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Oversight and accreditation processes have failed
repeatedly in the USA but seldom as dramatically as in the
two Tenet Healthcare scandals. This web page examines these
failures.
Jul 2003 Accreditation of little value
The hospital later pointed to its high accreditation score as evidence of quality health care. But Tenet critics take little comfort in such endorsements and outright ridicule the company's own "Circle of Excellence" awards for hospital administrators.
Whistleblower Wants Tenet to Come Clean The Street.Com (Melissa Davis) Jul 25, 2003
The oversight processes in the USA have failed and failed repeatedly in spite of multiple attempts to beef them up and make them more successful. Aged care is the best example of the failures in state oversight and Tenet is the best example of failures in accreditation.
A number of factors have been blamed for this including
1. Political donations and friendships. Politicians appoint the people who oversee hospitals and nursing homes. When their credible business mates complain that they are being targeted by overzealous employees the politicians tend to believe them. Few heads of departments will risk crossing their political masters. Politicians are courted by making them members of company boards.
2. A shared pool of staff. Management and nursing oversight staff are drawn from the same pool of people. Not only do they have friends and contacts in the facilities but they move from one to the other. Staff doing oversight work improve their employment prospects as they can walk into jobs training facilities to pass inspections and hide deficiencies. Finding deficiencies is always embarrassing and could prejudice future prospects in the industry.
3. Oversight bodies are underfunded and understaffed. Their findings and routinely vigorously contested by the corporations then taken to appeal after appeal. They employ the best lawyers whereas government cannot afford this and use in house legal resources. The companies quite often win their actions. As a consequence moral declines, apathy prevails and an equilibrium of mediocrity results. Instead of insisting on large fines agencies negotiate and accept token payments.
4. Corporate staff in the accreditation or oversight body. Close relationships between accreditation bodies and the companies that pay them to accredit their hospitals creates conflicts of interest. Corporate staff from the big companies were directors of the The National Association of Private Psychiatric Hospitals. More recently Tenet had two staff in senior positions on the JCAHO.
5. No pressure to improve care. Incentives in the marketplace reward poor medicine. There are few if any financial pressures driving operators to increase the standards of care. In a marketplace it is ultimately money and only money that counts. In July 2005 the Washington Post ran a series of articles examining this - see "Bad Practices Net Hospitals More Money" by Gilbert M Gaul.
6. The power of market pressures. The factors listed above are simply mechanisms which illustrate how the response to market pressures - the power of the market - works itself out. These forces are so strong that the system and the people in it must respond. In the USA, more than in Australia no one can challenge the market paradigm and remain credible. When it comes to pressures on the system oversight and accreditation agencies are fighting a losing battle.
Example 1
President Bush appointed Thomas Scully as head of the federal
Medicare policy and oversight division. Scully had been chairman of
the Federation of Health Care Systems in Washington for many years.
This is the body representing and lobbying for the large for profit
hospital corporations in the USA. Its directors and staff come from
the big companies. Michael Focht, COO of Tenet was a director.
Michael Ford who was the subject of allegations in Singapore was on
its ethics (or ? quality assurance) committee.
I sent Scully information about these people which he did not acknowledged. This questioned their suitability to represent the industry. When the American Medical Association approached him about this they met a brick wall. I received a succession of unrelated defamation actions that were never prosecuted.
Scully was one of the driving force behind a very controversial bill which gave drug companies vast profits from Medicare. He is claimed to have suppressed the true costs of this. When Scully left he was given a special dispensation to negotiate for his next job. He had many in the drug companies to choose from. He elected to lobby for them.
Sep 2005 Influence for hire
Heretofore, the alliance (a group of for profit aged care chains) has been a loose confederation of like-minded companies employing only one full-time Washington-based policy adviser and a number of high-profile hired-gun lobbyists, such as former Rep. Vic Fazio (D-Calif.), former Republican National Committee Chairman Ed Gillespie and former Centers for Medicare and Medicaid Services Administrator Tom Scully.
Breaking from nursing-home group, for-profit chains strengthen alliance The Hill. September 7, 2005.
