of disease. Results are based on how well patients do. They don't go down to Barnes and Noble and look it up in the U.S. News and World Report.

For example, The University Health Consortium is an organization of 113 academic medical centers, and their affiliate. The UHC compares like hospitals. For example, Parkland would be compared with other large, 700+ non-profit urban hospitals. In other words, their peers. The results are not supposed to be secret. But, Parkland refuses to release it.

But below is a copy of their recent performance.

The left side compares Parkland's performance with its peers for the first quarter of the year. On the right side, Parkland's results are compared with their peers over the past one year. (Click on the table it if it's too small). Generally, longer periods of time such as a year are more reliable because the effect of short term fluctuations are reduce. Explanations will be provided below. But, first, let's look at the Legend towards the bottom.

A black circle means that patient care results are far below safe, acceptable levels, and place the hospital in the bottom 10% of the country in that speciality. A half-filled black circle means that in that specialty, the hospital does not meet acceptable, targeted results, and ranks in the lower half of the country in that specialty. A circle with a dot in it means the hospital meets safety targets, and performs as well as its peers. Two circles with dots in them mean that the hospital does an excellent job, and ranks in the top 10%. However, if there is an exclamation mark next to it, that means that the hospital doesn't do enough of that surgery for the results to be considered statistically acceptable.

A little triangle on its side, like the one next to Surgical Oncology, which has been circled, means that the hospital has been issued a Safety Alert for that specialty. It means that the hospital has had much higher mortality in that specialty than is normal for two straight years, and for at least half of the past year, its mortality was over 40% higher than it is at normal hospitals. Click on the chart to enlarge it.

For the first speciality, spinal surgery, at both the three month and one year time period they earned two circles with dots. However, there were exclamation points next to both. This means that Parkland does so little spinal surgery that there wasn't enough information to rank their performance. That is why on the last column at both the 3 month and one year assessment period, the last column, "Rank," was left blank.

Next comes Surgical Oncology, and it's not good news. First, there is the little circled triangle that as the legend indicates, means that it's under a Quality Alert for having extremely high mortality than is normal for a hospital, and this has persisted for several years. For their annual performance they received the black circle that means it is, "substantially worse than the target range." More than 90% of other peer hospitals did better, so it was ranked in the bottom 10%. Notice on the far right, their Rank for the year. They came in 86th out of 90 hospitals that offer Surgery Oncology. There were only four hospitals worse than Parkland in the United States.

These figures are based on patient outcome results (not telephone surveys published in drug store magazines.)

There are serious concerns about General Surgery and about Trauma Surgery quality as well. As can been seen on the right, General Surgery received a circle that was half black, which as the Legend shows, means that Parkland's General Surgery service performs worse than the target range. This means it is in the bottom half of all academic surgery programs.

During the first quarter of the year Parkland's, "World Class" Trauma Surgery service also had the half black circle rating, meaning that its performance was below the target range, and ranked in the bottom 50% of all trauma programs in the country. At least by the end of the year they received the circle with the dot in it, which means they became an average trauma program. Urology, with the half black circle, retained its rank in the bottom half of all academic programs in the country for the whole year.

Vascular surgery was horrible for the first quarter of the year. It ranked 84th out of 96 hospitals. Pretty much at the bottom of the barrel. But, by the end of the year they improved to receive the circle with the dot, meaning they moved to within target range.

Other results are below. As can be seen in the first line, post-operative surgical care was out of the target range. It means that post-operative care at Parkland is well below acceptable. Given that it has been exposed that unsupervised medical students provide most patient care at Parkland, this is not a surprise.

It is not clear why they grouped many different, disparate services in the next section. But we can see how the "product lines" are faring.

We can start with the "World Famous" Parkland Burn Unit. As can be seen, for the quarter, and for the year, it earned the half black circle, meaning that it's mortality was too high, and its functioning was below the targeted, acceptable range. Its ratings were consistently poor, all year long. For the first quarter of the year the Burn Unit mortality left them ranked #32 out of 42 Burn Centers. For the year, they were ranked 29th out of 41 Burn Units. In other words, they ranked in the bottom 30th percentile. 70% of Burn Units in the U.S. have better patient outcomes than Parkland. I guess that it is just like the trauma service, just because you did something well in the 1960's, you shouldn't get to rely on that forever. (Click on the report to enlarge it.)

I think it is now clear how to read this report. We can see the circled "triangles" next to Gynecologic Oncology, and next to Orthopedics. This means that they have been under a Quality Alert for two years because of very high mortality, including having a mortality rate 40% higher than normal for at least half of the past year. Parkland Gynecologic Oncology was ranked 82 out of 85 academic hospitals in the U.S. Only three hospitals in the country did worse.

We can see that Orthopedics was ranked 100 out of 107 hospitals. Cardiology, Cardiothoracic Surgery, Gastroenterology, Gynecology, Plastic surgery, rheumatology, neurosurgery, neonatology, all were in the bottom half of Hospitals, and were cited for not being in the target range for U.S hospitals - meaning they have many more deaths and complications.

Only otolaryngology ranked towards the top, with the two circles with dots in it. They were ranked 16th out of 91 peer hospitals. Transplant services, like spinal surgery, weren't ranked because they do too few transplants at Parkland.

It is untruthful for Parkland to keep bragging about its, "World Class Trauma Unit," and its, "World Class Burn Unit," when they are average or below average compared to their peers. If they are not even equal to their peers in the U.S, how can they claim to be "World Class?" I guess they feel if they repeat it long enough, people will start to believe it

We can see that in almost every single "Product Line," Parkland fails to meet its target range of keeping up with its peers. Out of 25 specialties offered at Parkland, 14 are below average and do not meet acceptable target mortality rates, and three that are under Quality Alerts,

These are the facts: not the US News Report that allows over 600 hospitals to pay them thousands of dollars for the right to put up a seal on billboards claiming they are "The Best Hospitals In The United States."

There are additional quality metrics that are used by the government to fashion health care incentives and reimbursement, not to sell magazines..

There is a federal agency called the Agency for Health Research and Quality (AHRQ). It requires mandatory data reporting of 14 complications that are tightly linked to health care quality, mortality, and outcome. They analyze not opinion polls, but about 12 million actual health care claims per year, and investigate how well the care of those patients turned out.

AHRQ reports indicate how dedicated hospitals are to ensuring patient safety. Here is a report of a typical Dallas Hospital. (Click on the reports to enlarge).

Here's a typical report from a hospital in El Paso, Texas.

Now, below is Parkland. I tried dozens of cities to try to find a worse hospital, but I couldn't.

What about UT Southwestern Medical Center private hospital, like Saint Paul? So many billions of dollar donated, and Podolsky keeps telling us that UT Southwestern is a World Class Medical Center they have over there at St. Paul.

Well, I thought it would be a little unfair to compare UT Southwestern to real world class hospitals like the Mayo Clinic, Cleveland Clinic, Brigham and Womens Hospital, Duke, etc. Here are the safety results for UTSW Medical Center. They are as bad as the results are for Parkland.

It appears that UTSW cannot compete even compete in health care quality with Texas Tech at Lubbock.

I even tried to see if the "World Class" UT Southwestern could beat out much smaller University hospitals, like in Iowa, or in Honolulu. Not possible.

So, these are the real numbers. Not the results in "paid for" drug store magazines where they call physicians and ask for their opinions on what are the five best hospitals in North Texas. The federal government requires these types of reports shown on this website. Taxpayers have a right to see them. Parkland and UT Southwestern continue to refuse to release them. Citizens have every right to know about whether they are putting their lives at risk when they to to certain hospitals.

So, the results are here.

Because of their very poor patient care results there is one thing you can be sure of: Ron Anderson of Parkland, and Dan Podolsky of UT Southwestern will be dragged kicking and screaming into the new era or modern medicine, where notifying your results will be required. Cars have to release their safety results. Hospitals will soon have to do so, also.

Now we know. The reason why these two characters at these two hospitals are kicking and squealing about being exposed is because they both rank so low in quality and patient care outcomes.

UT Southwestern and Parkland: The Real Truth About Their Hospital Rankings

2011-07-20T23:24:00.000-06:00

If you want to buy a car or a refrigerator, there are ratings available to help you make a selection.

Until recently it has been impossible to obtain information about the quality of your local hospital is. They didn't report their results, and their reputations were based on how well they advertised. Fortunately, this is changing.

Hospitals are being required to report their results to the federal government, and to the public. OPEN reporting of results is considered one of the most promising ways of all available means of improving health care.

For example, out of the hundreds of county hospitals that do knee surgery in the United States, obligatory reports to the U.S. Government indicate that in terms of patient outcome results, Parkland is fifth from the bottom out of all hospitals in the United States. It's Orthopedic residency program has been investigated to decide if it should be closed. Parkland's knee surgery results were so bad that publicly available ratings had a RED ALERT warning people that they should reconsider allowing their orthopedic surgery to be performed at Parkland.

The University Hospital Consortium placed the Parkland Orthopedic Surgery Team on a National Quality Alert, and had informed the public that for two straight years Parkland Orthopedics ranked in the bottom 5% of all county hospitals in the country. Also, for the six months out of the past two years, that allowed Parkland surgeons to perform their knee surgery were 40% more likely to die than if they had their knee surgery performed anywhere else.

If Ms. Ned knew that, do you think she might have made a different choice.

There is a big problem when hospitals don't have to report ratings. For example, while Parklands Orthopedic Surgery website was under a red alert for being the 5th worst county hospital for knee surgery in the country, Parkland's website and it's TV ads were raving about their, "World Renowned Orthopedic Surgeons."

Everyone knows that public reporting is the best way to improve results. It's the American way.
But in Dallas, Ron Anderson of Parkland is suing the Texas Attorney General, because the Texas AG has ordered him to make the results of his hospital's care public

Daniel Podolsky, the new UT Southwestern President, hired a team of attorneys to try to lobby the Texas Legislature to change the Texas constitution so that UTSW won't have to report it's (reportedly abysmal) results to the public.

We have some of the data here. But first, we have to distinguish between data, and paid advertising. And second, we were surprised to be scooped by the Dallas Morning News a few days ago about this very same topic.

The government, large companies, HMO's, and large insurance plans DO NOT rely on drug store magazine advertisements like the U.S News and World Reports top 100 hospitals ratings to judge health care quality.

That's as silly as relying on the U.S. News and World Reports articles that rate the top ten beaches in the U.S., the top ten large trucks, the top 50 hotels. Every month they sell a magazine that rates a different thing.

No one relies on $2.50 cent magazines to rank the best hospitals in the country. So lets move beyond that.

They call 250 doctors around the country, and asking them, "In your opinion, in your specialty, what are the 5 best hospitals in the country?"

Not very scientific.

Doctors will have heard of Harvard, Hopkins, Yale, but not Southeast Missouri Obstetrics center, which may have better results than any of them..

The magazine gives their opinion poll five times more weight in its final rankings than it gives to the hospitals own actual patient safety record.

The U.S. News and World Report Best Hospitals in the U.S. Ratings say they evaluate 4,852 hospitals in 16 specialties. However, in 4 of the specialties the rankings are based on nothing more than telephone surveys asking doctors who they think the 5 best hospitals in their specialty are across the country.

I don't think that a doctor in Boise, Idaho has any idea about the quality of care provided in a hospital in Ocean Town, New Jersey.

They say they choose the best hospitals out of 4,852 hospitals in the U.S. But, they dismiss any hospital that is not a teaching hospital, or that is not associated with a medical school. Yet are only 130 medical schools in the U.S.

Then they throw out any hospital that has less than 200 beds, any that do not have four types of high-tech radiology diagnostic devices like a PET scanner or certain types of machines to give radiation therapy for rare forms of cancer, (even though most medium size hospitals don't have the number of patients to justify the expense, and share such machines, and a hospital can't have a cancer radiation treatment suite if they are not a cancer hospital).

This does not leave a lot of hospitals out of the 4,852 left to qualify for the "Best Hospital in the U.S." rating.

But they are still not through. The magazine then trims the list even further by eliminating any hospital that does not treat more than 270 cancer patients per year, even if it's a medium size hospital that does not treat cancer. Then, they throw out any hospital does not treat more than 767 with a primary a pulmonary problem, even if they do not have a pulmonary ICU.

These figures severely disadvantage the community hospitals that form the backbone of patient care in the U.S. and favor large medical school facilities.

So, let's forget about these news magazines, and focus on the government reports that Parkland and UTSW fight to keep secret.

Then, the US New and World Reports Ratings allow you to "opt in" and be advertised by them as One of the Best Hospitals in the U.S., as long as you agree to pay.

Since they cut out any hospital not associated with a medical school, or that does not have a residency program, or that does not have more than 200 beds, even though they say they rank the best out of 4,852 hospitals, but right off the bat they exclude 88% of all hospitals for reasons that have nothing to do with performance.

They then give ALL of the remaining 150 hospitals a deal; they can advertise that they were chosen as one of the BEST hospitals in the U.S., and if THEY AGREE TO PAY US NEWS AND WORLD REPORT THEIR MARKETING FEE, THEY CAN PUT THEIR SEAL UP ON BILLBOARDS ALL OVER TOWN!

This has been so much more profitable for them than their issues on rating the top ten beaches in the U.S., the Top Ten Large Trucks for Sale in the U.S.," the top ten European vacation spots, and so on.

It's been so profitable that in the last few years they decided to expand the number of BEST HOSPITALS IN THE UNITED STATED," from 150 a few years to ago, and increased the number that received that award to 622 HOSPITALS THHIS YEAR. AFTER ALL, every hospital they SELL the seal to, they make more profit.

If you have a big check book, according to the U.S. News and World Report, you can, "Become a Featured Hospital. The Featured Hospitals program is designed to help your hospital attract patients whose medical needs match your expertise. Your hospital's name and logo will appear directly within our prestigious, heavily referenced "Best Hospitals rankings in the speciality or specialties of your choice. To learn more about this marketing opportunity with U.S. News Media Group, contact Marc Siegel at 212-916-8706, or msiegel@usnews.com."

If you are on a tighter budget you can just by and, "Display a Best Hospitals Badge. Is your hospital ranked by U.S. News? Proudly display a Best Hospitals badge (or Best Children's Hospitals badge) on your website, in your advertisements, or in your promotional materials. Contact usnews@wrightsmedia.com or call Wright's Media at 877-652-5295 for more information about how to use the badges."

