Medical center must address problems
Commentary by R. DENNIS DAVIS, M.D.
As a United States senator recently said about the Firestone tire scandal,
"What does it take to put a company on notice that perhaps they've got a defective
product out there?"
We unfortunately live in a time of hospital/doctor "companies"
and medical care "products." The inappropriate result, even in this little,
close-knit valley, is the emergence of corporate mentality in the delivery of health care.
If that produced a better "product" then it might be excused, but, at least in
the case of St. Luke’s Wood River Medical Center, it doesn't.
I had hoped to end my 20-year-plus radiology career in the Wood River
Valley by completing the transition into a new modern hospital. But St. Luke’s
dismissal in August of myself and other radiologists, who had provided service to the
valley for a combined 32 years, represented the hospital’s response to being put on
notice for the past two and a half years about patient care problems.
Respected organizations such as the Harvard Medical School and The
Institute of Medicine have pointed out the large number of errors made by hospitals and
doctors that result in patient injury (up to 98,000 per year). St. Luke’s in Boise
was the center point of an article in the Oct. 11 issue of USA Today about alleged
mistakes there that may have resulted in extensive brain damage to a newborn boy.
I want to point out current problems in health care delivery to enable
this community, collectively and individually, to take responsibility for its own health
care, rather than relinquish it to any organization or individual practitioner. I want to
help the community understand that a shiny new hospital and good bedside manners don't
necessarily equate to good care--that medical care is very personal and requires personal
involvement and lots of questions to the providers.
If I am able to accomplish that, I won't be very popular with the hospital
(not that I am now) or with some doctors--but that isn't too important since I am now
retired and free to speak my mind without fear of further retribution.
First, let me give a little of my background. I have practiced medicine
since 1967, in Idaho since 1975. Since 1980 I directed the radiology department at Moritz
Community Hospital and subsequently the Wood River Medical Center. I was a 10-year
hospital board member, medical staff president twice, formed the Wood River Medical
Society and helped form and was president of the Hospice of the Wood River Valley.
In addition to my role as a physician, I am also unable to sit back and
watch while inequities play themselves out. I therefore had major roles in the difficult
hospital consolidation, the Sun Valley mayoral recall, Sun Valley Ski Education Foundation
safety concerns, and so on.
I also have a deep need to give back to this community, as it did to our
family after our daughter, Muffy, was paralyzed in a ski racing accident in 1989. Just
possibly, in the future, I can assist people in getting through the confusing maze of
health care to arrive at a safe, effective solution to their individual medical issues.
Someone once said that if you want to know where to get quality medical
care in a town, ask the radiologist or pathologist, particularly if they've been patients
themselves. I qualify on both counts. Since I spent virtually all my work time within the
walls of the hospital, I am well aware of how it operates and how individual doctors
perform. The information to follow is my opinion based on over 20 years of such practice
in the Wood River Valley.
I was one of the first people to meet with Ed Dahlberg, president of St.
Luke’s, to ask for help in transforming the fragmented care in the Wood River Valley.
With high hopes, I took an active role in getting St. Luke’s into the valley. After
its appointment of Jon Moses as CEO of the Wood River Valley hospitals about two and a
half years ago, I began to point out multiple problems in the X-ray department that
affected patient care. My concerns are documented in multiple memos and notes.
To date, few, if any, of those problems have been corrected. Frustration
that few of my concerns were being adequately addressed led to my reporting of them to the
current hospital board, the St. Luke’s administrative staff and the community council
leaders.
Other doctors were voicing similar complaints about other areas of
hospital operations. That left the hospital with two choices--either deal with the
problems or get rid of the complainers. Many of the complainers are now gone; most remain
in practice somewhere in Idaho and are therefore loath to criticize St. Luke’s. Dr.
Alice Police has left the state and I am retired and therefore feel no such reticence.
(Editor’s note: Dr. Police was one of three general surgeons
practicing in the Wood River Valley and performing procedures at St. Luke's Wood River
Medical Center. She said she closed her practice and left the area in July in part because
she felt she was rebuffed by the hospital in her attempts to establish a breast-care
center here. Her story is disputed by Jon Moses. See Mountain Express, Aug.30, page
4.)
Let me elaborate on some of the problems I faced in radiology and how they
affected patient care:
· Radiologists provide information to a patient’s doctor to
help him/her provide more appropriate treatment. If that information isn't provided
timely, it is of little value. The average time for delivery of my dictated reports to a
patient’s doctor was five days. It should be under 24 hours. I had to call or
hand-write reports to the doctors to attempt to mitigate this problem. Even the
handwritten reports didn't solve the problems since an ineffectual distribution system
frequently didn't allow these to get to the doctors. I believe those problems have
contributed to patient suffering and safety. It is easy to see why. (Editor’s note:
According to Bill Bodnar, vice president for corporate development at St. Luke’s in
Boise, the hospital’s turn-around time for radiology reports to the Wood River
Medical Center during the past month averaged 34 hours, including those done on weekends.)
· Other problems with the transcription system abound in spite of
attention having been called to them for almost three years. Doctors sometimes received
wrong or inaccurate transcriptions of my reports. For a radiologist whose primary purpose
is to provide information to patients and doctors, that became unbelievably frustrating.
· Radiologists prefer not to perform and interpret their studies in
a vacuum, but rely on an accurate history and comparison with prior studies. It was common
at WRMC for me to get inaccurate histories, confusing my diagnoses. If prior exams are not
obtained, the radiologist can be misled into thinking that something on an X-Ray is new
and needs treatment.