Jan 2006 Thomas Scully
Thomas Scully was a hospital industry lobbyist before President Bush appointed him to run Medicare. In that job, Mr. Scully famously threatened to fire his chief actuary if he told Congress the truth about cost projections for the Medicare drug program. Mr. Scully had good reasons not to let anything stand in the way of the drug bill. He had received a special ethics waiver from his superiors allowing him to negotiate for future jobs with lobbying and investment firms - firms that had a strong financial stake in the form of the bill - while still in public office. He left public service, if that's what it was, almost as soon as the bill was passed, and is once again a lobbyist, now for drug companies.Meanwhile, Representative Billy Tauzin, the bill's point man on Capitol Hill, quickly left Congress once the bill was passed to become president of Pharmaceutical Research and Manufacturers of America, the powerful drug industry lobby.
Surely both men's decisions while in office were influenced by the desire to please their potential future employers. And that undue influence explains why the drug legislation is such a mess.
The K Street Prescription THE NEW YORK TIMES January 20, 2006
Example 2
Tenet recruited Robert Kerrey, the Democrat who almost defeated Bush in the 2004 election to its board in 2001. Kerry had played a prominent role in health care. He must have supported Tenet's business policies because he did not protest or resign in protest after the exposures. How suited was he to serve on Bush's 9/11 committee? He was the alternative to Bush in 2004 - some choice!
May 2007 Tenet management
J. Robert Kerrey, President of New School University in New York City, joined Tenet Healthcare Corporation's Board in March 2001. Prior to becoming President of New School University, Mr. Kerrey served as U.S. Senator from Nebraska from 1989 to 2000.Kerrey, 62, was appointed the seventh president of New School University in January 2001 after retiring from the Senate. New School University is one of the nation's leading institutions for education in the arts and social sciences, continuing education and urban studies.
Kerrey recently served on the National Commission on Terrorist Attacks Upon the United States, an independent bipartisan commission created in late 2002 by Congress and President George W. Bush, to prepare a full and complete account of the circumstances surrounding the September 11, 2001 terrorist attacks.
--------------------------------
Kerrey served on the National Bipartisan Commission on the Future of Medicare and was a member of the Senate Finance, Appropriations and Agriculture committees. In addition, he was chair of the National Bipartisan Web-Based Education Commission created by Congress to make federal policy recommendations on Internet learning. He also served as co-chairman of the National Commission on Restructuring the IRS, which led to authorship of comprehensive reform legislation that has changed the way the Internal Revenue Service operates.
Tenet Healthcare's web site http://www.tenethealth.com/TenetHealth/OurCompany/J.+Robert+Kerrey.htm accessed May 2007
Accreditation bodies are funded by and have close associations with the companies whose hospital's they accredit. Company officials hold senior positions in these bodies.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is commonly seen as a global leader and model of accreditation practices. It now operates internationally and is emulated by others. In fact it has been singularly ineffective and heavily criticised in the USA. Representative Pete Stark after whom the US anti-kickback Stark laws are named has in the past been scathing about the failures of the organisation, its close relationships with corporations, and its lack of accountability to the public. He tried to introduce legislation to make it more accountable to the public.
The JCAHO's history is of a series of failures each time followed by renewed public claims to greater rigour but they never tackle the key problems in the organisation itself. The response to the criticism following the 2002 Tenet scandal was predictable. I am not criticising the JCAHO for not trying. It is simply incapable of addressing the powerful forces at work and it is structured in a way which makes it vulnerable and unable to do so.
Aug 2003 Another revamp after Tenet scandal
The Joint Commission defends its reputation. But it has also pledged to revamp its entire accreditation program because of "the need for major changes in the quality oversight process."
Untangling Tenet's Ties to Watchdog (Melissa Davis) The Street.Com Aug 7, 2003
Until 1994, when it was renamed to escape its past, Tenet Healthcare was called National Medical Enterprises or NME. Prior to the 1990's scandal the company's hospitals had been inspected by federal/state authorities, by the insurers and by two accreditation authorities. None of them picked up that vast numbers of children and many adults had been needlessly and deceptively admitted to psychiatric and chemical dependency hospitals, kept there for prolonged periods and given vast amounts of unneeded treatment, None noticed that company officials had taken over from doctors in admitting and treating patients. In fact this was almost industry wide and was accepted as the norm.