Or if you really don't have the money, you can do a bargain deal and purchase a "Get a Best Hospitals Reprint. For more information on how to promote your Best Hospitals ranking with reprints, an eprint on your Web site, or lapel pins for your employees and associates, please contact Wright's Media at 877-652-5295."

So, these reports based on statistically meaningless methodology, where random phone calls asking doctors to name five hospitals with a good reputation in their specialty carries six times as much weight in the final ranking as patient safety results, are for sale, and are used as marketing tools by UTSW and Parkland all over Harry Hines Blvd and the Central Expressway. They are NOT used by oversight agencies that rely on scientific methodologies.

Sorry for delaying posting so long, but will shortly post the REAL government data, not the drug store magazine data. In the majority of specialties, from surgery, to cancer, to gynecology, to orthopedics, to obstetrics, Parkland ranks as one of the worst hospitals in the United States. Hard data, not from magazines, but from government rating reports will soon follow.

UT Southwestern and Parkland Hospital: Is Parkland Really a "World Class Hospital?" Now You Know the Truth

2011-07-01T20:04:00.015-06:00

Both Parkland and UT Southwestern claim to be "world class." The community has long accepted their self-proclaimed status. However, the fifty seven articles published in the Dallas Morning News, many of which have been syndicated nationally, are beginning to change that perception. When hospitals make such claims it should be based on data.

Ron Anderson maintains a culture of secrecy that would make North Korean leader Kim Jong-iL blush. As shown on this blog, after Texas Attorney General Greg Abbott told him to turn over the Parkland data Anderson refused and responded by suing him, a matter still awaiting trial before the Court. It will take years. However, we have some of the data here. So, let's see if it shows that Parkland is "world class."

The first question is, does Parkland have a culture that supports "Patient Safety?" There is a standard questionnaire that hospitals use to measure whether a hospital supports having a safe environment for patient care, such as allowing employees to report problems without punishing them, proper supervisor and manager expectations, the use of teamwork, open communications, and other factors.

How does Parkland compare with its 105 peer institutions that make up the University Health Consortium (UHC = large, inner-city, urban medical school affiliated safety-net hospitals)? On every single item in the questionnaire Parkland (blue bar) ranks well below its peers (red bar), especially in having a non-punitive response to people that report errors (first item).

As you can see, in creating a corporate culture of safety, Parkland is below average in every single measure.

The federal Agency for Healthcare Research and Quality (AHRQ) has also developed a number of patient safety indicators. They are things like deaths in surgical patients with treatable conditions, hip fracture mortality rate, and other problem indicators. When used together they form the Patient Safety Index, or PSI. Many, many hospitals and state Departments of Public Health use them to assess performance, and publicly report the results to allow one hospital to be compared with another. Here is how Parkland stacks up against the 105 University Health Consortium (UHC) hospitals that are considered to be its peers.

The lower the number, the better. Parkland is happy and we are happy to see that they are improving. Unfortunately, they went from being one and one-half times worse than average, to being only 10% worse than average compared to their UHC peers. Certainly not world class.

The National Quality Forum (NQF) is a group that everyone listens to when it comes to health care. That includes the U.S. Congress, the Joint Commission, the Center for Medicare and Medicaid Services, and just about everybody else. They have developed a list of Serious Reportable Events (NQF SRE). These are the types of things that are supposed to "NEVER, EVER" happen in a hospital. They are completely preventable. Items on the list of SRE's include sending a newborn baby home from the hospital with the wrong parents, operating on the wrong patient, cutting off the wrong leg, letting a patient get raped or commit suicide while in the hospital, and so on.

Both federal and state laws require hospitals to report every NQF SRE to appropriate governmental oversight agencies. As reported in the Dallas Morning News, Mr. Cornell, the patient who was apparently killed in the Parkland Psychiatry ER by Parkland staff, and Ms. Ned, the Parkland employee who suffered a leg amputation when she underwent a knee replacement operation that was performed by a surgeon-in-training with just two months of training in a five year training program, had NQF SRE's that were supposed to be reported to the government. Neither of these patients were reported.

As shown in published federal documents, Parkland's attempt to hide them resulted in failed inspections, and the government telling them that if they did not remedy the situation, they would no longer allow them to participate in Medicare and Medicaid. This is the same as forcing them to close down.

How is Parkland doing on NQF SRE's? Not very well. Most citizens of Dallas have heard of Ms. Ned and Mr. Cornell's cases because of the extensive media coverage they had. But, as you can see below, Parkland averages three of these types of cases every month (the solid red line is the running average). Sometimes, they have as many as six. What is really scary is that the number is not decreasing.

Four of the SRE's above consisted of doing the wrong operation on a patient, or doing surgery on the wrong patient. This happens when someone goes to the OR for a gall bladder operation but they do not read the wrist band ID bracelet correctly, mistake the patient for someone else, and do a cataract or a kidney surgery on them instead. Four patients fell and suffered a fracture or a brain injury. Seven patients were seriously injured or killed when they received medication that was supposed to go to somebody else, or they received the wrong dose of a dangerous drug and it killed them or nearly killed them.

Another standard way of measuring how good a hospital is consists of measuring, "High Harm Events." These are complications that cause enough harm to either cause the patient to remain hospitalized, or that results in permanent injury or death. Most are due to errors, although about 25% of the time they are unavoidable, as when a patient receives a medication and goes into shock from an allergic reaction to it, but no one knew about the allergy.

Parkland has an abnormally high rate of HHE's. Only 26% of these were not their fault and were unavoidable. The rest were due to true serious medical errors that caused high harm. In the graph below, the dark bar with the diamonds is the number of HHE's in that month. The solid red line is the average for Parkland over the entire time period.

Don't you think that the solid red line on the graph shows that about 70 patients per month, not 60, experience High Harm? Whether it's sixty or seventy, causing high harm to sixty patients per month is not normal. It is definitely not world class. In fact, it is far worse than average when compared to the nation's safety net hospitals that are Parkland's peers. All of the above graphs came from a meeting of the Parkland Board of Managers.

This means that they know that Parkland is not a good hospital. Despite that, at the end of the year they always give Ron Anderson a quarter of a million dollar bonus for doing an outstanding job. They also give millions of dollars in performance bonuses to the managers responsible for these results. This is surprising, because the most common causes of HHE's found at Parkland are lack of technical competency, lack of care planning, not following normal infection prevention protocols, and lack of communication. Assuring that there are good communications, proper planning, and so on, would seem to fall into the type of skills that managers are supposed to cultivate.

The University Health Consortium (UHC) has a program called the Patient Safety Net (PSN). Member hospitals anonymously report errors, or what are called, "near misses." These are, for example when somebody was about to do an operation on the wrong patient, and somebody noticed just in time to stop it. It's good that they stopped it in time, but it's not supposed to have gone to the point of putting the patient in danger in the first place.

In order to avoid sounding negative some hospitals refer to "near misses" as "good catches." This means that someone caught the error just in time to prevent harming or killing the patient. Parkland engages in something they call, good catch "Games." This is when they encourage employees to try to make a good catch. It seems as if that does cause some catches, but it only lasts for about one month, then goes back to baseline.

PSN's are also reported on x-bar graphs. The dark line with the diamond is the number of errors/near misses/good catches at Parkland per month. The solid red line is Parkland's average for the period. When a number goes above or below the dashed red lines, it's considered "out of control." More about that after the graph.

Studies published in prestigious medical journals such as Health Affairs have proven that the more "near misses" a hospital has, the higher the complication and death rate is in that hospital. The red line indicates that Parkland has about 850 "near misses per month. The purple line with the boxes is the "near miss" rate for Parkland's peer hospitals in the University Health Consortium, or UHC. As previously mentioned, the UHC consists of other large, inner-city, urban safety net hospitals that have 700 beds (about the same as Parkland), and that are affiliated with a medical school.

The purple line means that Parkland's peers experience about 600 near misses per month. In other words, Parkland has 38% more dangerous situations that can harm or kill a patient than the average safety net hospital with the same type of patient population and size.

The dashed red lines in the above graph are called the upper and lower control lines (LCL and UCL). When the number of events goes above the upper dashed line (UCL) in a month it is considered to be, "out of control," as happened in May and August, 2008. When the number of events goes below the lower control dashed line (LCL) it is considered to be out of control, but in a good way. It means that the rate of mistakes is so low compared to Parkland that it couldn't possibly be due to chance or luck.

You can see that every single month Parkland's peer hospitals are "out of control" in how much better they perform than Parkland: they are always below the lower control limit (LCL). The number of dangerous situations that develop in those hospitals is much lower Parkland's every single month.

Now, what is a hospital supposed to do when it makes a mistake? It is supposed to be transparent, and own up to it. Denial will do them no good. On an individual level, health care workers are supposed to be upfront with the patient's family. Many studies have shown that malpractice suits often occur when an error is made and the doctors and hospital try to hide it. When the patient or family finds out, they sue them. But, if the doctor or hospital disclosed to the patient or their surviving family that an error occurred, in most cases, they do not sue. Most patients (or their families) just want the truth, and to be acknowledged.

Recently, there was an article in the Dallas Morning News written by the wife of patient who was taken to the Parkland burn unit. The family never met the attending. The family had many concerns about medication errors and lack of communication and the harm they could see this was doing to their family member. No matter how much they complained, no one would listen. When the opinion piece was published in the News on June 10th after serious harm had occurred, Parkland finally responded.

Its Chief Medical Officer Dr. John Jay Shannon responded by writing an Opinion piece that was also published that day. In comments published on the News website the letter has been described as being, "delusional," or, "full of arrogance."Instead of acknowledging that Parkland has serious patient care quality problems, to the point that the federal government is currently deciding if it is an irretrievably broken hospital and needs to be shut down, Dr. Shannon appeared to be in denial.

He completely missed that this was a legitimate family complaint, thanked the patient's family for giving kudos to Parkland, and referred to Parkland's greatness as being known "worldwide." He blew off their concerns, and refused to concede that many serious complications had occurred.

"Disclosure" is an important aspect of a hospital's commitment to safety. Telling the patient's family and being open with them when something goes wrong is also a patient safety goal endorsed by the Joint Commission and other medical organizations that focus on health care quality. Moreover, disclosure is not always voluntary. A "Sentinel Event" occurs when there is an unanticipated event in a hospital that leads to patient death, or serious physical or psychological injury that is due to an error, and is not the normal course of the patient's disease process or its treatment. In order to remain accredited hospitals must promptly report ALL Sentinel Events to the Joint Commission.

We previously discussed the National Quality Forum and its Serious Reportable Events (NQF SRE) list, such as operating on the wrong patient, discharging a newborn to the wrong parents, letting a patient get abducted from the hospital, forgetting a surgical instrument inside of a patient, and other types of serious problems. In order to maintain their accreditation hospitals must promptly report all NQF SRE's to the appropriate authorities in the Texas State Department of Health.

Not only does disclosure enhance patient safety, it's also the right thing to do, and is required by law. How well does Parkland do on this patient safety measure?

This is really disturbing. We know that Ms. Ned and Mr. Cornell were two out of many patients who experience a Sentinel Event or NQF Serious Reportable Event at Parkland every year, and neither of them were reported to appropriate authorities. As stated in an editorial in the Dallas Morning News, Parkland's culture of secrecy was putting the hospital itself at risk for being closed down by authorities.

We can see from the graph on the left that Parkland had 15 Sentinel Events that year, more than one per month. But, it only reported 53% of them. What's worse, one-quarter of the time (27%) they don't even know whether or not they reported it, even though reporting it is required to maintain accreditation. From the graph on the right we can see that Parkland averaged three Serious Reportable Events per month. Parkland only reported 33% of these cases, and appears to have broken the law in the remaining two-thirds. And 11% of the the time they don't even know whether or not they reported the SRE, even though reporting SRE's is required by law. Loose management indeed!

It seems to me that Parkland's own data shows that not only are they not world class, they can't even keep up with their peer-institutions in the United States. And they don't report it. They hide it. The next time they run a commercial proclaiming that they are one of the best hospitals in the world, you will now know the truth.

UT Southwestern and Parkland: I'm Sure CMS Will Have a Lot to Do When They Get to Parkland for What is This, Their Ninth Recent Visit?

2011-05-28T16:14:00.004-06:00

We know that Ms. Ned had a total knee replacement operation performed by a resident in her 6th week of orthopedic residency training. The attending surgeon billed for the case. It is illegal for a surgeon to bill the full fee for an operation if he or she did not provide the post-operative care. We know that medical students and doctors-in-training provided Ms. Ned's post-operative care, and none of them were advanced enough in their training to diagnose the obvious complication that was before them. The potential Medicaid fraud in her case exceeds $1,000,000, as her medical bill surpassed that level months ago.

Here is another example of "The Parkland Way" of treating patients like Ms. Ned. This patient, whose name will not yet be revealed, also had an amputation. She had known, severe cardiovascular disease documented all over her medical record. This put her at high risk of having a post-operative cardiac complication. Close post-operative monitoring and attending supervision would be warranted.

But, the only notes in her chart were written by third year medical students. The student was supervised because underneath their note, someone else wrote, "Agree with Above." Unfortunately, that was written by an intern. No attending ever saw the patient. This was a Medicaid patient. This type of care, as in Ms. Ned's case, constitutes billing fraud. Only an attending is allowed the manage a patient. Residents must work only under supervision. And notes that merely say, "agree with above," no matter who wrote it, are not accepted by CMS.

Below is the record of a Medicare patient who also required an amputation of the front of her foot. The two stars in the column on the right indicate that the surgery started at 19:20 (7:20 PM), and ended at 20:10 (8:10 PM). The two stars in the column on the left indicate that the Fac Surg (faculty attending) arrived 10 minutes after the amputation was already underway (19:30), and left 15 minutes later at 19:45, about 25 minutes before the operation was completed. This could not possibly allow supervision of the critical portions of the case, such as the level of the amputation before the skin incision is made, and whether the amputation has removed all of the dead tissue, something assessed towards the end of the case. The resident that performed the case was an intern, supervised by a third year resident. The patient went on to have multiple complications, as will be shown below.

No attending surgeon had seen this patient prior to the amputation being performed. The amputation site would not heal. Finally, one month later, it was noticed that the patient had significant arterial disease of the leg, and had insufficient blood flow to allow the foot to heal. Multiple vascular surgery procedures were performed. For one, the attending never showed up. There was a very lengthy reconstructive procedure on 5/21, performed by residents, with the attending present for 1 minute.

