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Content of this page When sterilizers in a Californian hospital were found to be operating sub-optimally hospital administrators forbade the staff from telling the surgeons. They would have cancelled operations and financial targets (and ? bonuses) would not have been met. Surgeons have responsibility for their patients and make the decisions as to whether it is safe to operate or not. The chief of surgery resigned in protest when he found out. The JCAHO took no action.

   

The series:- Tenet and its doctors
In July 2003 I wrote a web page titled "Tenet Health Care and its doctors" which included the story of Tenet's relationship with its doctors going back into the 1990s. In 2007 I put the material about Redding hospital into a separate web page and wrote two more about this revealing scandal within a scandal. The kickback allegations too had become a major player in the wider scandal. This has also been moved to a separate web page and updated. More Tenet sagas which involve doctors have come to light and these throw additional light on the many problems in Tenet's operations. While they deal with more than just the doctors they all contribute to the story of doctors and form a saga. I have therefore arranged them as a series called "Tenet and its Doctors".

 The web pages are

• Tenet Healthcare and its Doctors before the 2002 scandal
• Tenet Healthcare's Redding Hospital : Unnecessary Cardiac Procedures I (2003 page)
• Tenet Healthcare's Redding Hospital : Unnecessary Cardiac Procedures II (2007 page)
• From Singapore to Redding : A long trail to follow (the story of one administrator)
• The fallout from the Redding Scandal
• Tenet and Kickbacks
• Tenet, its Doctors and Price Fixing
• Dangerous Heart Surgery : Palm Beach Gardens Hospital in Florida
• The Saga of Failed Sterilizers
• Tenet Has Problems With its Doctors

CONTENTS

• Background
• Sterilizers at Garden Grove Hospital
• The Joint Commission
• Lucky Tenet/NME

The way in which the pressure for profits created by Tenet's culture impacts on the way hospital administrators neglect their responsibility to patients is dramatically revealed by what happened in Palm Beach Gardens Hospital in Florida (see separate page). The extent to which doctors can be induced to comply with corporate dictates is also illustrated.

The information available indicates that large numbers of patients sustained serious complications with some deaths. The doctors continued to operate under unsafe conditions and did not speak out.

Slightly less disturbing and without the dire consequences are the reports about Garden Grove Hospital in California. In this instance there were no reports of adverse consequences but this might be partly because the chief of surgery in the hospital found out, refused to operate, handed in his resignation in disgust and then spoke out publicly.

At this time Tenet was in disgrace, losing money and on the back foot. Although he will now be viewed suspiciously the consequences for him will be less than if he had spoken out when Tenet was making vast profits and its credibility unchallenged.

What happened in this instance was that the Sterilizers were not operating properly so that surgical instruments were only partly sterilised, posing an admittedly smaller risk than at Palm Beach in Florida. There was an increased risk and at the very least routine surgery and emergency procedures with serious consequences from infection should have been discontinued until the problems had been fixed. The hospital would have lost revenue as a result.

Knowing that the surgeons would refuse to operate staff were instructed not to tell surgeons about the failure and the potential risks to their patients. Administrators were once again making clinical decisions and overruling clinicians. Once again Tenet's administrator made denials which proved to be false. All of this happened in the 1991 scandal.

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Jul 2003 Chief of Surgery learns what has been happening
Rosen, who at the time served as chief of surgery at Tenet's Garden Grove Hospital in suburban Southern California, had just learned that he'd spent months operating with instruments cleaned by what appeared to be broken sterilizers. The "flash" sterilizers, often used to clean surgical instruments soiled during operations, had repeatedly failed to kill resilient spores during routine test runs. And now hospital administrators, aware of the positive spore tests all along, were telling Rosen how to explain the situation when federal inspectors showed up for a big evaluation the following day.

Instead, a nauseated Rosen resigned and went straight to federal authorities.

"This information was being withheld from the very surgeons entrusted with care of the surgical patients," Rosen complained in a 2000 resignation letter to then-hospital-CEO Mark Meyers. "Such behavior is beyond belief. I feel it is a deliberate attempt at cover-up for financial reasons."

