Author: P Hasselbacher

Cardiologist Pleads Guilty to Doing Unnecessary Angioplasties at St. Joseph’s Hospital London.

Not Just a Bad Idea.  It’s Against the Law!

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Yesterday, the Office of the US Attorney, Eastern District of Kentucky, released a public notice that cardiologist Dr. Sandesh Rajaram Patil “pleaded guilty to charges that he falsely recorded the severity of patient’s illnesses in order to receive payment for numerous [medically unnecessary] heart procedures” while working at St. Joseph Hospital in London, then and now part of the CHI/KentuckyOne Health system.  A prison term of some 3 years is anticipated. St. Joseph London has repaid the government $256,800 for an unstated number of cardiac stent angioplasties done in its hospital in 2009 and 2010 for which falsified bills were submitted. You can download a copy of the announcement at the FBI site, or here.

This means that we do not have to hedge anymore by referring to “alleged” angioplasty abuse. Frankly, I was not aware that criminal proceedings were underway but should not have been surprised. Neither do I know if there are ongoing criminal charges against other physicians at the hospital, or the hospital itself. Certainly there are a multitude of civil suits from patients pending against physicians and hospital alike. If I were a Blue Cross or a Humana, I would be getting in line for some refunds as well. The story is, unfortunately, far from over at this hospital and others in the state. The phrase “tip of the iceburg” comes to mind.

What was agreed to? Can we know?
As seems to be the case in such “settlements,” there appears to be a discrepancy between what the court assumes it has extracted in terms of admission, and what Dr. Patil is willing to concede. According to reporting by Andrew Wolfson, reprinted often in today’s papers, Patil’s attorney appears to claim (in contrast to the the use of the pleural in the announcement) that the degree of blockage in an artery was exaggerated for only a single patient, and that Dr. Patil “didn’t do anything that he didn’t think was medically necessary.” Its hard for me to get from one artery to three years in jail without access to the charges and the pleadings. What does the United States Attorney know that we do not? I am not completely surprised at the sentence, but how are we to judge its fairness without access to the facts. St. Joseph Hospital London had to give back a quarter of a million dollars. Was that too much… too little? The hospital submitted bad bills for payment. Does it have any culpability? If it does not, then it deserves to have its name fully cleared. As I have suggested for several months now, without full transparency and accountability, a cloud will hang over these and other hospitals and cardiologists for the foreseeable future. No one deserves that. Local physicians must be able to recommend their hospitals to their patients without reservation. Patients must feel comfortable going there.

[Addendum: I obtained additional insight into the matter of “how many” arteries were at issue, and what the magnitude of the hospital pay-back might tell us.  See my comments below. Add your own] Continue reading “Cardiologist Pleads Guilty to Doing Unnecessary Angioplasties at St. Joseph’s Hospital London.”

Safety of Louisville Hospitals: Are we there yet?

Further consideration of recent Leapfrog Hospital Safety Scores.

Earlier this month I offered a preliminary description of the third iteration of Leapfrog’s Hospital Safety Scores for Kentucky’s hospitals. I continued to be concerned about the large and increasing number of Kentucky Hospitals that escape evaluation, including some that should be looked at the hardest. Of the 45 hospitals that were evaluated this round, one quarter saw their scores change one way or another. Two of Louisville’s four hospital systems saw their scores fall one letter grade to as low as a D, and none received an A.

Hospital reaction and criticism.
Hospitals that do well are happy. Those who do not may understandably make an effort to mitigate the adverse publicity. Jewish Hospital and St. Mary’s Healthcare (which received a D) raised an objection we have heard before– that the playing field is not level. Is it true that hospitals that do not participate with Leapfrog’s proprietary and totally optional hospital survey are at a disadvantage? Leapfrog says no– hospitals are not penalized for having empty boxes in the evaluation matrix. What happens is that all the other items (mostly obtained from the Medicare Compare database) are simply counted more heavily. KentuckyOne also argued that the data on which the scores are based is outdated.  (Who is to say that newer data will not be worse  than the old!)   I think both these arguments deserve consideration but in my opinion fail to explain the drop in scores for two Louisville Hospitals.  After all, only a handful of hospitals in Kentucky participate with Leapfrog. Whether a hospital benefits or not probably depends more on how good their performance on the survey is.  Yes, the data on which the scores are based will probably be more that a year old, but virtually all Kentucky hospitals are in the same boat with respect to timeliness of data and Leapfrog participation.  The Kentucky playing field, at least, is pretty level!  I will provide examples from selected hospitals to illustrate this discussion. Continue reading “Safety of Louisville Hospitals: Are we there yet?”

KentuckyOne Health Confronts Legitimate Role of Contraception and Abortion in Healthcare.

Catholic Church enters 20th century on reproductive health by passively accepting justifiability of contraception and abortion in its institutions.

See Partial Retraction

Background.
The Roman Catholic Church, Catholic Health Initiatives (CHI), and KentuckyOne Health (KOH) most certainly had only an incomplete understanding of what they were getting into when they assumed management earlier this year of a secular University of Louisville Hospital and also effective control of the academic medical practices of the University’s faculty and trainees. These religious organizations must now also learn how to deal with contemporary academic research standards. KentuckyOne is promoting its intention to participate in the University’s clinical research enterprise. Indeed, Jewish Hospital has been doing so for many years. Increasing clinical research is also a prominent part of the UofL’s commercial research enterprise.

As Catholic organizations, CHI and KentuckyOne expect University employees, physicians, trainees, and patients to accept its religious tenants with respect to medical care. Indeed, trainees are now required to attest that they have received training about those religious directives. I suspect these faith-based organizations were unaware of the extent to which the Church itself was going to have to, in turn, confront and modify some of its traditional dogma in order to participate in the clinical practices and research of a modern, science-based University and Medical School. By entering the contemporary world of research; CHI, KentuckyOne, and their supervising Catholic Church have tacitly acquiesced to the reality that contraception and abortion are integral to scientific and medical standards of honest and ethical clinical research. Even if unintended, this is a break-through of historic proportions in the history of religion. I congratulate the Catholic Church for allowing its medical mission to enter the 21st Century. Allow me to explain how the Church is being forced to confront and partially alter its previously sacrosanct medieval dogma. Continue reading “KentuckyOne Health Confronts Legitimate Role of Contraception and Abortion in Healthcare.”

Leapfrog Hospital Safety Scores Released: Third Iteration.

mapMay2-13Doing not so good? Blame the test.

On May 8, the Leapfrog group released the third iteration of its Hospital Safety Scores. The first appeared in June 2012, and the second in November. I have expressed concerns about the value to curious professionals and consumers alike because of things like volatility of scores over the short term, lack of inclusion of the many small hospitals in the state, and lack of correlation with safety scores proposed by other organizations. Nonetheless, the Leapfrog Group was one of the earliest to push for public disclosure of hospital safety parameters and its evaluation deserves to be taken seriously. I will break out the data underlying the scores and compare it to last November’s in more detail later, but for the time being, here is a raw count of the results for Kentucky hospitals.

Continue reading “Leapfrog Hospital Safety Scores Released: Third Iteration.”