How much did the UT Southwestern Vascular Division of the Department of Surgery bill Medicare for their one minute of faculty service during the angioplasty, arteriography, insertion of stent, and all procedures in the left hand column from 843 to 9904? Over $30,000 for that minute of faculty coverage during resident performed procedures. The hospital bill paid by Medicare was many times that amount.

Since it was documented that there were no post-op notes, and surgical billing requires documenting post-op care with post-op notes, and and Vascular Surgery faculty presence was only documented for one minute during hours and hours of vascular surgery, should UT Southwestern be submitting bills for these services? Let's see what Willis Maddrey has to say. He has too many titles for me to remember, but they are more or less, the UT Southwestern Chief of Clinical Affairs, the UTSW Chairman of the Ethics Committee, the UTSW Chairman of the Billing Committee, and now he holds the title of, "Special Assistant to UT Southwestern President Podolsky."

This was in response to a question concerning whether or not these bills should be submitted to Medicare and Medicaid when there is no documentation that faculty members played a significant role in providing the care for these patients at Parkland.

The attending surgeon must be present for the critical part of an operation. According to CMS, only the attending is allowed to define which portion of an operation is the critical part. It's impossible to do that if you don't even know that the patient exists.

Maddrey was asked questions about several depositions given by faculty members who complained that residents would see patients in the ER, take them to the OR, perform an operation, and then during the operation at the moment of their choosing, call the faculty member and tell them, "Come on down to the OR, we're cutting off this lady's foot, and we think we're at the critical part, and we need you to come on down and sign the paperwork." Here is what Dr. Podolsky's Chief Advisor had to say. (Note, this is not a criticism of the residents, who are competitive with those in other programs. These are just Department of Surgery policies established by Bob Rege, Jim Valentine, and others who are not willing to follow the rule and regulations, and that will eventually get them into severe legal trouble.

Remember, this is not something the residents set up. They are marching to the orders of the UT Southwestern Department of Surgery.

UT Southwestern and Parkland: Read The Federal Investigation Report of the Jessie Mae Ned Case

2011-05-07T14:22:00.000-06:00

Pretty hard to believe that this report by CMS, the Center for Medicaid and Medicare Services, reflects the practice of a hospital in the 21st century. Keep in mind that twice in the last few years CMS threatened to bar Parkland from billing the federal government because the medical services were unsafe, and below acceptable standards. If anyone doubts that, the federal documents have already been posted on this website.

For those who may have missed it, below is the CMS report on the investigation of the care of Ms. Ned. Among the findings, despite being nearly thrown out of the federal reimbursement programs for unsupervised care provided by residents, at the time of her care Parkland still did not have a written policy on the supervision of residents. The poor patient had the artery that goes to her leg completely tied off. Her post-operative care was provided by a medical student who repeatedly documented the blood flow into her foot as being normal. It is extremely unlikely that someone at the medical student level has ever seen an ischemic foot before, yet a medical student provided most of the post-op care.

Two days post-op when the patient still had no feeling in her foot, the residents and students were still writing in the medical record that they were still just waiting for the anesthetic to wear off for the patient to regain normal feeling in her foot.

There is no documentation that an attending ever saw her post-op, as is required for billing Medicare or Medicaid. The resident did attest that the attending was there for the important part of the operation. But many have seen hundreds of such "attestations" where the OR time sheets indicate that the attending was in the operating room for less than a minute or two for operations that took hours to complete. There are many such attestations that, "the attending was present during all significant portions of the case," when the attending wasn't present during any part of the case. In fact, Parkland used to deliberately HIDE the OR time sheets that show when the attending arrived to the OR, and when they left, and as a matter of policy kept them hidden from the billing staff and the billing compliance staff. So, I'd take it with a grain of salt.

It's hard to imagine there was any supervision of Ms. Ned's case. Three days later, with her leg muscles dead, the residents took her to the OR with a diagnosis of "compartment syndrome," condition caused by swelling or bleeding within one of the four compartments of the leg. Yet, the residents documented in their own note that there was no swelling at all within the leg. The medical student had no experience, and the resident did the operation and that supervised the student had only been training in orthopedics for a few months.

The document below shows numerous serious infractions, including attempting to hide this event from all of the appropriate oversight groups, hoping it would never see the light of day. Why, Parkland didn't even recognize her case as being a complication, or in any way out of the norm. Click on document to enlarge.

UT Southwestern Hospital and Parkland: At the VA Hospital, Fraud Runs Throughout the System

2011-04-27T15:08:00.001-06:00

The VA hospital system has very strict supervision requirements. they are stiffer than the CMS requirements that govern other hospitals.

The Dallas VA ICU is covered by members of the UT Southwestern Department of Surgery. The VA pays the Department of Surgery about $300,000/year for providing this service. Service is provided by a faculty member of the Division of Burns, Trauma, Critical Care for a one week period for 26 weeks out of the year.

One Division member was assigned to the VA ICU for a week, but became very sick with the flu, and was unable to work. He notified Robert Rege, Chair of the Department of Surgery, and Chair of the and Burn, Trauma, Critical Care Unit, that he would have to assign the back-up surgeon to provide coverage.

Upon his return two days later he asked one of the residents which physician was assigned by Rege to provide coverage to the patients in the surgical ICU at the VA. The resident responded, "no one, we were on our own for the two days."

The faculty member went to the medical records and read the patients' charts for the past few days in order to familiarize himself with how the patients had been doing, and also to read the admission notes of the patients that had been admitted to intensive care during his absence. Over the two days there were about 20 daily AM progress notes, for a total of about 40 notes. There were also about 15 invasive procedure notes for procedures with significant risk performed on patients, and were about 10 in-patient admission notes written for patients that had been admitted to the ICU in critical condition. All of these notes were written during the two day period when there was NO attending present.

The attending was STUNNED to read that in every single one of these dozens of notes written while he was at home sick in bed, the resident had written that he was at the bedside directly supervising the history and physicals, was present on morning rounds, and supervised all invasive procedures!!!

He decided to look a little deeper. The $300,000 per year that the VA paid to the UTSW Department of Surgery for providing "on-site coverage" in the ICU for 60 hours per week was filled in the following way, with slight surgeon-to-surgeon variation. The surgeon would arrive at 7:00 AM for rounds, and stay on-site at the VA until about 5-6:00 PM, Monday through Friday. On Saturday and Sunday they would only have to be present for five more hours. They would do rounds from 8:00 AM to 10:30 AM, then go home. Thus, they would have spent 60 hours physically in the VA ICU. Fulfilling the hours this way, the attending surgeons were never present at night.

The surgeons had to fill time-in, time-out sheets. He verified that no attending surgeons were present at night, or after 12;00 PM on weekends. He looked at all notes written at night and on weekends for newly admitted patients and for invasive procedures. Even though the attending assigned to the VA ICU was not there at night, every single time, the resident dictated that they were physically present with them at the bedside.

This was brought to the attention of Dr. Rege, Dean Gilman, and President Podolsky, as can be seen below. Names are deleted for HIPAA purposes. The note on the bottom of this page was written in the middle of the night, while the attending was at home, sick.

The words, "Dr. XXXXX and I simultaneously obtained the history at 1:12 AM is not true. There are thousands of these false records. Why would the residents write that. Who told them to do it? Who said it's OK?

UT Southwestern and Parkland: Is Lauren McDonald Attempting Research Fraud?

2011-04-01T20:10:00.002-06:00

If Dr. Lauren McDonald isn't forced to resign from her position as Chair of the Parkland Medical Board, or get into serious trouble with UTSW for attempted research misconduct, then Parkland and UTSW have no shame. Faking your way as having written a medical article published in a research journal is a violation of the medical ethics policies published in every peer-reviewed journal in the United States. If you fake that you were an author when you were not, you can get banned from all of the medical journals owned by the publisher - for life.

She tried to muscle her way into getting her name on a research article without being part of the research, simply because she said she was on the Parkland Medical Board. These "honorary co-authorships" were firmly banned as unethical and an abuse of power by Chairpersons." She engaged in this scheme with the help of Ron Anderson and John Jay Shannon.

She wrote in an email to Anderson, "Is there any study being done at PMH that I could be included by virtue of the BOM or as participation as a nephrologist?"

She wanted to do this to fraudulently advance her career by faking a credential. "I need to be on an article (grant/funding) from an organization such as NIH, VA, etc. ie federal funding to get the FASN (Fellow of the American Board of Nephrology designation).

Most journals will publish a formal retraction if they are defrauded in this way. Why couldn't she get her name on a medical publication the usual way, by earning it? Is this what passes for leadership?

Not only that, if she fraudulently lists herself as having NIH or other federal funding by muscling her way onto a grant of a UT Southwestern faculty member, she puts all federal funding at UT Southwestern at risk. The feds have pulled all federal funding from medical schools such as Johns Hopkins for not having proper informed consent. They would certainly do it for this too.

See: http://www.dallasnews.com/investigations/headlines/20110401-mcdonald-email-to-parkland-executives-i-need-to-be-on-an-article_1.ece

This lack of honesty at the top leads to the following type of problem with patient care.

UT Southwestern and Parkland: Compliance Officer Admits Fraud

2011-03-23T20:40:00.004-06:00

On this website there are posts recommending that Parkland staff file Qui Tam lawsuits. These suits were started during the civil war when the government found that they were charged exorbitant amounts of money for war supplies, that were in essence, junk; boots made out of cardboard, bullets that wouldn't fire. Under Abraham Lincoln a law was passed stipulating that anyone who notified the federal government of persons that were defrauding them would share in the money that the government recaptured from the profiteers.

Sadly, such fraud persists to this day. Many remember the headlines resulting from contractors charging the Pentagon $500 for a hammer that can be purchased for $3 at Target, or charges of $800 for a $17 Costco toilet seat.

Unfortunately, health care is now the business sector that accounts for the greatest loss of federal government and taxpayer monetary loss. UTSW and Parkland have a long legacy of ripping off the federal government. There is almost no time when they are not under federal investigation for Medicare and Medicaid fraud.

At no time in the history of the State of Texas has this been more urgent than today. The state is drowning under so much debt that they are planning drastic cuts in services to children and disabled people. Texas has the most children without health insurance coverage, and is considering adding over 350,000 more children to that list in order to reduce Medicaid expenditures.

Defrauding Medicaid in order to bulk up Parkland profits for bonuses raises serious concerns. Parkland's own staff have complained about rampant billing fraud for years.

In this post, the Billing Compliance Officer revealed that fraud is found fraud across all Departments, from Surgery, to Medicine, to WISH, Pediatrics, and and just about everybody else. The more he tried to do his job, the more he was criticized, until he eventually lost his job. The evidence is clear, and the documentation is irrefutable. But, Parkland and UT Southwestern escaped that time on a technicality. That technicality will be discussed in subsequent posts.

Below is an example of what a Qui Tam lawsuit looks like. Please keep in mind, some people have left comments on this website urging people to file a Qui Tam lawsuit. That is not the purpose of this blog. We are neutral on that issue. It is your own personal choice.

If you do notice fraud at Parkland and want to file a Qui Tam, you will be joining a long line, or, so I am told by people who have contacted me under aliases; one is known only as Qui Tam Dan. The other, who appears to not know about Qui Tam Dan, refers to herself as Key Tan Tanya.

Notice on the next sheet that the person who is reporting the fraud is the Director of the Office of Billing Compliance. He tried to get them to stop it for many years, but was unable to. He ultimately had to report the crime to the law.

How many Departments are out of compliance with federal anti-fraud regulations? It seems like all of them are:

Notes of a meeting where the key executives of UT Southwestern and Parkland (think Chairman of Departments, Deans, other leaders of Parkland and UTSW);

Remember, Parkland and UT Southwestern have never contested the widespread billing fraud. When Ms. Ned was operated on by a resident with only 2-3 months of training in orthopedics, and the attending was not there, Medicaid was billed over $1,000,000.

There is no doubt that Ms. Ned was not an isolated case. From the above records it appears that there is a long line of people complaining about billing fraud at UT Southwestern and Parkland.

It appears that the federal government and Texas Attorney Generals Office are ripe and ready to return enough fraudulently obtained money to federal and state coffers to restore needed health care services that are proposed as sacrifices to balance the budget, and to pay for more executive bonuses at Parkland.

UT Southwestern and Parkland Hospital Stories: A Website That Will Never Be Taken Down

2011-03-05T19:36:00.002-06:00

As you would expect UT Southwestern and Parkland want this website taken down. In fact, they asked for it recently when asking for a settlement. Not only will it not be taken down, it has now been "indexed" to all major search engines, even to search engines in other countries. That means that each page of this website will always be on the internet, and people will find it when they search for UT Southwestern Parkland. These pages already appear on the first or second page when a search for UT Southwestern Parkland is performed.

It seems that there has been some work on other websites to make the posts and comments here as well as those to come in the near future (due to the proximity of the legal blow-up) impossible to remove.

There is an interesting website for people to post about complaints and fraud. It gets hundreds of thousands of "hits," so within a few weeks search engines automatically find the reports that are there. Consumers find them when they search using keywords containing the name of the business or enterprise. No matter what, that website never, ever takes anything down. Even if the person posting it asks them to do so, once posted, it just cannot be done. That permanence is their reason for existence. Their policy that explains it is posted below, in case someone has an interest in using this website (click on each in order to expand it to full size for better readability). The post itself is here:
http://www.ripoffreport.com/hospitals/ut-southwestern-medi/ut-southwestern-medical-center-dab94.htm

UT Southwestern and Parkland:Lauren McDonald Has Known About The Problems The Whole Time

2011-02-07T20:58:00.000-06:00

Excerpt of a letter hand carried and delivered to,

Lauren McDonald, MD

Chairwoman, Parkland Board of Managers

Dallas Nephrology Associates

1420 Viceroy Drive  

Dallas, Texas 75235

XXXXXX? How many patients must be harmed before you will do the right thing?

On August XX, XXXX, a patient nearly died needlessly because UT Southwestern Medical Center and Parkland administrators and leaders callously interfered with appropriate physician patient-care clinical decisions. Selfish, misguided acts and decisions are being perpetrated and made on the innocent and sick patients of Dallas County – all as a pretense to maneuver your collective legal positions in litigation related to patient care, resident supervision, and improper and inappropriate Medicare and Medicaid billing fraud. XXXXX.

Michael Silhol, with the knowledge and participation of senior administration and leadership at Parkland and UT Southwestern together with you are placing the citizens of Dallas at serious risk by interfering with medical decision-making. Mr. Silhol and you should refrain from using your power for illegitimate purposes.

