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Sunday, Sept. 19, 2010 | 2 a.m.
Do No Harm: Hospital Care in Las Vegas, Part 3
- Patients at risk under the knife
- Routine surgery, harrowing result
- A cry for help
- Doctors avoid discipline
- Colorado transparency unique
- Last drumroll
- How the Sun identified surgical injuries
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Nevada may have more surgical mishaps than should be expected, based on national benchmarks, but it's almost unheard of for hospitals to sanction a physician.
Doctors' privileges were revoked or suspended 73 times in Nevada from January 2007 to July 1, 2010 — an average of 21 actions a year, according to Doug Cooper, executive director of the Nevada State Board of Medical Examiners, which licenses physicians.
Nevada has about 10,000 active medical doctors, so about 1 in 475 has some action taken against his or her privileges in any given year.
Cooper said he thinks such moves are rare because doctors are doing a good job.
Dr. Sidney Wolfe, director of health research for the advocacy group Public Citizen, sees poor oversight, not high quality, in the numbers.
Wolfe said hospitals nationwide woefully oversee physicians, which is reflected in the number of facilities reporting to the National Practitioner Data Bank, a clearinghouse on disciplinary actions against doctors. Hospitals must report suspensions or revocations of doctors' privileges to state licensing boards and the Data Bank.
About half of hospitals nationwide had not submitted a single sanction since the Data Bank started in 1990, Public Citizen said in a 2009 report.
In Nevada, the absence of disciplinary reports was even more stark, with 58 percent of hospitals never reporting suspension or revocation of physicians' privileges, Public Citizen found.
(It is impossible to identify the reporting record for individual hospitals because of the confidentiality of the Data Bank, which is intended to prevent incompetent health care providers from moving from state to state without anyone knowing their history.)
Hospitals aren't the only ones failing in their oversight role, according to Wolfe. Doctors, who largely police themselves on hospital committees or through licensing boards, are violating the public trust, he said.
"They're not doing peer review and (are) thereby endangering patients," Wolfe said.
Several factors inhibit the disciplining of doctors. Hospitals don't want to turn away surgeons who can generate millions of dollars in revenue because they might take their business elsewhere, Wolfe said.
"The hospital doesn't want to curry disfavor with them by doing something that would be reportable to a databank," Wolfe said.
Hospitals' inability to discuss peer-reviewed cases also complicates the disciplinary process, said Dr. Jim Christensen, an allergist who has sat on the physician oversight committees of local hospitals and oversees the quality program at Spring Valley Hospital.
Peer review is confidential by law and doctors often work at several facilities, he said. So even hospitals owned by the same company aren't able to share findings of substandard care, he said.
The threat of litigation also discourages aggressive action, doctors told the Sun. It's easier, and common, to pressure the problem physicians into moving on without taking action against their privileges, said a doctor who has worked on several physician oversight committees. But that merely pushes the problem onto someone else — putting more patients at risk.
Confidential peer review also impedes the Medical Board, Cooper said. When the board receives a complaint about a doctor, it has no access to information uncovered by hospitals' peer reviews, he said.
The law that governs hospital credentials favors individual physicians, making it difficult to suspend those with problems, several doctors told the Sun.
"It is virtually impossible to get a physician kicked off a medical staff," said Dr. John Ruckdeschel, CEO of Nevada Cancer Institute.
Alex Richards contributed to this story.
It's impossible to evaluate this story without knowing how "hospitals" make decisions to discipline doctors: who, or what positions or boards, within hospitals render them, how information about doctors' performance can be known or gathered, the competence of hospital administrators to evaluate medical performance, and the consequences to everyone involved when hospital administrators err the other way.
Also, there is such a knee-jerk anti-hospital slant to this entire series, that it's impossible to take too much of it seriously. This is not Pulitzer stuff; the series is way too lop-sided and lacks honest investigative quality. Standing on the outside looking in is not how investigative journalism works.
This Dr. needs to have his license jerked forever. He did surgery on my father-in-law, and my father-in-law never came home.We wished he could have came home to go the cleveland clinic where he could of lived..I am so glad we live in Cleveland with the Cleveland clinic.We will not take a gamble on our health care.
The original headline for this story was "Doctors avoid discipline." (I have a printout.) Apparently because the article does not present a single instance of a doctor avoiding discipline, someone at the Sun changed the headline to "Nevada hospitals rarely sanction physicians." This is no less deceptive, for the article nowhere even addresses the numbers of disciplinary actions against physicians, let alone against those deserving them.
The struggle to slant the story and its headline to fit the sun's agenda may not be over.
Unfortunately, even if these so-far unsubstantiated pre-judgments turn out to be true, if and when investigative journalism ever occurs here, the Sun's credibility will be tarnished because it is clear beyond doubt what hole the Sun is trying to squeeze the facts into.
If the quality of medical care is anything like the quality of journalism here, we are, indeed, in a lot of trouble.
I've worked in the medical field over 20 years; I personally witnessed a doctor fly into such a rage that a nurse jumped between he and another physician - the ongoing rumor had been that he was addicted to cocaine. Another lived in & practiced out of his car, another smelled so heavily of alcohol that she poured on perfume in an attempt to mask it. Then there was the doc who was so old & forgetful he should have been a patient. There were many, many situations that I knew were discussed with administration, but no doctor wanted to turn another in. It was unbelievable.
Sure, the story sounds slanted. But the healthcare field isn't a friendly one, considering that a common phrase is that nurses "eat their young," (meaning that new nurses aren't exactly treated well.
The medical field is highly political and people watch their back. Ausserordnung says that "if the quality of medical care is anything like the quality of journalism here, we are, indeed, in a lot of trouble.
They ain't even scratched the surface, baby.
I have recently seen a specialist for future spine surgury and was quite impressed with his bedside manner. I called up my medcal insurance co. and asked if there was a way I could reference his name. The insurance rep. told me to type his name in the address bar of my computer. I did. Pages on this Doctor came up on the search, and it wasn't good. Seems during a spinal operation he made a mistake and ended up crippling his patient and tried to blame it on his parner who wasn't even in the operating room at the time. He was charged with a felony. This was at the begining of this year. In June of this year I saw him as he was still "practicing medicine". After reading multi medical horror stories on this guy, I opted to not use him.
Scarey thing is this Dr. Knoblach whose patient was killed because of the wrongly placed clamp and she hemorraged days later, she did the same gall bladder removal on my wife a little over a year ago. I have never felt so violated in my life.
Has somebody rewritten the Hippocratic oath?
People have got to be forewarned on their Doctors' history?
It's a sad reality that some of the doctors are more a danger than the medical problems they are treating.