· The radiologists were required by contract to perform the
technologist portion of ultrasound exams when the technologist wasn't there. That meant
that on a busy day, other patients would have to wait. Other hospitals solve that dilemma
by cross-training more than one technologist to do ultrasound.
· A hospital performing major surgery needs the ability to quickly
detect life-threatening complications such as blood clots to the lungs. Nuclear medicine
tests are routinely used for that. For some time, WRMC has had those tests available only
one to two days a week. I believe that reflects the hospital's inability to retain enough
qualified personnel.
· Poor scheduling of patients commonly leads to extended patient
waiting, which can be aggravating and nonproductive for the patients and in some cases
increases the patients' discomfort. Front desk personnel performed beyond expectations but
were often overwhelmed.
Those and other problems are the responsibility of the hospital, not the
radiologists. In my opinion, the hospital's failure to solve the problems reduced my
ability to deliver good patient care.
I am not as intimately familiar with the problems in other departments of
the hospital, but judging from innumerable comments from other doctors, nurses, and
hospital staff, similar problems abound.
One area with which I am quite familiar is the breast care center concept,
having initiated with Dr. Police the formation of the Breast Care Task Force several years
ago. Although CEO Jon Moses has stated that everything necessary or desired has been
ordered, I and other members of the task force see it differently. Of the essential items
outlined to the hospital, approximately half are scheduled to be implemented. The hospital
has built a nice new mammography suite, not a breast care center--and has lost the
services of the primary breast surgeon, along with significant potential donations by
doing so.
Some people might think and St. Luke’s might say (should they even
admit to any problems) that those will all be solved when the new hospital opens. I
believe the problems are unrelated to bricks and mortar, but rather are problems of poor
leadership and failure to address operational issues affecting patient care. They won't be
solved without a change in the way the hospital, old or new, is being run. That seems
unlikely as, in my opinion, St. Luke’s pattern has been to build shiny new hospitals
rather than correct underlying operational problems.
Hospital business and revenues continue to fall as doctors leave or do
more of their work in their offices and less in the hospital. Most perplexing of all: Why
doesn't St. Luke’s simply address the problems? Not understanding corporate
mentality, I haven't come up with a satisfactory answer. Is a new building the answer ? I
don't see why.
Another area of major concern to me is the performance of surgical and
medical procedures in the hospital which, because they are performed so infrequently, have
no business being done there. There are procedures, authorized by the public hospital
board, being done at WRMC in extremely low volumes. Medical studies clearly point out that
that increases the risk of patient complications and death. I have asked the hospital and
medical staff to review that issue.
Undoubtedly, Jon Moses, St. Luke’s, the community council, some
doctors and some benefactors and others will disagree with my opinion and offer their own.
I would ask the community to compare my 20-plus-year record here and Dr. Police's record
here with the two-and-a-half-year experience of Jon Moses and St. Luke’s. Mr. Moses
has conducted his own survey of the medical staff's evaluation of hospital management. If
the results of his own survey refute this letter, I am sure Mr. Moses will be glad to make
the survey public. Don't hold your breath.
All of us involved in the St. Luke’s project have a great emotional
commitment in it, making it psychologically difficult to question whether we have done the
right thing. To do so is particularly difficult for large benefactors. It is far more
comfortable to get behind the party line and agree to "just get the damn thing
built." It is somewhat easier for me, having labored under this ineffectual system
for two and a half years.
It is clear to me that without a strong message being delivered to St.
Luke’s from the community, the patient-care concerns won't be addressed. So far,
judging by the hospital sign issue, administrators seem totally unresponsive to public
opinion. They have certainly seemed unresponsive to medical staff opinions, unless they
agreed with them.
Jon Moses has implied that I did not share St. Luke’s vision. If that
vision includes responding to constructive criticism aimed at improving patient care by
getting rid of the critics rather than addressing the problems, then I would agree that I
don't share it. It is not the vision I had in mind when I worked closely with St.
Luke’s to address the local medical problems early in this endeavor.
The problem, it seems to me, is that the medicine delivered in hospitals
is, to a great extent, controlled by the managers of that institution. Have they forgotten
that if one patient’s well-being is sacrificed they have violated the basic trust
placed in them by their community? It seems that too often their economic ledgers don't
allow the implementation of changes that would benefit individual patient care; the
financial status of the hospital is placed above the individual’s well-being.
If ever there is anyplace where that could be done differently, it is this
valley. We have no managed care and an immense philanthropic base. We need a hospital
organization that is willing to get out of its box and look at the unique needs and
abilities of this community--to be willing to face up to the difficult challenge presented
by members of the medical staff trying to practice L.A.-style medicine without the volume
to make that viable.
It has been my experience over many years that patients, regardless of
their financial situation, have great difficulty in making appropriate medical decisions.
They trust their doctors and hospitals to do the right thing. That doesn't always occur.
If, when those deficiencies are pointed out, the only response is to "kill the
messenger," eventually the public will demand better. Perhaps my new job is to
continue to make the public aware of those deficiencies.
As we move to a non-public hospital, this challenge will be even greater.
I think many of us now feel, however, that we can't simply sit back and trust the new
providers of our primary source of health care to do what is best for us individually.
Dr. Dennis Davis has been a practicing
radiologist in the Wood River Valley for more than 20 years.