As such, on August XX, 20XX, XXX a mentally ill patient who shot himself in the face. One week prior XXX on August X, 20XX, this patient was admitted to Parkland with his gun shot injuries – a fractured mandible, which was ultimately repaired by the Oral/Maxillofacial Surgery Service (OMFS).

On the day the OMFS service stated that the patient appeared to meet the medical criteria to have his endotracheal tube removed and, accordingly, wrote a progress note in the medical record indicating that the mandible (which supports the tongue) was stable enough for extubation. Remarkably, according to the notes, this patient had been in the ICU for seven (7) days, in critical condition, without ever seeing an attending trauma and/or OMFS surgeon.

Despite everything about which XXX'S have been complaining and everything you continue to deny ever occurs, all of this patient’s post-operative surgical care was provided by interns and residents, even though the patient was in critical condition.

Within minutes of this patient’s endotracheal tube being removed, he developed an upper airway obstruction and needed an urgent tracheotomy. The patient was strangling due to a progressive collapse of his airway. On immediate assessment, XXX instructed the trauma fellow to perform a “jaw lift” maneuver to “buy” some additional time. XXX also sent one resident to “stat page” the OMFS surgeons, and another resident to page the FACULTY.

XXX paged the OR and requested to speak with an attending anesthesiologist. XXX was transferred to a voicemail recording machine in the anesthesia work room.

All the while as XXX was dealing with this situation, the patient’s condition was rapidly deteriorating – although he was being supplied with 100% oxygen, his arterial oxygen saturation was falling; he was delirious because of his mental illness, and he was fighting for air. The approximately two hundred forty pound (240) patient struggled for every gasp of air against our one hundred thirty (130) pound trauma fellow’s attempts to pull his mandible forward to open his collapsed airway.

DR. FACULTY returned the page. The ICU resident explained to him that there was an acute airway obstruction, and asked "DR. FACULTY to come up.” The resident hung up the phone and said “DR. FACULTY said he can’t come up. He said he’ll come later.”

XXXX. DR. FACULTY arrived to the ICU twenty-eight (28) minutes later.

Rather than assessing the situation and seeking information, DR. FACULTY complained, “Why don’t you just call anesthesia and intubate the patient! That’s what they’re here for.”

Obviously DR. FACULTY did not understand the full extent of this patient’s history and problems. The patient was thrashing about in respiratory distress. In order to intubate the patient, the anesthesiologist would have had to heavily sedate the patient, which would have caused deep muscle relaxation. The type of sedation required for intubation would have caused this patient’s already diminished airway to completely collapse, potentially precluding an endotracheal tube being able to be physically passed through his collapsed airway.

DR. FACULTY then paged the anesthesiologist, wasting additional precious time. When the anesthesiologist arrived, she took one look at the patient and said, “I’m not going to intubate this patient here. This patient needs to be in the OR.” The team literally rushed through the hallways pushing the patient’s bed stat to the operating room.

This patient, who underwent an operation on August 6^th, who nearly died because of the delay in performing the urgent tracheotomy on August 13, 20XX, has been in the intensive care unit now for eleven (11) days. At that time, there was still not a single pre- or post- operative note in the chart by the OMFS faculty member who operated on the patient’s mandible, or even by DR. FACULTY, who performed the emergency tracheotomy, despite the fact that the patient has had multiple complications, including infection and failure of his mandibular repair. Students, interns, and residents have provided all of this patient’s post-operative surgical care. Remarkable, isn’t it? The system is still broken and you have failed to correct the problem XXXXXX.

As an aside, the patient with a tracheal injury operated on July 11^th, 20XX, was admitted to the intensive care unit, and remained in the hospital for one week on the X trauma service, he was never seen by an attending physician: all post-operative care was provided by students and interns. Not one attending faculty physician ever made rounds on this patient.

Were you aware of the fact that the primary long-term risk of a tracheal injury is the development of tracheal stenosis over the next six (6) to twelve (12) months? The residents, acting without any attending faculty supervision, released the patient from the hospital with no appointment for follow-up care in the trauma clinic.

V. The Current State of Affairs

XX For years, people took a hands-off approach and allowed senior residents to treat patients with complete autonomy with little or no regard to patient outcomes. Now, some trauma surgeons are not willing to allow residents to have such autonomy. Some trauma surgeons are requiring and mandating that all laws requiring resident supervision and patient care issues be followed. You will not listen. Parkland and UT Southwestern will not listen. Lives are at risk.

As such, what once may have been a pillar of our community is crumbling around us – surgeons are quitting and/or resigning in droves, resulting in a call schedule that can not be filled with a sufficient number of trauma surgeons for a number of days each month.

The attending physicians on call, for approximately twenty five percent (25%) of the time, are non-trauma surgeon(s) who have not managed a trauma case for as long as several decades. One was removed from the trauma panel several years ago due to deficiencies in care that were documented by the Trauma Quality Improvement process. Many of these surgeons do not even meet the basic American College of Surgeons Committee on Trauma requirements – they do not have a current Advanced Trauma Life Support (ATLS) certificate, or the necessary sixteen (16) hours per year of trauma specific Continuous Medical Education (CME).

The citizens of Dallas would be appalled if they knew the truth of what was happening in their own back yard in their very own trauma hospital. Although the youngest pediatric trauma patients are taken to Children’s Hospital, injured children fifteen (15) years and older are transported to Parkland. These children will be cared for by surgeons with no trauma training, experience, or required CME, all because Parkland and UT Southwestern is short sided, unable to attract and retain quality faculty, and continues to revoke privileges of those physicians who truly care.

Now, most shockingly, because you have no place else to turn, you have deemed three 6^th year surgical residents enrolled in fellowship programs in the Department of Surgery as trauma faculty, and are allowing them to take call as attending surgeons. XXXXX

Parkland’s own Trauma Medical Director has stated that the current call schedule has so many unqualified individuals taking trauma call that it “makes a mockery of our profession.”

XXXX is an abuse of power and trust. XXX. How many people must die or become seriously injured before you will stop these abhorrent practices?

Sincerely,

____________________

UT Southwestern and Parkland: What Will Happen with the Joint Commission? Will We Finally Get To See the Report?

2011-01-26T23:59:00.007-06:00

Transparency is starting to have its day. Twenty years ago it was shown that the post-operative stroke rate after carotid end-arterectomy varied from 12% at some hospitals, to as low as 0.5% at other hospitals. Outcome differences of similar magnitude existed after surgical procedures for a variety of cancers. But, patients had no way of knowing what the outcomes were at the hospital they had chosen. "Great" hospitals were often considered "great" based upon nothing more than their own self-endorsing proclamations.

A few states made it mandatory to publish outcomes. That forced many programs to improve, and other programs to close down. It was noted that good results for many common but complicated operations depended upon the amount of times the surgeon had performed the procedure. Studies showed that two-thirds of carotid end-arterectomies were performed by surgeons who performed less than 12 per year, and many performed only three or four of these cases. That's where the poor outcomes were often coming from. High volume surgeons and centers had far fewer deaths and complications. Unfortunately, patients had no way of knowing about the results or experience of their own surgeon, or their own hospital.

Many large, Fortune 500 corporations that provide the health insurance for up to one-third of insured Americans, concerned about the effects of health insurance on business profitability, set up rules; they would not pay for care for certain operations if performed at a center that conducts an insufficient number of those cases. Little by little the days of secrecy were ending, and medical transparency was making headway.

The Joint Commission has an agreement with CMS, the federal government agency that pay for Medicare and Medicaid. If the JC finds that a hospital fails to meet certain quality standards, the hospital loses its "deemed status," or right to be paid for claims for services to Medicare or Medicaid patients. A copy of a letter from CMS to Ron Anderson, informing him of Parkland's loss of its deemed status has previously been published on this website. But because of secrecy, it was difficult, and took years to obtain that letter. The citizens of Dallas didn't find out until around two and one-half years later.

The Joint Commission also doesn't inform the public when a hospital has problems with accreditation, is put on probation, conditional accreditation, or has any other type of severe difficulty. Only after a hospital repeatedly fails after being given multiple opportunities to pass, does it lose accreditation. During all of that time, the hospital is given a "Gold Seal of Approval" by the Joint Commission," the same type of symbol that any fully approved hospital receives. It is so difficult to be publicly disclosed as failing that 97-98% of all hospital beds in the U.S. are JC approved.

But, the Joint Commission have just taken important "baby steps" towards allowing patients to know more about the hospital to which they entrust their health than just what the hospital wants to tell them.

The CMS Open Government Plan started several months ago will share Medicare data on quality, and costs in order to help Americans understand health care performance in their communities compare health care it with others, and to demand improvements.

And on its part, the Joint Commission now allows public citizens to know if a hospital has lost its accreditation, nearly lost it, or is about to lost. Before, it was nearly impossible to get that information. And, even after a failed inspection, conditional accreditation, or preliminary denial of accreditation, a hospital still gets a seal next to its name on the JC website, indicating that it was, "Accredited by the Joint Commission." Only after being told what the problems are, being given repeated opportunities to correct them, and repeatedly failing to do so, would a hospital eventually lose JC accreditation.

That's why Parkland has always claimed on its website, as well as this and other websites, that it has "never failed a Joint Commission inspection." That claim is made even though they failed an inspection two years it failed its inspection two year in a row.

2008 Parkland was labeled as a facility that was dangerous to patients seeking help at that facility. Because of Parkland's policy of complete secrecy these findings were kept hidden from the public for over two years, until the a Public Information Act Request forced them to release this finding, it was covered by the DMN in August 2010.

And, Parkland fails these Joint Commission inspections again and again. The message below about "Requirements for Improvement" found 14 critical safety failures. That was worse than the next year's inspection that found only about 11 critical safety problems.

Employees receive messages like the one below from Ron Anderson's office, telling them to meet for "educational meetings" in the Ron Anderson Conference Room.

---------- Forwarded message ----------

From: "XXX XXXXX XXXXXX" <XXXXXX@parknet.pmh.org>

To: ednet.swmed.edu>Date: Mon, 10 Sep 2007 17:20:06 -0500

Subject: Your Immediate Attention Needed: Training/Refreshments Served

We need you.....and 20 minutes of your time......

As as a result of the July 9, 2007 - July 13, 2007 Joint Commission

Survey, Parkland received 14 Requirements for Improvement (RFI). The corrective action for each of the RFIs will be implemented Tuesday, September 18, 2007 and will impact the physician practice at Parkland due to new forms, new processes and new expectations.

Please assure that you attend on of the six (6) upcoming Joint

Commission Physician Education sessions. All sessions will be held in the Ron J. Anderson Conference Room which is located inside the Parkland Cafeteria…..

The Joint Commission's expectations are that all Medical Staff and

House Staff receive this overview. Thank you in advance for your participation.

XXXX XXXXXX

Executive Assistant

Medical Affairs

214.590.1852

214.590.1403 fax

XXXXXXX@parknet.pmh.org

---------------

.
Is it right for Parkland to fail its inspections every year and tell everyone that it passes with flying colors, but no one gets to see the reports except for Ron Anderson and a few others?

What will the Joint Commission report say about the serious complication that occurred to Ms. Ned, that required the amputation of her leg? (corrected statement) At least under its new rules if Parkland fails, is put on, conditional accreditation, or pending completion of mandatory changes in the following critical areas, the new transparency laws provide the public with a means of finding out about it.

UT Southwestern and Parkland: Why It's Better for Them to be Honest and Open

2011-01-11T14:51:00.000-06:00

There has been a lot of wailing on Harry Hines Boulevard by Parkland and UT Southwestern because citizens now want to know if they have been good caretakers of the taxpayers money. However, it appears that these institutions don't want to give up the information, as required by law.

Government transparency enables US, the taxpayers, to easily hold our county hospital and state medical school accountable for how they spend OUR money, and take care of OUR health care needs. It provides the ability to hold people accountable, and it seems that they are afraid of being held accountable.

“Open government is critical to an informed public, and an informed public is critical to democracy.” – Judith Zaffirini

Transparency in government is not a new issue. John Adams, 2nd president of the United States, wrote, “Liberty cannot be preserved without a general knowledge among the people, who have a right and a desire to know.” In other words, a healthy system of government is an open government that allows all who desire to know to find the information they are seeking.

It adds clarity and accountability to a system, that left unchecked, is prone to corruption. Freedom of information acts, and published government audits are great examples of how the federal government has encouraged transparency in the past (Source: State Surge).

Perhaps if these institutions had been open about their operations all along, UT Southwestern Hospitals own internal auditors would not have recently found that they engage in "systemic non-compliance" with Federal Medicare and State Medicaid billing regulations.

Parkland might now have leadership that would not have steered them into the cross-hairs of a federal investigation for $50 million in fraudulent billing to Medicare. We are belatedly finding this out because Parkland hid these Medicare overcharges from their own auditors in order for their auditors to deem them as being financially in order.

In previous posts on this website some recent Texas Public Information Act requests filed by private citizens have been shown. The U.S. Attorney General has told Parkland that according to the laws of the State of Texas, this information must be handed over to the citizens requesting it. As also shown on this website, Parkland decided to sue the Attorney General, the State's leading law enforcement official, because apparently they want to keep breaking the law and be able to continue to violate the Freedom of Information Act.

Eventually, it will all come out. Below is another pending Public Information Act request. Parkland refused to obey it, and it is also being handled by the Texas Attorney Generals Office. Why are they willing to break the law and risk civil and criminal penalties including time in jail, and being found guilty of official misconduct, if they have nothing scandalous to hide?

But, I suspect that when these backlogged requests are finally fulfilled we will find out, and there will be serious repercussions.

The most recent request will obtain the following information. You can see that once allegations of fraud surface, and audits seem to confirm that it takes place at both institutions, the public is not going to let it go. As usual, the more they try to hide, the more reason they give people to dig. It seems that people aren't willing to just sit back and say, "well, it's Parkland and UTSW. They are important institutions. Its OK if they steal the taxpayers money."

The cover-up is usually worse than the crime. I wonder how UT Southwestern and Parkland will look when they run out of efforts to stall, and the information in this and the other public information is obtained and disseminated to the public.

No wonder that in desperation they hired a lobbyist (with taxpayer money!) to try to repeal the Public Information Act!

UT Southwestern and Parkland: Parkland Sues Attorney General Greg Abbott to Prevent Mandatory Release of Potentially Catastrophic Information to the Public!

2010-12-31T12:09:00.002-06:00

As previously documented on this website, Parkland has filed a lawsuit against the Texas Attorney Generals Office. Recall that an individual unknown to me filed a request to Parkland and to UTSW for release of information related to the ongoing investigations into health care fraud.