Half of all NME hospitals pleaded guilty in a criminal plea and were sold off as part of the US $379 million criminal plea and settlement agreement in 1994.
Insurers
NME sent out instructions to staff starting with a letter headed
WEECHEETUM INSURANCE COMPANY rejecting payment. Staff were instructed
not to write comments in notes which indicated that patients were
better but to ensure that documentation showed that there were still
problems needing attention.
One would expect insurers, acting for those whom they had been paid to assume responsibility for, to be vigilant, not only about the bills they were asked to pay. but the sort of care their charges received. It seems that oversight by insurers was almost nonexistent.
Dr Richard Stuckey complained to insurers but got nowhere. A contact in the insurance business told him that the bigger the bills the higher the fee they charged and the more profits they made.
When the frauds were exposed and the scam stopped the insurers joined together and made several hundred thousand dollars by suing NME and then settling the actions.
It is important to understand how the market operates and that insurers are part of this market. They are there for their shareholders not for those they insure.
Apr 1992 No oversight by insurers
(Comparing with insurer oversight in General hospitals) That never happened in a psychiatric hospital even though we were cranking out bills in the $50,000 to $70,000 range. I'd never seen an insurance auditor the whole time I was there.
Statement Russell Durett NME administrator page 96Insurers connive
I took these bills to the parent insurance company - Prudential - - - - - I was stunned when these executives showed no interest in the abuse by Fair Oaks. They made jokes about a bill for over one hundred thousand dollars submitted by Fair Oaks for a Prudential employee. - - - - - - It was 'business as usual' for them. They showed no interest in the less expensive outpatient model.I was dumbfounded. Then one of the Prudential physicians who happened to have been my instructor at - - - - pulled me aside. He said "Bob don't you know we like big bills here. Big bills mean big premiums and big bonuses."
Dr Richard Stuckey letter dated 25 September 1991 page 276
The Profits of misery: How inpatient psychiatric treatment bilks the system and betrays our trust. Hearing Select Committee on Children, Youth, and Families. House of Representatives Second Session April 28, 1992
Medicare and
Government Oversight
I have no information about Medicare and state oversight of the
psychiatric hospitals. Medicare uses state divisions to oversee the
conduct of care in hospitals and nursing homes. I cannot recall any
reports suggesting that they exposed or acted on what was
happening.
One of the agencies defrauded was CHAMPUS, a government insurer covering department of defence personnel. The government Accounting Office vets the bills and the practices. It claims to investigate any complaints. In evidence to the congressional inquiry, on official acknowledged that there had been serious problems in the 1970s "But during the 1980s little monitoring was done". (page 175)
I am aware that complaints were made but these clearly did not get beyond the desk of the fraud investigator in charge. After the scandal was exposed NME employed him as part of their remediation program. There was little publicity about any remediation action he took.
Accreditation
Texas was the state where the fraud and misuse of children was
most flagrant and where the kidnapping of a teenager led to the
exposure of the scandal. This was not by any oversight body but by a
policeman who chose to believe the teenager's parents rather that the
hospital that had sent a team out to bring him in. The second and
sentinel fraud prosecution commenced in Texas.
I have a response to my questions from the prosecutors indicating that all of NME's psychiatric hospitals in Texas were fully accredited by the JCAHO, the USA's premier hospital accreditation body. I have no knowledge of any action by the JCAHO against any of the psychiatric hospitals in other states. Some time after this the JCAHO made much of reforms it had made to its processes.
There was another accreditation agency, the National Association of Private Psychiatric Hospitals (NAPPH). It accredited psychiatric hospitals. It was an industry body founded and funded by the corporations. Corporate staff from the companies were among the directors and managers. As far as I am aware that, while it claimed to do so, it seldom if ever inspected any psychiatric hospitals but accredited them - in effect a deceptive marketing tool for the industry.