Meyers responded by saying that the hospital had reacted appropriately, that positive spore tests didn't necessarily indicate a malfunction, that wound infections had not increased and that hospital patients were placed in no danger. A hospital industry watchdog group later largely concurred.

But Rosen dismissed Meyers' reassurances, saying the CEO was relying on "non-physicians making medical judgments," and expressed fresh outrage that he'd been kept in the dark.

Although Meyers claimed that all doctors were properly informed, the hospital's own infection control supervisor indicated otherwise. In a letter to Meyers just after the controversy erupted, Douglas Clark -- a medical doctor who chaired the infection control committee -- said the operating room supervisor had "received instruction from her superior not to share the positive spore-test results with the surgeons."
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But his (Rosen) stomach never really settled after his experience with Tenet. He believes that patients have needlessly suffered -- and even died -- because of a corporate business model that's "incompatible with good health care."

Tenet focuses on "the bottom line, regardless of what is good for the patients," he said.
Whistleblower Wants Tenet to Come Clean The Street.Com (Melissa Davis) Jul 25, 2003

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More disturbing still is what happened when the surgeon reported what had happened to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This is the body responsible for monitoring standards in the hospital and ensuring that processes set up in the hospitals protect patients from harm.

The JCAHO accepted the hospitals explanation and refused to investigate. The JCAHO has a very poor record for addressing serious problems. They have been particularly ineffective in regard to Tenet, perhaps because of the number of Tenet staff in senior positions at the JCAHO. One of those on the JCAHO's board was an internist who was also Garden Grove's chief of staff.

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Jul 2003 JCAHCO takes no action
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.
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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.
Whistleblower Wants Tenet to Come Clean The Street.Com (Melissa Davis) Jul 25, 2003

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Tenet seems to have been remarkably fortunate in the sudden deaths of people who may have been in a position to expose its practices. This was at times when inside information and documents might have major consequences such as conclusively refuting their denials.

Way back in 1992 Dr Robert Stuckey, an elderly psychiatrist from New Jersey died alone on his boat shortly before he was to give evidence to a national inquiry in Washington. He had many years of close experience with Tenet's predecessor NME in New Jersey where it had close links with politicians long before it was exposed in Texas. His report was never found. (See Proceedings of "Profits of Misery" House of Representatives Hearing held in Washington Apr 28, 1992). In fairness he was not a well man.

In 1991 Dr Victor Chang, Australia's eminent cardiac surgeon was gunned down in broad daylight in Sydney in what was prosecuted as an extortion attempt. This was only a few weeks before Tenet (then NME) received approval to enter Australia.

Dr Chang did some work and training at Tenet/NME's international hospital in Singapore. He was in a position to know what happened there. Staff from this hospital were to run the operations in Australia. Serious allegations were later made about unethical behaviour in this hospital.

It creates an uncomfortable feeling that one of Tenet/NME's administrators was imprisoned in the 1990s for threatening to kill someone who planned to speak out.

It sounds as if the doctor below was not the sort of person who would stay silent.

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Jul 2003 Outspoken doctor dies
By alerting authorities, Rosen feels he did his best to protect future Tenet patients. He also raised concerns with fellow Garden Grove doctors, including a popular physician who led the medical staff and served on the hospital's governing board. But that doctor -- a man named David Litke who reminded some people of a young Marcus Welby -- has since passed away. He died suddenly at the age of 43 just days after Tenet's world blew up with the federal raid of Redding.

"He was found dead at his desk last October," said Rosen, who considered Litke a close friend. "That's about all I know."
Whistleblower Wants Tenet to Come Clean The Street.Com (Melissa Davis) Jul 25, 2003

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When Australia's Tenet/NME operations were threatened in 1993 a retired judge at risk of improper influence was appointed by politicians to make a critical decision which allowed the company to continue operating in Australia. These may all be unrelated incidents but we should be aware of their unusual frequency at key times in the Tenet story.

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Web Page History This page created July 2007 by Michael Wynne