The tides have inexorably shifted to require release of medical care outcomes, costs, and information about how a public hospital is being managed. This has been shown to be highly effective in improving care, and the costs of care. People stop frequenting hospitals with high complication rates. This prompts improvements. Purchasers of health care stop frequenting hospitals that charge too much for inferior outcomes or average results. This improves resource utilization, and reduces costs.

Before you buy a car or a vacuum cleaner, you can get information about its quality through consumer reports, or through the internet. Why can't we find out how good a hospital is? After all, it's only your or your loved ones' health, and it's your tax dollars at work.

It seems that these institutions have a lot to hide, especially Parkland, as they have chosen to sue the Texas Attorney General to prevent having to release information that they are required to release by law.

Despite the slogan, "Tomorrow's Health Care, Today," it appears that Parkland and UTSW will only be dragged kicking and screaming into the 21st century practice of medicine. In the prior post about this lawsuit against the AG, Parkland refused to provide information about the multiple ongoing fraud investigations by CMS, the Attorney General, the State Pharmacy Board, the Office of the Inspector General, and other regulatory agencies. Recall that Texas Attorney Greg Abbott ruled that Parkland's attempts to conceal public information from a citizen that requests it results in a presumption that they are guilty of attempting to hide public information, and as a result, by law, they are now required to release ALL of the requested information.

Parkland apparently feels that it is above the law, and instead, decided to sue Texas Attorney General Greg Abbot for requiring them to reveal this public information to the public. In this extension of their lawsuit against the lead law enforcement officer and agency in the State of Texas, it's now about retaliation.

UT Southwestern and Parkland have long histories, and indeed, national reputations for crushing any dissenters among their employees. They fire, push out, slander, demote, financially penalize, attack reputations, and do whatever they want in order to maintain the status quo of allowing unsupervised residents to provide care as if they are the attending, as occurred with Ms. Ned. Think of how much money they save by only having to pay the salary of a resident, rather than the salary of a fully qualified surgeon. Think of how much money UT Southwestern saves by not having to hire faculty, and by freeing the existing faculty to go to the UTSW private hospital to take care of wealthy non-minority patients, while the residents provide the indigent and minority care at Parkland. It would seem to be a financially rewarding setup.

Now, some citizen whose identity is unknown to me filed a request to UT Southwestern and Parkland, asking for documents not related to fraud, but to recent cases where UT Southwestern and Parkland allegedly retaliated against their own medial staff that complained about the lack of resident supervision, the two-tiered health care system at UTSW, and other potentially explosive issues. The Attorney General has ruled that Parkland must release most of this information as well.

The requestor also asked for copies of the last few years' Joint Commission inspection. The Attorney General ruled that they must also release part of these reports as well. Recall, Parkland always say that they have passed the Joint Commission's inspections, but they won't release the documentation, and we know that is not true. Parkland is now also suing the Texas Attorney General to prevent having to release the public portions of the Joint Commission inspections as well.

Here is a letter from Parkland's attorneys (Dallas County Hospital District, aka, DCHD). Parkland and UT Southwestern have been hiding stuff like this for years, even though it is against federal and state regulations. One can only assume that by filing a lawsuit against the Law, they are hoping to delay the eventual release of this information as far as they can into the future. Click on images to see in full size.

Here is a copy of part of the original request for information to both UT Southwestern's Leah Hurley, and the now departed, disastrous, Michael Silhol.

Below is a copy of Parkland's lawsuit that now includes their attempt to not only hide the information about fraud and other illegal activities that the Attorney General has ruled is public information, but to also hide information about retaliation, and about failed Joint Commission inspections. Note, it is here in its entirety. For time's sake, I think that only the first three and one-half pages are relevant.

Below is a document that can only be read one way: Parkland is stalling. For example, the requestor asked for records related to 16 people who were allegedly targets of retaliation. Notice in the first bullet point, Parkland is asking if that mean any records concerning each of the 16 individuals, or records (emails, etc,) that list all 16 victims as a group.

The Attorney Generals' response is fairly lengthy. I will post all of it. It is pretty technical, so be warned. But, I will highlight in red boxes what I believe are the salient parts. In essence, it amounts to Parkland attempting to conceal public information, presumably because the public is not going to be very happy with them after they see it. The following document, and the one previously posted on this website where the AG ruled that they have to release information about the fraud and other investigations, is what Parkland's lawsuit against the State of Texas is actually about.

The following is where Parkland's attempts at concealing routine meetings and communications by calling them "medical meetings" is disallowed as an attempt to just call nearly everything a "medical meeting," in order to prevent disclosure. It also says that they are not allowed to just call everything, "protected by peer review," or the Patient Care Review Committee (PCRC). This has traditionally been one of Parkland and UT Southwestern's favorite methods of sweeping things under the rug.

In the following page, the second box refers to UT Southwestern's common practice of having Leah Hurley just sit in the room. Then, whenever anyone asks for the notes of that meeting in reference to lawsuits, retaliation claims, malpractice, or whatever, they say it is, "protected by attorney-client privilege." Not so, according to the law. Just because you sit a lawyer in the room like a potted plant in order to claim privilege doesn't mean that she or he is performing the duties of a lawyer at that moment. Therefore, privilege in such cases doesn't exist. The Attorney General is telling them that Parkland is obligate to provide the material that they falsely claim is protected by attorney client privilege.

Here is some additional material concerning Parkland's abuse of attorney-client privilege.

Next, Parkland tries to hide documents by falsely claiming the "attorney work product" privilege. Work that involves an attorney and client prepared for a trial or lawsuit is privileged because you shouldn't have to tip your legal strategy to your adversary. According to the Attorney General, Parkland abuses this privilege as well in order to hide things from the public.

Next, the requestor apparently asked for the entire file in the lawsuit where UT Southwestern, through the actions of Dean Gregory Fitz, were found to have engaged in discrimination on the basis of race, religion, ethnicity, skin color. These records were requested after the trial. The Attorney General points out to them that once a trial is over, the material is no longer protected by this privilege. Accordingly, they must now hand the entire file related to the racial discrimination case concerning the Dean of UT Southwestern Medical School over to the public.

In summary, by law Parkland must release most of the material in this request that it is trying to hide from the public.

Concerning the material in the other post, where a member of the public requested information about fraud and other potentially legal activities, the Attorney General ruled that the public is entitled to see all of it.

These disclosures will only improve the health care of the citizens of Dallas. If they are not doing anything illegal and/or, then there is nothing to hide. If they are, then we have a right to know, and the right to hold them to account.

In summary, when Ron Anderson and his cronies do not like the law, they just go ahead and sue the law. We now have Ron Anderson suing the State of Texas, spending millions of dollars of taxpayer dollars on legal fees to do so, for the sole purpose of hiding information about his performance from the public citizens that pay his salary. We have also observed similar behavior from UT Southwestern President Daniel Podolski, who also will not release any material to the news, under blatantly false pretenses such as saying that he can't talk about Mrs. Ned due to confidentiality, despite her signing a confidentiality release.

What type of institutions behave like this? How many other hospitals are suing the State of Texas?

UT Southwestern and Parkland Hospital Stories: Is it Legal Over There?

2010-12-19T21:37:00.000-06:00

The Dallas Morning News article concerning resident supervision was well done. Certainly, lack of supervision is a nationwide problem to some extent. The real issue is the extent of lack of supervision by UT Southwestern physicians when practicing at Parkland. It was enough to ultimately cause all of the trauma division faculty, except for two "career Parkland" trauma docs that have practiced only there, to resign and leave. They had all been recently hired from elsewhere.

Allowing patients to believe that a fully trained doctor is in charge of their care, while residents are calling the shots, is unsafe, and questionable on so many levels.

But what are the legal rules referred to in the recent DMN articles concerning billing rules, and does anyone recognize infractions occurring at Parkland?

According to the above, an attending physician must examine the patient prior to surgery, and revise or confirm the plan of care, and document this in the record. There have been major struggles trying to implement this at Parkland, with resistance starting at the top with Ron Anderson, filtering down through Bob Rege and other surgery managers. Few patients would ever see a surgeon (instead of a surgical trainee) prior to undergoing an operation for purposes of confirming a diagnosis and plan. Illegal if billed for? Fraud? Every see that at Parkland? Or perhaps the UT Southwestern Department of Surgery is not billing for services, and are working for free?

What is the legal definition of a procedure requiring direct supervision, or physical presence of the surgeon during performance? As indicated below, it is any procedure where a deviation in technique could harm the patient. That pretty much defines most operations.

In a prior post, the actual Parkland supervision policy and procedures were posted on this website. They were in bold conflict with the law. The policy said that there are no general surgical procedures performed at Parkland that require direct supervision. Not even the removal of major organs. There weren't even any that required personal supervision, legally defined as being present in the building. For those who have followed this blog, Parkland's policy did not require the faculty to be present in the building during surgery. They just required that a senior resident be available for consultation (by phone!) from somewhere on campus.

And, this must all be documented in the medical record, unless the UT Southwestern faculty member is doing their work at Parkland without expecting to be paid:

How many workers at Parkland have seen patients remain in the hospital for days, weeks, and even months, without there ever being a note left by an attending physician?

UT Southwestern and Parkland: Their Latest Lawsuit

2010-12-07T10:37:00.000-06:00

Was previously posted that Parkland, a public governmental entity that is supposed to be open to public scrutiny, has been refusing to release public documents. After all, the public is supposed to know how they are performing. Attorney General Greg Abbott is defending Parkland and UT Southwestern in billing fraud lawsuits, and against the doctor, or several doctors.

On the other hand, the same Greg Abbott is fed up with them acting as if they are not accountable to the public, and their unwillingness to reveal public documents. It was previously noted here that he issued an order for Parkland to release the documents related to their fraud, overbilling of Medicare, the ongoing U.S. Inspector General Investigation of overcharging Medicare, Medicaid, and other problems. But these documents did not come through on a prior post. I'm not sure how the other documents were posted, but I think they will come through on this post.

In essence, they Attorney General said that because they are hiding documents, and over-redacting documents that need little or no redaction in order to hide public information, they have gone so overboard that there is now a legal presumption that all of the documents that they are hiding, with few exceptions, must be handed over to the press. The exceptions are private email addresses, some attorney client privilege (but not the stuff they routinely sit Leah Hurley (sp?) in the room for in order to claim. The constant Podolsky claim of "HIPAA and patient confidentiality" is also moot: it's OK to redact names, but not to use that as an excuse to hide behind in order to conceal hundreds of pages of unrelated evidence. Sorry, the image could not be cropped, so you may have to scroll well below image to see remaining text. Click on to enlarge.

The records were from an open information request by someone named Ericson, whom I do not know.

The entire file is over 115 pages long. What follows is just an excerpt from the Attorney General's Office, telling them that because they are refusing to release information, and are redacting information that requires no redaction, they forfeit any right to continue to hide these documents, and must reveal them.

Notice the last paragraph of the above, "a governmental body's failure to comply with the procedural requirements of section 552.301 results in the legal presumption that the requested information is public and must be released....." Well, the Attorney General has ruled that Parkland and UTSW must now give it all up. Thus, as shown above, in order to avoid complying with the law, they have decided to sue the Texas Attorney Generals Office. Such Schadenfreude.

2010-11-26T06:02:00.000-06:00

Per the documents below, Ms. Ned was not the only case of residents operating without supervision. It happens at Parkland all the time. Much sworn testimony has already been provided here, including video of Ron Anderson saying an amputation is no big deal, "it's just a few swipes of the blade."

Below is the record of an 18 year old Hispanic woman who underwent a gall bladder removal. According to the notes on the operative report, documented by a faculty member whom Ron Anderson and Bob Rege pushed out of UTSW for wanting to supervise the care of his patients, no attending ever saw the patient pre-op, only residents had written an evaluation pre-op note (but it was incomplete), there was no attending note or documentation that a qualified surgeon had seen her before she was taken to the OR and underwent surgery, and the consent form did not have the name of the faculty surgeon. He just walked into the OR, only to be surprised to find out that he was listed as performing a surgery on a patient he had never seen before, and didn't know existed.

Also, the times indicate that the patient was seen in the ER by residents at 0:50, and didn't go to the OR for nearly two days - there was ample time for a surgeon (not a trainee) to have seen her to decide whether or not she needed surgery, how the surgery should be done, and so on. This is a daily occurrence. Ron Anderson, Bob Rege, and Alfred Gilman were told about this. Their collective responses were, "so what?"

Below is a document related to an inquiry conducted by Willis Maddrey, who was the Chair of the Compliance Committee at UTSW, and also the Chair of the Ethics Committee. This is an interview of a senior faculty member who told him that the surgeons, "staff from the lounge," and the residents take the paperwork for billing and documentation out to them for signature. Now Podolsky has joined in with Anderson and crew, and is saying that it is all the fault of the DMN for reporting this stuff.

UT Southwestern and Parkland: It Starts at the Top

2010-11-15T07:08:00.000-06:00

The poor woman who lost her leg as a result of unsupervised surgery, is not an isolated case. There are several amputations performed per day. Whether or not to amputate, how to do it, and the actual performance of it, are left to doctors-in-training, often during the middle of the night, without proper consent, or faculty supervision. Here is the Chairman of the Department of Surgery, under oath, providing his views about patient supervision, informed consent, billing fraud, and other matters.

12 *********************************************************
13 ORAL AND VIDEOTAPED DEPOSITION OF
14 ROBERT VINCENT REGE, M.D.

24 Q. Do you think that prior to a leg being cut off
25 of a patient that an attending should be able to see

0289

1 them?
2 A. I do.
3 Q. And evaluate them?
4 A. I do.
5 Q. And do you believe even prior to a toe
6 amputation, that that patient deserves the right to have
7 an attending look at them and examine them to see if
8 medical management would be the appropriate course of
9 treatment as opposed to amputation?
10 A. I do.
11 MR. DRAKE: Object, form.
12 Q. (BY MS. ALDOUS) Do you know that there are
13 occasions when attending physicians have been notified
14 that their patients are undergoing surgical procedures,
15 and they walked in the surgical suite and the leg has
16 already been amputated and is in the bag, when the
17 attending didn't even know the patient was in the O.R.?
18 Did you know that?
19 A. Well, you showed me a e-mail from Dr. XXXX in
20 which he spoke about the case where that was his concern.
21 Q. Did you know that's happened with -- with
22 physicians more than Dr. XXX?