Apr 1992 NAPPH
Mr Bryant (on panel): Based on your organisations (NAPPH) history, it is of absolutely no use to the public. It may have a marketing value for your members but it has zero value for the public."
The Profits of misery: How inpatient psychiatric treatment bilks the system and betrays our trust. Hearing Select Committee on Children, Youth, and Families. House of Representatives Second Session April 28, 1992 Discussion Page 166
Medicare is responsible for oversight to ensure that those it covers are properly cared for. It usually contracts with a state body to do the actual surveillance.
Outlier payments
Medicare is responsible for paying and for vetting the bills sent
in by the hospitals. They must surely track these with computers and
analyse billing trends. This is how you pick up fraud and health care
fraud is the USA's major fraud problem. It was not Medicare but a
market analyst who picked up that Tenet had vastly increased its
outlier charges which were now many times those of competitors. It is
difficult to believe that staff working for Medicare in Washington
were not aware of this.
We need to remember that Scully was in charge of Medicare in Washington at this time. He may have had little interest in prosecuting his former friends and colleagues- those he had once strenuously lobbied for and might again. Staff may have been reluctant to draw his attention to this problem, particularly when he was so busy changing the Medicare system - making it more profitable for the drug companies and hiding the true costs.
Redding
Hospital
Medicare is a federal responsibility but the actual oversight is
conducted by the Californian Health department under contract. Because
findings and rulings are so frequently challenged these agencies
operate within tight guidelines and narrow operating requirements.
This inevitable restricts their scope and leads to an emphasis on
process and form of services rather than their substance. The latter
is bedeviled by subjective assessments and differences of
opinion.
They claimed that the responsibility for acting is referred back to the federal department. It is clear that there were problems detected at Tenet's Redding hospital, that Redding refused to do anything about this and that the agency then allowed Redding to get away with it.
Note that the California agency and Klutz, referred to below have been heavily criticised by aged care advocates in regard to their failures with nursing homes. Critics blame the close association of their political masters with the companies.
Note that the state referred the matter to the federal authority, where Tenet's previous lobbying ally, Scully, was in charge.
Jul 2005 Medicare oversight
It took a whistle-blower to alert the FBI about what turned out to be one of the nation's worst examples of overzealous medicine. But warning signs about Redding were in plain sight for years, documents show. That they were ignored goes a long way toward explaining the breakdown in oversight of the nation's health providers.
--------------------------------------
For years, warning signs at Redding Medical Center were missed by regulators and accrediting organizations. In the mid-1990s, researchers at Dartmouth Medical School reported that Medicare patients in Redding were twice as likely to have open-heart surgery as patients in San Francisco and other California cities. By 2002, the year Frank had surgery, the rate had nearly tripled.
"At the time, we wondered what was going on in Redding," said John E. Wennberg, the chief Dartmouth researcher.
The Dartmouth data were readily available to Medicare officials; they came from agency files. But federal regulators rarely look at those numbers and don't use them to guide hospital inspections.
Medicare's rules for inspections are tightly prescribed, said Steven Chickering, an official in the San Francisco office of the Centers for Medicare and Medicaid Services. Even if he had been aware of the Dartmouth studies -- and Chickering said he was not -- a spike in open-heart surgeries alone would not have warranted a review. "Data in itself may have many meanings," Chickering said.
Most federal inspections of hospitals are prompted by a complaint from a patient. In July 1999, the California Department of Health Services, which is paid by Medicare to investigate complaints, sent a team to Redding to look into the death of one heart patient.
The team found that the medical staff refused to review medical charts, including those from seven cardiac patients who died in the previous two years, said Anthony Way, a physician with the state health department.
The hospital filed a plan of correction that August. The following October, Medicare ordered the state regulators back to Redding. This time they found that cardiac doctors were not submitting data for review to the hospital's quality-assurance committee. The hospital again promised to fix the problem.
But according to Way, within six months, "the principal cardiologist and cardiothoracic surgeon no longer participated in this monthly peer review because they were -- quote -- 'too busy.' "
Nonetheless, federal officials took no action. No more inspections were ordered until December 2002 -- two months after the FBI raid.
----------------------
When state regulators returned to Redding in late 2002, "it was almost the same as three years ago," Way said. In one 11-month period, doctors had performed 3,240 cardiac catheterizations, a number comparable to a major teaching hospital, Way said. Only six had been reviewed.
State regulators said they did what they could. "It was up to [Medicare] to follow up," said Brenda G. Klutz, who oversees inspections for the California Department of Health Services. "We have no fining capacity for hospitals."
CHRONIC CONDITION The Waste in Medicare Spending: At California Hospital, Red Flags and an FBI Raid: State Regulators Cited Concerns but Say They Couldn't Force Change Washington Post July 25, 2005
Palm Beach Gardens Hospital in Florida
This scandal in which large numbers of patients developed serious infections was due to problems in the hospitals theatres where insects were breeding in the ceilings ad there were other breeches in sterility. The company would not fix the problem over several years because of the costs. Instead they had bug zappers in the operating theatres. The state authority had documented these and multiple other problems but neither they or the JCAHO which must have inspected the hospital did much about it except threaten - until multiple patients commenced law suits. The agency accepted the hospital's "plan of correction" and then, when nothing happened, fined them US $323,800. It soon rolled and accepted US $95,000. The patients got a more realistic US$31 million.
The JCAHO didn't even notice if it actually looked.
Aug 2003 Accreditation failure
"The inspections are farces," said Cal Warriner, a Florida attorney representing more than 100 heart surgery patients who contracted serious chest infections at Tenet's Palm Beach Gardens Medical Center. "You should take absolutely no comfort in knowing that a hospital is JCAHO-accredited."
--------------------------
Palm Beach Gardens, for example, was fully accredited when federal Medicare authorities nearly shut the hospital down last year. Even as Medicare issued its rare death threat, warning that Palm Beach Gardens patients were in "immediate jeopardy," the Joint Commission continued to offer its powerful stamp of approval.
Untangling Tenet's Ties to Watchdog (Melissa Davis) The Street.Com Aug 7, 2003
Tenet had one positive piece of news to announce Thursday. State and federal surveyors on Wednesday concluded a review of its 204-bed hospital in Palm Beach Gardens, Fla., and will allow the hospital to continue participating in the Medicare/Medicaid program.
Executives Leave Beleaguered Santa Barbara, Calif.-Based Tenet Healthcare. Ventura County Star November 8, 2002
Click Here to a separate page where what happened is reviewed.
Liver
Transplants
The health department in California had failed to notice that the
results
from Liver transplants and also
cardiac surgery in some Tenet facilities fell below accepted
standards. While hospitals must have maintained their own figures for
mortality the state department overseeing hospitals probably did not
have ongoing access to these. They had to do a separate survey of
Cardiac surgery to detect the problems that existed three years
earlier. It is interesting that two other hospitals had shut down
their programs when their results were unacceptable. This is
something which Tenet was unlikely to do given the implications for
profitability. These hospitals referred their waiting list patients
to USC.
Jul 2006 Liver transplants at Tenet's USC
The California Department of Health Services said Wednesday that it found the newly released statistics (on liver transplants)"a concern" and will begin investigating. Meanwhile, the U.S. Centers for Medicare and Medicaid Services, already under fire as lax in oversight of transplant programs, is conducting a broad review of all federally funded centers.
---------------------------------
The troubles at USC University Hospital, owned by the for-profit Tenet Healthcare Corp., only adds to concerns about the performance and oversight of liver centers in the Southland.
St. Vincent in Los Angeles halted its liver program in September after officials admitted that in 2003 its doctors improperly arranged a transplant for one patient using an organ intended for another, higher-priority St. Vincent patient. Staff then falsified records to cover up the situation, officials have said.UCI in Orange shut down its liver program in November after The Times reported that 32 people awaiting livers died in 2004 and 2005 while the hospital turned down viable organs that might have saved some of them. For more than a year, the hospital had no full-time liver transplant surgeon.
John Rader and others had initially been on the liver transplant waiting list at UCI but were referred to USC by doctors.