23 MR. DRAKE: Objection, form.
24 Q. (BY MS. ALDOUS) Where they had been notified
25 that their patient is in the O.R., they walk in, and a

0290

1 limb or a digit has already been amputated before they
2 have a chance to see the patient; did you know that?
3 A. That was the --
4 MR. DRAKE: Same objection. Let me make
5 my objection.
6 A. Yes. That was the case that was brought to my
7 attention.

--------

16 Q. And, in fact, if that happened more than once,
17 and the attending actually -- his services -- his or her
18 services were billed when they weren't even there before
19 the amputation took place, that would be Medicare or
20 Medicaid fraud, would it not, sir?
21 MR. DRAKE: Objection, form.
22 A. If they were not there for the key portion,
23 then that would not be correct billing.
24 Q. (BY MS. ALDOUS) Well, I would think the key
25 portion would be before the leg would be cut off, don't
0291
1 you think?
2 A. Yes.
3 Q. What would you do if things like that were
4 brought to your attention?
5 A. I would speak to both the residents and to the
6 attending who -- if it was the attending's fault for not
7 being there.
8 Q. So you'd side with the residents on that one
9 too?
10 MR. DRAKE: Object to form.
11 A. No, I did not say that. There is the
12 possibility that the residents did not call, but I have
13 also had complaints about attendings not showing up when
14 they were called and said they would be there. Luckily
15 not so much on my service.
16 Q. (BY MS. ALDOUS) Now, you were of the opinion
17 that residents needed to be treated very independently in
18 the burns, trauma, critical care, correct?
19 A. Yes.
20 Q. And that there was an obligation by the
21 attendings to have them man cases and teach them?
22 A. Yes.
23 Q. Now, you said in the -- let me ask you this.
24 What arguments are you aware of that existed in the
25 burns, trauma, critical care about toe amputations?

0292

1 A. I'm not sure what you're referring to.
2 Q. So you don't -- you don't recall?
3 A. No.
4 Q. Okay. Dr. XXXXX (new attending) felt unwanted by the chief
5 residents in the surgical suites, did she not?
6 MR. DRAKE: Objection, form.
7 A. Dr. XXXXXXX told me that.
8 Q. (BY MS. ALDOUS) And did -- have you ever
9 discussed that with Dr. XXXXX?
10 A. Yes.
11 Q. And what did she say?
12 A. Well, actually I spoke to the residents who
13 actually gave me very positive feedback about her, and so
14 when I spoke to her, I told her that that was not -- her
15 perception was not what they articulated.
16 Q. Okay. So here again the residents were right
17 and Dr. XXXXXX was wrong; is that what you're saying?
18 A. The residents did not articulate problems with
19 Dr. XXXXX, and they gave her excellent evaluations.
20 Q. Do you --
21 A. I don't understand why that perception was in
22 place.
23 Q. But do you agree after your visit with Dr.
24 XXXX that she did have that perception?
25 A. She did have that perception, yes.

0293

1 Q. So she had that perception, Dr. XXXXX had
2 that perception, Dr. XXXX had that perception, and Dr.
3 XXXX had that perception (all new surgery faculty recruited from around the country), but they were all wrong?
4 MR. DRAKE: Objection, form.
5 Q. (BY MS. ALDOUS) True?
6 A. I did not -- I did not -- I did not have any
7 indication from the residents, either in evaluations or
8 in my discussion, that they had particular problems with
9 those physicians.
10 Q. But those physicians were of the opinion the
11 residents had problems with their involvement in surgical
12 cases, true?
13 A. True.
14 Q. But you think all those physicians were wrong,
15 they were just imagining something that didn't exist?
16 A. I don't understand why there was a division
17 when the residents were evaluating them well and giving
18 me positive feedback about them.
19 Q. So you believe what the residents were saying
20 versus what the attendings were saying, true, in that
21 regard?
22 A. I believe that they had a perception that they
23 weren't well accepted, and I believe the residents did
24 not have a problem with them.
25 Q. So you believed the residents?
0294
1 A. I believed --
2 Q. The attending said the residents are resistant
3 to us being in the operating room, the residents told you
4 no, we're not resistant, and you believed the residents?
5 A. No, that's not the question that you asked.
6 Q. Well, that's the question I'm asking now.
7 MR. DRAKE: Objection, form.
8 A. The question that you're asking now is did
9 the -- did the attendings believe that the residents were
10 resistant to their presence or participation in the
11 operating room; is that correct?
12 Q. (BY MS. ALDOUS) Yeah.
13 A. Yeah, I believe that they had that perception,
14 and I did speak with them about that.
15 Q. And did you think they were wrong, the
16 attendings were wrong in that perception?
17 A. No.
--------
Rege on informed consent (a viewpoint subsequently found by CMS to be illegal)

17 Let me ask you this. Would you agree with me
18 the patient has a right -- I think you told me this
19 earlier -- whether they're at Parkland, Zale Lipshy, or
20 St. Paul, to visit with their attending physician, the
21 one who's going to be responsible for the surgery, prior
22 to the surgery occurring?
23 A. They have the right to do that.
24 Q. And would be unacceptable for a patient to be
25 taken back to the O.R. and it not be known who the
0315
1 attending was for that patient?
2 A. Not necessarily.
3 Q. In nonemergent situations.
4 A. In nonemergent situations it is important for
5 them to know who will provide the care for them and be
6 their surgeon, and that they will be supervised by
7 faculty, because this is a teaching institution.
8 Q. So my question to you is: Absent an emergency
9 situation, does a patient have a right to know who the
10 attending is going to be on their case?
11 A. They have a right to know.
12 Q. Before the procedure takes place?
13 A. Yes.
14 Q. In fact, that's the law, is it not?
15 A. I don't believe that's the law.
16 Q. You don't think so?
17 A. No.
18 Q. All right. Well, what do you think the law is
19 about that?
20 A. They need to know the circumstances under which
21 their case will -- will be performed. They need to know
22 who is the surgeon of record, that is the one who will be
23 providing most of the operative care. They need to know
24 the procedure that will be done. They need to know the
25 risks and benefits of that procedure.

0316

1 Q. And who the attending is. You've already -- I
2 thought you already agreed with me on that.
3 MR. DRAKE: Objection, form.
4 A. They need to know that they will have
5 supervision by a faculty attending.
6 Q. (BY MS. ALDOUS) Well, they need to know who
7 the attending is, not just that it's some attending.
8 A. I don't think that's necessarily so. (Actually, federal requirements indicate that the patient MUST know the name of the faculty member. That faculty member performs the surgery, allowing residents to participate as appropriate. Residents are so incidental in the eyes of the law, that there name is expressly NOT supposed to be on the consent form. They are not allowed to function as "the surgeon.").
9 Q. All right. Maybe I misunderstood you hours
10 earlier. Are you telling me it is appropriate for
11 patients to be taken to the operating room when they do
12 not know who the attending is who is ultimately
13 responsible for their care, if it's not an emergency
14 situation?
15 A. It -- it is appropriate in circumstances,
16 especially in urgent emergent cases where the attending
17 changes on shifts, that they know there will be a faculty
18 and that faculty may change, depending on the
19 circumstances.
20 Q. I just said in -- not in an emergency
21 situation.
22 My question to you, sir, is: In situations
23 other than a life-threatening emergency, would you agree
24 with me a patient should know who the attending will be
25 on their surgical case?

0317

1 A. I don't think it's necessary that that has to
2 be the case.
3 Q. Well, do you think that if the patients at
4 Zale Lipshy and St. Paul have a right to know, that same
5 right should belong to the patients at Parkland?
6 MR. DRAKE: Objection, form.
7 A. The situation is different at those hospitals,
8 and oftentimes that consent is being obtained without
9 residents present, and then the name of the surgeon of
10 record will be the surgeon who's obtaining consent.
11 MS. ALDOUS: Objection, nonresponsive.
12 Could you read that back, Detta?
13 THE REPORTER: "Well, do you think that if
14 the patients at Zale Lipshy and St. Paul have a right to
15 know, that same right should belong to the patients at
16 Parkland?"
17 Q. (BY MS. ALDOUS) Could you answer that
18 question, sir?
19 A. This question was raised in this -- and I asked
20 for legal opinion about this because I'm not a lawyer,
21 and it was vetted through internal and external law
22 firms, and the answer that I was given is that --
23 MR. DRAKE: Hang on.
24 THE WITNESS: Yes.
25 MR. DRAKE: Don't -- don't relate any

0318

1 advice or communications you received directly from
2 internal or external counsel.
3 Q. (BY MS. ALDOUS) Well, was it your lawyers?
4 A. No, it was Parkland who notified me that they
5 have developed a consent form which is legal and properly
6 used. (Parkland and UT Southwestern changed the consent form, and indicated that it should not be completed until after the operation. This is after it was pointed out that faculty members were being listed as performing surgery. There were no cases where the faculty member listed as performing surgery were in Africa, but there were cases where the faculty member was in Europe. Overall, about 25% of the time, the faculty member listed as performing surgery was not even in Dallas, or in the state of Texas. So, the form was changed in order to hide that fact. Rege approved.)
7 MS. ALDOUS: Well, I can talk to him about
8 what he's talked to Parkland about. You're not saying
9 that that --
10 Q. (BY MS. ALDOUS) These lawyers that you say
11 were vetted through, they weren't your lawyers? You
12 didn't have an attorney/client relationship with them,
13 did you?
14 A. No --
15 MR. DRAKE: Hold on.
16 MS. ALDOUS: Let me finish --
17 MR. DRAKE: Okay.
18 MS. ALDOUS: -- laying my predicate.
19 MR. DRAKE: Okay.
20 Q. (BY MS. ALDOUS) And UT Southwestern did not
21 have an attorney/client relationship with the lawyers
22 that you just said vetted this consent form issue, true?
23 MR. DRAKE: Objection, form. You can
24 answer the question.
25 A. The question was answered by legal at Parkland
0319
1 Hospital, UT Southwestern legal was involved, and there
2 was outside counsel that an opinion that was asked for.
3 Q. (BY MS. ALDOUS) Okay.
4 A. That's what I was told.
5 Q. Okay. So I want to make sure I understand what
6 you're saying. You do know that the informed consent
7 form has been changed at Parkland in February of 2008,
8 true?
9 A. Yes.
10 Q. And you're saying that UT Southwestern was
11 involved in that process; that's what you just told me,
12 right?
13 A. That's what I -- I believe, yes.
14 Q. Okay. So you believe that in conjunction with
15 Parkland, UT Southwestern in February of 2007 changed the
16 consent form for surgical procedures for patients at
17 Parkland, true?
18 MR. JOHNSON: 2007 or 2008?
19 Q. (BY MS. ALDOUS) 2008. I'm sorry.
20 A. Yes. I was just going to say that. 2008.
21 Yes.
22 Q. All right. And you were actually consulted and
23 involved in that process as well, were you not?
24 A. I was asked to look at the form when they had
25 finished and put a form into place that was a candidate
0320
1 form.
2 THE REPORTER: "I was asked to look at the
3 form when they had finished and put a form into place
4 that was a candidate form."
5 Q. (BY MS. ALDOUS) Well, did you -- did you help
6 write that form?
7 A. No.
8 Q. What input did you have on that form?
9 MR. DRAKE: The instruction is not to
10 reveal -- if you communicated anything back to counsel
11 for UT Southwestern, not to reveal your communications
12 between that counsel.
13 A. I was basically asked to look at the form and
14 instructed on how it was to be used.
15 Q. (BY MS. ALDOUS) And you agreed with the form,
16 correct?
17 A. Yes.
18 Q. Now, you knew that Dr. XXXXX, in addition
19 to raising billing impropriety issues and raising
20 resident supervision issues and raising the two-tiered
21 system between Parkland patients versus Zale Lipshy and
22 St. Paul patients, had also raised the issue of improper
23 consent forms, true?
24 A. True.
25 Q. That is something that he had been talking to

0321

1 you about for quite some time, had he not?
2 A. I believe that he brought that up several
3 months before February of 2008.
4 Q. Well, do you recall that being an issue prior
5 to Dr. Gentilello's demotion -- no, he says it wasn't, so
6 I'm going to withdraw that.
7 Do you recall that being an issue as of
8 September of 2007 with Dr. XXXX?
9 A. That would be the time-frame that I would
10 recall, yes.
11 Q. Okay. Now -- and Dr. XXXXX was saying
12 patients are being taken to the operating room with
13 consent forms that list attending physicians who in some
14 circumstances are out of the country. Did you know that?
15 MR. DRAKE: Objection, form.
16 A. I -- I don't recall that.
17 Q. (BY MS. ALDOUS) Would that be of concern to
18 you?
19 A. Yes.
20 Q. If a consent form had, for instance, XXXX
21 XXXXX as being the attending surgeon, and XXXX XXXX
22 was in London, England, during the time the surgery was
23 performed, that would be improper, would it not?
24 A. It would be incorrect, yes.
25 Q. Well, it would be improper, would it not?

0322

1 A. Uh-huh.
2 Q. Correct?
3 A. Correct.
4 Q. And it would be improper under policies and
5 procedures of UT Southwestern, would it not?
6 A. The consent issue is a hospital issue. I'm not
7 sure that there are policies and procedures about that in
8 UT Southwestern.
9 Q. Well, the consent issue was a UT Southwestern
10 issue 'cause Dr. Gentilello brought it up and was
11 concerned as one of the faculty members at UT
12 Southwestern, correct?
13 A. Correct, but --
14 Q. And it wasn't -- I'm sorry. Go ahead.
15 MR. DRAKE: Object, form.
16 Q. (BY MS. ALDOUS) And it wasn't just Dr.
17 XXXX that brought up this consent issue, was it?
18 A. The -- there was -- once he brought it up,
19 there were several other people who were concerned about
20 it.
21 Q. And said, we don't feel comfortable operating
22 on patients under the current system by which consent
23 forms are being documented, correct?
24 A. Correct.
25 Q. And in response to that, what UT Southwestern

0323

1 and Parkland did is went ahead and changed the consent
2 form so an attending could sign the form after the
3 surgery, true?
4 A. I don't think that's true.
5 Q. Well, how did they change it, Doctor?
6 MR. DRAKE: Object, form.
7 A. I don't have the form in front of me.
8 Q. (BY MS. ALDOUS) Do you think it would be
9 appropriate for the consent form to show that the
10 attending surgeon may be determined after the surgical
11 procedure is performed?
12 A. It may be appropriate.
13 Q. Well, is it appropriate?
14 A. It may be appropriate.
15 Q. Well, do you have an opinion yes or no? I mean
16 you're the Department of Surgery chief.
17 MR. DRAKE: Objection, form.
18 A. Under certain circumstances it would be
19 appropriate.
20 Q. (BY MS. ALDOUS) Well, what circumstances would
21 it be appropriate?
22 A. The -- the supervising faculty member may
23 change because of the circumstances that are going on
24 with care of other patients, availability of faculty,
25 change of shift, to name a few.