USC Center Is Latest With Transplant Woes : University Hospital has among the nation's highest death rates for those receiving new livers, data show. The state plans to investigate. LA Times July 13, 2006
Accreditation has become a complex process which looks at form rather than substance. It examines hospital structures with impressive sounding names like "quality of systems and processes" rather than what is actually happening. In spite of this the staffing problems at Tenet hospitals seem to have been overlooked as was the non-existent peer review process at Redding hospital. Both were the sort of things they would be assessing. Note that they are a public/private organisation and that Tenet's Biodi represents the public not the private organisations. This illustrates how the system becomes skewed in the corporate interest.
Aug 2003 JCAHO functions
Through a private/public sector partnership, the Joint Commission has been inspecting hospitals -- and essentially clearing them for government funding -- since Medicare was born nearly 40 years ago. Although accreditation can be sought elsewhere, the Joint Commission handles the bulk of health care inspections across the country. The organization portrays itself as the "nation's pre-eminent standard-setter in health care" with a "well-established track record in improving the safety and quality of care in hospitals." But its record is far from perfect.
Untangling Tenet's Ties to Watchdog (Melissa Davis) The Street.Com Aug 7, 2003
Tenet's relationship with the JCAHO
Two senior Tenet staff held board positions in the Joint Commission for Accreditation of Healthcare Organisations (JCAHO). The JCAHO claimed that there was no conflict of interest and that they had no influence on accreditation processes. It is worth noting that Biondi was chairman of Tenet's ethics committee over the period leading up to the 2002 scandal - the ethics committee that should have prevented this. He departed Tenet's board in 2004.
Apr 2004 Biondi off Tenet board
Tenet said. Biondi and Cloud, both elected to the board in 1998, decided "to focus their energies on other endeavors," Tenet Chairman Edward Kangas said in a news release.
Tenet proxy details director turnover, CEO pay Modern Healthcare's Daily Dose Apr. 5, 2004
The JCAHO monitors quality processes in the hospitals to be sure they are working correctly. The peer review process is one of the most important of these. It is difficult to understand how Redding hospital continued to get top marks until one looks at their role in the JCAHO. The priest Biondi was president of St Louis university. He sold his hospital to Tenet and joined Tenet's board. Together they introduced marketplace coercion into the hospital. He ended on the JCAHO's board not as an industry representative but to represent the community. He was joined on the board by one of the internists from Tenet's Garden Grove Hospital, a facility where anxiety has been expressed about the JCAHO's decision not to investigate a complaint.
Tenet staff on JCAHO board
Perhaps most notably, Tenet has friends inside the nonprofit organization charged with policing the hospital industry. Tenet director Lawrence Biondi -- a priest who chairs Tenet's ethics, quality and compliance committee -- also serves on the board of the Joint Commission on Accreditation of Healthcare Organizations. And at least one Tenet physician, who holds a leadership position at a Tenet hospital accused of risking patient lives, sits together with Biondi at the Joint Commission boardroom table.The two men are among just six Joint Commission directors -- out of 28 -- who also fill board seats at Joint Commission Resources, the consulting arm of the nonprofit agency. Hospitals regularly pay the consulting firm thousands of dollars just to prepare them for routine, but crucial, Joint Commission visits.
Tenet says the arrangement has brought no favors to its hospitals. And the Joint Commission itself sees no potential for conflict.
--------------------------------
Fulcrum analyst Sheryl Skolnick is more troubled. The veteran health care analyst-- who's tough to rattle after following hospital scandals for years -- expressed some clear discomfort about Tenet's ties to the Joint Commission board."The longer an entity exists, the cozier it tends to get," she admitted. "But this doesn't look very good ... It's just not right."
------------------------------
"Neither Father Biondi nor Dr. Frankenstein ever participated in any discussion involving any Tenet hospital, including Garden Grove," said Tenet spokeman Gary Hopkins, who went on to indicate that leaders at other for-hospital hospitals have been tapped to govern the Joint Commission as well.
---------------------------
Biondi wasn't a veteran Joint Commission director when Tenet tapped him for a spot on its own board in the summer of 1998. The university president -- who arranged the sale of a campus hospital to the Tenet chain -- had barely spent a month at the commission when Tenet offered him a board seat as well.