0324

1 Q. Well, I'd like not to just name a few; I'd like
2 for all of them to be named, all of the circumstances
3 where you think it would be appropriate for a attending
4 physician to sign off on the consent form after the
5 procedure.
6 A. That's all I can think of right now.
7 Q. Who would be the surgeon of record for Parkland
8 surgical patients?
9 A. It would be the person who was going to perform
10 the operation.
11 Q. Would that be the attending or the resident?
12 A. It could be the resident.
13 Q. Okay. Well, would you agree with me that it
14 would be inappropriate for the surgeon of record to sign
15 the consent form after the procedure?
16 A. Why?
17 Q. Well, I'm asking you, do you think it would be
18 inappropriate?
19 A. No.

UT Southwestern and Parkland: Parkland Sues Texas Attorney General Greg Abbot!

2010-11-01T04:06:00.000-06:00

Parkland is now suing Greg Abbot, the Texas Attorney General. The Dallas Morning News has been trying to inform the community about UT Southwestern and Parkland, two vital county and state government agencies. In order to vote properly, there has to be transparency. Under the Freedom of Information Act, or Public Information Act, except in very limited circumstances, ALL government documents must be made available to the public. This is standard in a democracy.

With Parkland refusing to turn over documents about illegal billing, fraud, US Department of Justice investigation material, and other matters to the Dallas Morning News, and to another private citizen requestor, the matter went to the Texas Attorney General. The ruling against Parkland was very severe because they were found to have been going out of their way to sweep a variety of documents under "privileged" status such as doctor patient confidentiality, when they were not about that at all.

Because they so duplicitously tried to hide documents under various non-existent confidentiality protections, two weeks ago on October 13, 2010 the Attorney General ruled that Parkland must now turn over ALL of its documents to the press. He ordered Parkland to comply within ten days. Those ten days have already elapsed

Parkland just flat out refused to listen to the AG's order. Instead, in order to tie up the issue in court for the next few years, last week Parkland filed a lawsuit against Attorney General Greg Abbot. It is a 118 page document. The key parts are excerpted below.

Next is some verbiage about a private citizen named Mark Erikson who also trying to obtain the same information. It mirrors the DMN one, and is not shown.

--------------
Below, you can see that because Parkland overly redacted the material they supplied to the DMN and to Erikson, the AG called foul play, and said they must now hand over all material, except for a small bit of exempted material; that which has patient identifiers, and also the Department of Justice requested that their investigation into Parkland and UT Southwestern's billing fraud not yet be released to the public.

------------------

--------------------------

----------------
The AG got to see the documents requested, and those same documents provided to the DMN and Erikson in response to their Freedom of Information Requests. Those documents were SO heavily redacted that the Attorney General cried foul, and said that Parkland is not dealing from the top of the deck. They are trying to hide something, and he ruled that they must now reveal ALMOST EVERY SINGLE ONE OF THE DOCUMENTS.

In fact, here is an example of the type of document that Parkland was supplying to the DMN in order to thwart their attempt of allowing the public to be informed about what is happening within a governmental entity. The document is essentially nothing but fully redacted pages.

The AG saw that in their North Korea like attempts at control, they were sweeping various documents under doctor patient privacy protections when these documents had nothing to do with patients. That's why the AG told them they now have to reveal them all.

I do not know who Mark Erickson is, but it seems as if he is aware of an ADDITIONAL, previously undisclosed billing fraud investigation involving Parkland and UT Southwestern.
-----------------

Here is an example of how redacted the documents provided to Mr. Erikson were:

And so it went, on and on, completely redacted page after page. Parkland was just going to ignore the Freedom of Information Act, and not give up anything about the ongoing billing fraud investigations, the Department of Justice Information, and other illegal acts, on the basis of "doctor patient confidentiality" and other ruses.

This was after they implied that they were going to obey the Federal Laws on Disclosure, and release public information to the public (PIA request):

Parkland considered that by sending these completely redacted documents, they were complying with the Public Information Act Laws. Sort of like sticking their thumb in the eye of the public.

Well, the AG Greg Abbott considered this to be a blatant attempt to suppress important information that the public has a right to know. He ordered Parkland to hand over all of the material the Dallas Morning News wanted within 10 days of his October 13th ruling. The ten days to submit the document have expired.

So now, Parkland is suing Greg Abbot, the Texas Attorney General, in an attempt to suppress this information by tying it up in court. This will allow them to suppress vital information necessary for the public to make appropriate decisions on election day tomorrow, especially for county commissioners and various legislators.

This is consistent with UT Southwestern and Parkland's long standing practices of hiding information so that the public cannot determine if the hospital is run in an ethical manner, without racism, discrimination or abuse of patients, and without illegal financial dealings.

The full AG decision will be posted soon.

UT Southwestern and Parkland: 17 Is a Senior Official Trying to Mislead People?

2010-10-20T16:50:00.001-06:00

March 19, 2010
(http://dallashealthcare.blogspot.com/2010/03/in-february-22nd-post-on-parkland-vice.html)

In the February 22nd Post on Parkland Vice-President and Lead Counsel Mr. Michael Silhol, someone made a comment as follows:

"Anonymous said...: Oh, and one more thing, this blog is an abysmal excuse for journalism. Had any investigation been done, you would have found that CMS subsequently issued Parkland a clean bill of health on all these issues. I notice that this second finding, based after the above concerns were addressed and re-reviewed, didn't make your blog? That doesn't seem very objective, instead, like whoever is writing these posts might have an agenda? I'm no seven-year old, but maybe we could find a ten-year old or so to examine the lack of objectivity? Come on Amsterdam, I've read your DMN posts. Time to identify yourself. More to come...time to fight this nonsense you've been spewing."

The "blustery" comment above from "Anonymous," could only come from a senior level Parkland Administrator. At this point, they thought that the "altered" CMS report was the only one available. They did not know that I had obtained the original report removing Parkland's "deemed" status, the letters to Anderson, and Parkland's 160 plus page "Plan of Correction" submitted to CMS.

Below is an email I received from CMS dated May 2009, eight months after Parkland failed a inspection, and lost its "deemed" status, or right to participate in Medicare. It refers to all of the deficiencies that were found. Why would it refer to Parkland's Plan of Correction if Parkland had a "clean bill of health?" Why would the letter say that there was so much sensitive material in the Plan of Correction that it had to be sent to the CMS main office in Baltimore for "extensive" redaction? The email below would not have been sent if, as the Parkland administrator above stated, CMS gave them "a clean bill of health."

Click on it to see it in full size.
The letter states, the document will have to go through our FOI Office in Baltimore before it can be released. FOI is Freedom of Information. Otherwise, this would all still be a secret today.

So, to "Anonymous" senior Parkland Official who commented on the February 22nd post and stated, "Had any investigation been done, you would have found that CMS subsequently issued Parkland a clean bill of health on all these issues," I ask the following question. How do you explain the above email?

Are you telling the truth? Maybe you hadn't heard of the Freedom of Information Act?

Bottom line - Parkland got booted out the Medicare and Medicaid program for sub-standard care a few weeks before the bond vote for the new hospital.

UT Southwestern and Parkland: 16 Follow the Money

2010-10-20T16:33:00.002-06:00

March 16, 2010
(http://dallashealthcare.blogspot.com/2010/03/ut-southwestern-and-parkland-is-it-all.html)

When you see a physician, you pay for each visit. When you see a surgeon and have an operation, you pay one price, no matter how many times you are seen. One "global fee" is billed that covers the pre-operative assessment where the need for surgery is assessed and planned, the operation, and all post-operative care for up to 90 days.

About 10-15% of the global fee pays for the work the surgeon is expected to perform before the operation. Most of the global fee is payment for doing the operation. After the operation the surgeon has to make rounds and see the patient, and address any complications. After the patient is discharged the surgeon has to see the patient in clinic. About 25-30% of the global fee is to pay the surgeon for post-operative care work.

A surgeon must provide pre-, intra-, and post-operative care in order to bill their fee. No activity performed by a resident is billable. If a resident provides the pre-operative care without supervision, the attending cannot bill for it. The same applies to operative and post-operative care.

There were complaints by residents that the newer faculty members wanted to see their patients pre-operatively. Residents complained that some of the new faculty, "insisted on scrubbing, putting on gowns, gloves and surgical masks, and participating in the operation when one of their patients went to the operating room, instead of letting the residents do it themselves."

Other residents complained about the new faculty making rounds and directing the care after an operation.

ALL of the "new" trauma faculty recruited from outside of UT Southwestern complained that the residents were running the show at Parkland. The surgery department was running wild, billing for activities largely or entirely performed by residents.

This was reported up the chain of command to Dr. Robert Rege, Chairman of the Department of Surgery. He refused to require faculty supervision at the county hospital for racial and ethnic minorities and the poor, out of concern that it would upset the residents who preferred to learn on them by trial and error.

Multiple new faculty brought these concerns to Dean Alfred Gilman. His administrative assistant took notes. He said, "for the good of your career, you better zip your mouth, and not tell anybody about this." He threatened to retaliate if anybody talked, because there was so much money involved (Not to mention that tit is illegal).

Below are the notes that were taken by the Dean's administrative assistant. I have blacked out the faculty's names to maintain their confidentiality. It should be noted that every one of the faculty members interviewed below were "pushed out" of UT Southwestern, and are now employed elsewhere.

After reading the comments, tell me what you think. Were the faculty taking care of the patient's at Parkland, or were the residents in charge? Given the money involved that would have to be refunded, did that have anything to do with UT Southwestern, working together with Parkland, pushing out the people who made the statements below? Click on the documents below to see them in full size.

UT Southwestern and Parkland: 15 Unsupervised Surgery, Routine Practice

2010-10-20T16:16:00.001-06:00

March 15, 2010
(http://dallashealthcare.blogspot.com/2010/10/ut-southwestern-and-parkland-15-example.html)

The "Parkland Tradition" means that the faculty are available if the residents want their opinion. This was shown in a previous post on UT Southwestern surgery supervision policy. For any type of operation, a faculty member or senior resident must just be "available on campus for consultation."

Most of the faculty working at Parkland trained there, or had been there for decades, and didn't know any other system. Research and innovation had been moribund. A wave of new faculty from around the country were hired to revitalize the program. They were uncomfortable with the patient care. They were told that they should not consider themselves "operating surgeons," but as "supervisory surgeons." They were told that their role was to be available if the residents needed them. Residents were expected to work out patient care problems on their own, and learn by trial and error.
To the right is an illustrative operative note of a 19 year old hispanic woman with "severe acute cholecystitis" who needed her gall bladder removed. Click on it to see it in full size

The "new" faculty member who was on call wrote a note to surgery department administrators, informing them not to bill for the surgery for the reasons outlined in the red box.

1. Federal regulations require that the patient must have a history and physical note (H & P) in the chart before the operation. The new faculty member wrote, "resident H & P incomplete, unsigned."

2. "No attending note," meaning that no faculty member had seen the patient and written a note, as required by federal regulations. The residents decided to take the patient to the operating room on their own.

3. "Consent did not have my name." Federal regulations give the patient the right to know who is going to operate on them. The name of the faculty surgeon who will be doing the operation must be on the consent form. By the time this faculty member had been called the patient was already under anesthesia, and could not sign the form giving him permission to operate.

The faculty member provided the times, showing that there was plenty of time to comply with federal regulations:

1. The patient was seen by an ER doctor on 10/23 at 00:50 (ten to one in the morning).

2. A surgery resident wrote the incomplete, unsigned H & P at 0600 on 10/23, or at six o'clock in the morning, or over five hours later.

3. The patient did not go to the operating room until six o'clock (18:00) the following day (10/24), thirty six hours after the resident saw the patient.

During all that time no one wrote a signed history and physical, and no faculty member saw the patient to confirm that the resident's plan was correct.

This "new" faculty member (who was "pushed" out of UT Southwestern shortly after he wrote this note), refused to bill for the operation. Before the new faculty arrived Parkland faculty would not have had a second thought about the appropriateness of this care, or about billing for it.

Every single one of the "new" faculty were pushed out for wanting to end these types of practices.

UT Southwestern and Parkland: 14 Why is a Dentistry Intern Doing Unsupervised Ano-Rectal Surgery

2010-10-19T12:22:00.001-06:00

March 15, 2010
(http://dallashealthcare.blogspot.com/2010/03/intern-in-dental-residency-allowed-to.html)

In a previously published post there was a video where Parkland CEO Dr. Ron Anderson displayed no concern about doctors-in-training (residents) performing major operations on patients without supervision by faculty surgeons.

Here is a case of an intern in the dental program doing a complicated anorectal operation on a patient, without any supervision by a surgeon.
The operative report is on the right. Click on it to see it in full size.

On the first page is a line where it says, "staff," which refers to the name of the faculty surgeon on call. I have blacked out the names of the individuals involved.

In the middle of the first page its says, "Statement of Staff Presence." As you can see, it was left blank, because there was no staff present. Towards the bottom of the second
page, there is a line where staff
physician places their signature.

Since the staff physician was not even notified, they refused to sign.

By Joint Commission rules, every operative report must be signed by a staff physician. It is an absolute rule. A hospital would get into trouble if there was an operative report that was not signed by a faculty surgeon.

Look at the title of the

person who signed the line "staff physician," on the
second sheet. It is DMD, MD.

DMD stands for "Doctor of Dental Medicine." He enrolled in a medical school that gave him a combined Dental and Medical Degree. He graduated from dentistry/medical school nine months earlier, and was an intern in the Dentistry and Oral

Surgery residency program at UTSW. He was not even licensed to fill in a cavity.

Residents in the dentist program spend a few months on the general surgery service to learn how to use instruments, place sutures, and to acquire other basic surgical skills.

The patient had a "large perineal wound," which is the lower part of your buttock, and the area between your legs, around the genital area. It is an extremely sensitive area, with lots of nerves. A large wound there makes it very painful to sit down. It's a horrible problem. Also the patient just had a leg amputation above her knee that had not healed.

After seeing the video of Dr. Ron Anderson in a previous post, you can see why it is considered OK for someone who is a dentist in training to be allowed to do a complicated operation on the type of indigent patients seen at Parkland.

Complaints were made to Dr. Robert Rege, the Chairman of Surgery at UT Southwestern, and to Dr. Jim Valentine, the Surgery Residency Director, but they always rejected change, and said "Parkland is a county hospital, the expectations are different."

These types of practices are what led to Parkland almost being shut down three times the following year when it was found that it did not meet basic quality standards.

UT Southwestern and Parkland: 13 Texas Informed Consent Regulations

2010-10-19T12:15:00.000-06:00

March 9, 2010
(http://dallashealthcare.blogspot.com/2010/03/texas-medical-disclosure-panel-was.html)

The Texas Medical Disclosure Panel was formed in 1977 to determine what patients must be told in order to make an informed decision about whether or not to undergo an operation.

Patients do not have medical degrees, and should be spoken to in accordance with the average person's level of education. Language in the consent form must be similar to the way people talk in every day life.

In order to provide hospitals with an incentive to use proper consent, the Panel ruled that any doctor who uses the approved Texas Medical Disclosure consent form who is subsequently accused of improperly informing the patient about the risks of surgery, will be presumed to be innocent. It will be the burden of the patient to rebut this presumption.

If the doctor the does not use the approved consent form, the jury will be instructed to presume that the doctor is guilty.

The Texas Medical Disclosure Panel requires that forms be available in both English and Spanish. The official forms can be downloaded from their website. The official Texas form is on the left. The official form used by UT Southwestern Hospitals is on the right. Notice that they are identical, except for addition of a few words to reflect activities that it is a teaching center. UT Southwestern Hospitals are compliant with the federal consent regulation. Click to enlarge.

Below is the consent form used at Parkland. It is not at all compliant with the Texas Medical Disclosure Panel requirements, is not readable to the average person, is not available in Spanish, and doesn't follow the Panel's consent form in any way. Any patient who sues a Parkland doctor for surgery and that signed this form will have the benefit of having the court instruct the jury that the doctor is to be presumed guilty of operating without proper consent. Click to enlarge.

UT Southwestern and Parkland: 12 CMS Altering Survey Reports is Against CMS Rules

2010-10-19T12:07:00.000-06:00

As mentioned yesterday, many people are starting to read this blog, and going back to the original posts. They are not easy to find due to a lack of indexing. So they are being reposted. Not all posts, just some of the original ones that people seem to be seeking to going back and reading.

March 9, 2010
(http://dallashealthcare.blogspot.com/2010/03/ut-southwestern-and-parkland-site.html)

A site survey of Parkland Memorial Hospital in Dallas conducted on 9/22/2008 by the Centers for Medicare and Medicaid services found numerous deficiencies, and ruled that the hospital did not meet the conditions for participation in their program. Subsequent letters confirmed loss of "deemed" or accreditation status as a participant in Medicare and Medicaid programs.

UT Southwestern/Parkland officials met with the Dallas CMS Office, and promised to change the way they provide patient care. They attempted to implement such changes several months later during the following year. As stated in the last post, on the basis of that unfulfilled promise, Mr. David Wright of CMS went back to the 9/22/08 survey and altered it to say that during the visit, no non-compliance was found. Here is the problem with that.

According to the CMS Site Survey Manual, here is what is supposed to have happened.

1. "All noted noncompliance must be cited even when corrected on site during the survey."
2. "Even if the hospital fixes the deficiencies while the site visit is still underway, the final report must still write that these deficiencies were found."

In other words, if deficiencies noted during a survey are fixed while the survey is still underway they must still be cited in the final report on that survey. Obviously, deficiencies fixed the year after the survey must also be cited in the report of the survey. You cannot go back and scratch out the findings of a survey that is several months old when someone changes what they do at some point in the future.

This stinks to high heaven.

There is evidence that suggests they broke additional rules. On October 6, 2008 Parkland CEO Dr. Ron Anderson received a letter summarizing the findings of the 9/22/2008 site survey.

It was shown in an earlier post on this website. It letter, "The deficiencies have been determined to be of such a serious nature as to substantially limit your hospital's capacity to render adequate care and prevent it from being in compliance with all conditions of participation for hospitals."

The Survey Operations Manual indicates that the Dallas Center for Medicare and Medicaid Services had the following duties:

"Explain that a statement of deficiencies (Form CMS-2567) will be mailed within 10 working days to the hospital."

"Explain that the Form CMS-2567 is the document DISCLOSED TO THE PUBLIC about the facility’s deficiencies and what is being done to remedy them."

"The Form CMS-2567 IS MADE PUBLIC NO LATER THAN 90 CALENDAR DAYS following completion of the survey. It documents specific deficiencies cited, the facility’s plans for correction and time frames, and it provides an opportunity for the facility to refute survey findings and furnish documentation that requirements are met."

"Inform the facility that a written plan of correction must be submitted to the survey agency within 10 calendar days following receipt of the written statement of deficiencies."

UT Southwestern and Parkland did not disseminate this information to the public, as required. Instead, it appears that UT Southwestern, Parkland, and officials in the Dallas Center for Medicare and Medicaid Services office erased all deficiencies from the final CMS-2567 form, and never reported it to the public as required.

More than a year after the survey, on October 14, 2009 a meeting was held in Mr. David Wright's Office to ask why the findings of the September 2008 survey were changed from substantiated to unsubstantiated, in violation of the rule that alterations to the document should be reported to the Office of the Texas Attorney General as fraud.

Media inquiries were made, and instead of handing out the document that listed the deficiencies that were present on the day of the survey, his office was handing out the one that had been altered.

He was also asked why the findings of the survey were never released to those who submitted the original complaint, and why the findings were not released to the general public as required by the state law.

Mr. Wright had no specific answers, other than to repeatedly say things had been,"mishandled," "someone messed that one up."

Mr. David Wright, please explain how changes in procedures for consent initiated in January, 2009 caused findings of what happened to patients who were operated months on in between July and September 2008 to disappear from the final report?

UT Southwestern and Parkland: 11 More Federal Cover Up

2010-10-18T13:58:00.001-06:00

March 5, 2009
(http://dallashealthcare.blogspot.com/2010/03/ut-southwestern-parkland-dallas-center_05.html)

Yesterday I posted an email with Mr. David Wright, Deputy Administrator for the Centers for Medicare and Medicaid Services (CMS), admitting that Parkland Memorial Hospital was not in compliance with CMS regulations, and was in the process of losing its accreditation.

Although hospitals may become compliant, CMS findings may not be altered and backdated to hide lack of compliance with federal regulations if a hospital meets compliance regulations at some point in the future.

Here is another email where Mr. Wright admits that Parkland was out of compliance. Click on it to see it in full size.

On 9/22/08 CMS inspectors found such severe problems they removed Parklands "deemed" status, and notified their staff, and Ron Anderson.

One month later on October 23, 2008, they met with Mr. David Wright. As he wrote in the email above, Parkland and UTSW met with him, and they agreed to change their practices, and start obtaining consent before operating on patients.

On 9/22/2008, Parkland was out of compliance, based on review of medical records for operations conducted between July and September of that year.

At the October 23, 2008 meeting Parkland agreed to draft new procedures, and submitted them for approval on 12/7/2008. They incrementally attempted to implement the procedures (but failed) during January and February 2009.

When Parkland submitted their December 2008 plan to become compliant Mr. David Wright of the Dallas CMS Office went back to the September 22, 2008 report and altered it, to make it state that on that date, federal inspectors found nothing wrong.

Neither Mr. Wright nor Parkland anticipated that the proof would ultimately be obtained through the Freedom of Information Act.

Instead of altering reports, the rules call for the investigators to return to the hospital in 90 days to conduct a full inspection to see if the deficiencies have actually been corrected in practice, not on paper.

If the problems were fixed, CMS would then issue a note stating so, and that Parkland, as of that point, meets conditions of participation, and has regained its deemed status.
Mr. David Wright did not send his team back to Parkland for the required inspection.

On the basis of the October 23, 2008 meeting, based on Parkland's promise to change, Mr. Wright altered the results of the September 23, 2008 inspection results.
Promises made in October do not change the fact that the medical records of patients who underwent surgery the previous July received care that did not meet basic federal requirements.
During the meeting in his office Mr. Wright said, "You are right, that shouldn't have been retrospectively applied. It was mishandled. But, there is nothing we can do about it now."

According to the dictionary, mishandled means "to deal something clumsily or inefficiently."

According to their own rules, altering an official legal document is not defined as potential fraud, not as mishandling.

I previously posted an internal memorandum written by the Dallas Centers for Medicare and Medicaid Services that they gave to their employees, advising them how to discuss Parkland's loss of accreditation with the press.

However, after the October meeting with Parkland, when the press did start making inquiries and asked to see the results of the September CMS investigation, Mr. Wright would hand them the altered one that said Parkland had a clean slate, even though he subsequently admitted that it was not correct.

Is it right for federal Medicare and Medicaid inspectors whose job it is to protect the poor, elderly and disabled, to alter documents in order to help Parkland cover up its flaws?

UT Southwestern and Parkland: 11 Cover Up at the Dallas CMS Office

2010-10-18T11:53:00.000-06:00

March 3, 2010
(http://dallashealthcare.blogspot.com/2010/03/ut-southwestern-parkland-dallas-center.html)

Previous posts showed the Centers for Medicare and Medicaid Services conducted an unannounced survey of Parkland Memorial Hospital on 9/22/2008, found that surgical services did not meet basic standards of care, and Parkland lost its deemed (accredited) status.

A letter to CEO Dr. Ron Anderson informing him of this, and an internal memo from CMS to its employees, telling them how to handle this information with the press, was also put on this website.

I mentioned that October 23, 2008 Parkland/UTSW officials and attorneys had a meeting with Mr. David Wright of the Dallas Office of the Centers for Medicare and Medicaid Services, less than two weeks before the bond election. They were able to get him to alter the form, and to give them a new one that said that at the 9/22/2008 inspection the government did not find anything wrong.

I already posted the original and altered forms, and the need to inform the Texas Attorney General of any alterations in the form.

Below is an email conversation that I had with Mr. David Wright, in October 2009, one year after he altered the form. This occurred after I obtained the documentation from the Central Office of CMS on the east coast, using the Freedom of Information Act (which took one year). Mr. Wright is the Deputy Administrator, or second in command, for the states of Texas, Louisiana, Oklahoma, Arkansas, and New Mexico. He admitted in the email that Parkland was out of compliance, and an improper cover-up document was issued.

Mr. Wright was as evasive as could be. He thought that I had only seen the document that said CMS found all charges against Parkland were unsubstantiated. I showed him the two different documents, with two different conclusions from the same investigation.

He did everything he could to avoid answering how a document that federal law prevents from being altered could be changed from saying one thing, and then after a meeting with Parkland Executives, be changed to say something entirely different.

You have to read the email from the bottom up: the 3:05 PM email to him, and his 4:40 PM response. Click on it to enlarge it to full size.
It took quite a few email exchanges to "squeeze" an admission from him that Parkland WAS out of compliance, the form that said findings were "unsubstantiated" was wrong, and that they changed the inspection result from one that led to Parkland's loss of accreditation, to one that appeared that Parkland had a clear slate.

UT Southwestern and Parkland: 10 Executive Vice-President John Jay Shannon

2010-10-18T11:33:00.002-06:00

February 28, 2010
(http://dallashealthcare.blogspot.com/2010/02/ut-southwestern-parkland-how-senior.html)

The previous posts showed that in September 2008 the Center for Medicare and Medicaid Services made an unannounced inspection of Parkland's surgery service. They found multiple deficiencies, and ruled that Parkland did not meet Conditions of Participation in the CMS program.

I also posted a document that was obviously altered that said CMS found nothing wrong during that inspection.

This was kept secret. It took nearly a year, and use of the Freedom of Information Act (FOIA) to force them to provide the records of the cover-up.

The infractions were such that Parkland had to file a Plan of Correction that was over 160 pages long, also obtained by FOIA.

Parkland and UT Southwestern management did not know that the unaltered CMS report and the Plan of Correction had been obtained by FOIA. When asked, they would show the media and others the "altered" report saying that CMS found nothing amiss (Why would there be a 160 page long plan of correction if nothing wrong was found?).

Parkland also repeatedly stated that the Joint Commission for the Accreditation of Hospitals (JC) surprise inspection conducted around that time found no deficiencies. Actually, the JC inspection found numerous deficiencies - eleven major infractions that if not fixed, would result in loss of accreditation. The CMS and JC inspections occurred with a few weeks of each other, and investigated entirely separate issues just weeks before the vote on a $1.2 billion tax increase to support Parkland.

The JC inspection was reported in the Dallas Morning on January 19, 2009, several months after the vote. But many details were left out.

Here is an excerpt.

"Staying Quiet

The News asked Parkland to release records related to the October spot-check, but hospital officials have sought to keep them secret. In a five-page brief to the state attorney general's office, they argued that disclosing the records would compromise the hospital's quality-review process. It has not been ruled on."

Among the most serious JC findings were, "Deficient leadership and staff qualifications." This is the same leadership that Parkland Board Chair Dr. Lauren McDonald described as so "outstanding" that it justified firing over 100 nurses to give them $1.7 million in end-of-year bonuses in 2009.

The primary disseminator of disinformation was Parkland Senior Vice-President, and Chief Medical Officer, Dr. John Jay Shannon, pictured at right.

He has repeatedly mischaracterized CMS and JC inspection results. He was aware that two oversight agencies had conducted separate and independent investigations and found Parkland to be out of compliance with basic standards of care, and their accreditation was at serious risk

For example, the email below contains a response from Dr. John J. Shannon, who did not know that the unaltered CMS inspection document had been obtained by FOIA. He sites the falsified CMS document, and claims that CMS and the Joint Commission inspection found nothing wrong

Finally, he stated that the ACGME, or Accreditation Council for Graduate Medical Education, also did an investigation and found no problems. The ACGME has nothing to do with consent, and does not investigate whether or not patients are operated on without supervision. They look at resident work hours, lectures, call rooms, and other educational issues that have nothing to do with regulatory compliance.

Click on the images below to enlarge to full size to see false statements:

Note, Parkland was inspected twice by CMS. The first resulted in loss of deeming status due to failure to meet Conditions of Participation, and the second resulted in an EMTALA violation.

Dr. Shannon received a 2009 bonus of $379,995 for his performance, which included nearly getting the hospital shut down on several occasions by two different accreditation agencies, and as you can see in the email above, he appears to have no problem denying it ever happened.