-----------------------------
Despite his ties to Tenet, absent from his Joint Commission bio, Biondi is among a small minority of commission board members who represent the public instead of the healthcare industry. The scant commission bios -- which also lack disclosures about committee memberships on the Joint Commission itself -- make it difficult to track a director's links to other organizations.Asked this week about committee assignments for Biondi and Frankenstein, Forstneger revealed that both men served on the accreditation committee the year the Garden Grove controversy erupted. Forstneger also singled out that particular committee as the only one that ever gets involved in inspection disputes. But he said committee members must sign a "conflict of interest" form and recuse themselves from any vote affecting facilities with which they have ties.
--------------------
Skolnick, for one, calls the situation a "troubling" one that could undermine the inspection process."It's like you know something's wrong, but you don't know who to tell," she said. "It's bad enough when the only thing at stake is money -- which is very hard to come by -- but it's much worse when it's somebody's health."
-------------------------
But by now, Biondi has already drawn sharp criticism for his performance as Tenet's ethics chair."When you look at all the scandals, the government lawsuits, the government investigations, the allegations of unnecessary patient deaths at Redding and Palm Beach Gardens, can anyone say the Ethics, Quality and Compliance Committee was doing its job?" asked M. Lee Pearce, a physician and shareholder who chairs the Tenet Shareholder Committee.
Although the committee withheld support for Biondi at Tenet's recent shareholder meeting, the busy priest -- endorsed by the company itself -- sailed to re-election. Since then, Tenet has expressed full confidence in its revamped compliance program.
Untangling Tenet's Ties to Watchdog (Melissa Davis) The Street.Com Aug 7, 2003
The JCAHO was glaringly exposed in Tenet's 2002 scandal. After the exposures it rushed to do something. It announced that it was mounting a series of unannounced inspections. They made a show of doing something after their deficiencies had been exposed.
Nov 2002 JCAHO responds to Redding
Charlene Hill, a spokeswoman for the Joint Commission on Accreditation of Healthcare Organizations, said her group has an "aggressive plan" to look at some of Tenet's hospitals to make sure they are in compliance with quality and patient-safety standards.
Tenet Says SEC Has Launched Informal Probe LA Times November 19, 2002
Nov 2002 JCAHO responds to Redding
Also, the Joint Commission on Accreditation of Healthcare Organizations is reviewing the "quality of systems and processes" at Tenet hospitals, the letter said.
SEC looks over Tenet :: Heavy trading prompts opening of informal file Modern Healthcare November 25, 2002
Jan 2003 JCAHO responds to Redding
Last week, the JCAHO completed several more in a series of unannounced inspections at Tenet-owned hospitals in South Florida and St. Louis, both Tenet and the JCAHO confirmed, totaling eight hospitals surveyed to date.
Tenet faces JCAHO surprise visits, management critic Modern Healthcare January 2, 2003
The accreditation failures became only too apparent as the story unfolded.
Aug 2003 Failed to detect problems
Last November, Tenet boasted that Redding Medical Center had scored "quite admirably" on a Joint Commission inspection carried out shortly before federal agents raided the facility. Even a follow-up surprise visit of the hospital, now suspected of performing unnecessary -- but highly profitable -- heart surgeries, turned up no real problems. A second unannounced visit detected some lapses, unrelated to heart activity, but still left Redding's accreditation firmly in place.
-----------------------------------
Instead (or producing the Mercer report on Redding), Tenet has chosen to highlight recent Joint Commission surveys that found problems at 19 randomly inspected hospitals but left all accreditations intact.
Untangling Tenet's Ties to Watchdog (Melissa Davis) The Street.Com Aug 7, 2003
Aug 2003 Peer Review at Redding
Normal checks and balances did not seem to apply to Dr. Moon, Redding physicians said. He was not only head of the cardiology program but also a hospital director. And though he was not board certified in cardiology or internal medicine - a credential he dismissed as insignificant - he was also head of the hospital's Cardiology Care Committee, in charge of conducting peer review of his own program's quality of care.
Court records say that committee rarely, if ever, met.
How One Hospital Benefited on Questionable Operations New York Times (KURT EICHENWALD) August 12, 2003
Jul 2004 Redding got high scores
In Tuesday's remarks, Grassley noted that the joint commission accredited Redding "and its renowned cardiac care department " in 1999 and 2002, before the October 2002 federal raid of the hospital and the offices of its top cardiologist and cardiac surgeon.
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"Redding was a hugely profitable hospital for Tenet," Grassley said. "It boasted about high scores from the joint commission."
Congressmen start bill to stop fraud in hospitals : RMC used as example of facility where federal oversight didn't work http://www.redding.com/ July 21, 2004
Jul 2005 Patients depended on it
Frank (patient) was shocked but quickly scheduled surgery, taking comfort in Redding Medical Center's excellent reputation. The 238-bed hospital overlooking the Sacramento River boasted that it did more open-heart surgery and cardiac tests than teaching hospitals twice its size. Just that summer the Joint Commission on the Accreditation of Healthcare Organizations awarded Redding a grade of 94, among the highest in the country.
CHRONIC CONDITION The Waste in Medicare Spending: At California Hospital, Red Flags and an FBI Raid: State Regulators Cited Concerns but Say They Couldn't Force Change Washington Post July 25, 2005
When the chief of surgery found that this hospitals management had forbidden staff to tell him about faulty sterilizers he resigned and reported this to the JCAHO. (see separate web page) They accepted the hospitals story. Did it help that an internist and chief of staff was on the JCAHCO board?
Aug 2003 Whistleblower gets a shock
Reeling at the thought that patients had risked serious infections from contaminated equipment, Rosen promptly alerted the Joint Commission on Accreditation of Healthcare Organizations in May of 2000. He told federal inspectors that flash sterilizers in the operating room had repeatedly failed daily performance tests, that hospital administrators had intentionally concealed the malfunction from surgeons and that department staffers were now "sanitizing" records that would expose the equipment breakdown.
But Rosen, who cited employees who could corroborate his story, was in for a major shock. JCAHO, the industry watchdog known to growl about the smallest misplaced exit sign, ignored the chief of surgery and accepted the hospital's explanation instead.
"Here I am telling them about a major threat to patients -- and the blatant destruction of documents -- and they just basically blow me off," Rosen marveled this week. "They gave the hospital a rating of 93."
Rosen would later voice his discomfort in a letter to the JCAHO.
"It was a surprise that, given the independent confirmation of the deliberate withholding of medical information, that any explanation would be accepted by you without penalty to the hospital," he wrote. "I would hope that this is not becoming an issue of your organization's accountability and credibility."
Contacted this week by TheStreet.com, the JCAHO confirmed that it received Rosen's complaint, requested and accepted an explanation from the hospital and then closed the case.
The hospital later pointed to its high accreditation score as evidence of quality health care.
Whistleblower Wants Tenet to Come Clean The Street.Com (Melissa Davis) Jul 25, 2003
Aug 2003 Powerful ties
But since then, TheStreet.com has discovered that Tenet -- and even Garden Grove Medical Center itself -- had powerful ties inside the inspection agency at the time of the Joint Commission visit. Biondi had joined the boards of both Tenet and the Joint Commission two years earlier. And Garden Grove internist Richard Frankenstein, who served two terms as the hospital's chief of staff and now chairs its governing board, held a board seat at the powerful agency as well.
Untangling Tenet's Ties to Watchdog (Melissa Davis) The Street.Com Aug 7, 2003
Dr. Mileikowsky formed the alliance after he was penalised by Tenet for exposing failures in peer review and assisting the patients who had been harmed by giving evidence in court. The alliance contains large amounts of information about misused peer review and about accreditation failures. Some relate to Tenet. It also includes a copy of the General Accounting Office's review of the JCAHO. This revealed that the JCAHO missed 80% of failures to meet Medicare requirements when compared with state based inspections. You can download it from the GAO web site http://www.gao.gov/cgi-bin/getrpt?GAO-04-850
There is another page on this web site about hospital accreditation.
Web Page History
This page created July 2007 by Michael Wynne
