Parkland’s Woes Not as Bad as Morning News Wants You To Believe

Update: Right here.

Parkland is far from perfect. No question that organization needs to make some changes in how it does business. But is Parkland as horribly mismanaged and dangerous to its patients as the Dallas Morning News would lead you to believe? More specifically, is the ongoing Centers for Medicare and Medicaid Services (CMS) review of the hospital as monumental and unprecedented as the paper has made it out to be? I don’t think so.

Surely by now you’ve heard about the survey of the facilities conducted by the Texas Department of State Health Services, which led CMS (no idea why it’s not called CMMS) to issue a report saying the hospital was putting the health of its patients in “immediate jeopardy.” Fix the problems, said CMS, or we’ll withdraw your funding. Effectively, the hospital would be shuttered.

Sounds pretty bad, right? In a big front-page story (sub. req.) about the CMS report two Sundays ago, the News drove home the direness of conditions at Parkland with this money quote:

“It appears safety was routinely relegated to a lower priority by other pressures,” said Vanderbilt University professor Ranga Ramanujam, a national expert in health care safety. “The CMS action is extraordinary. I am hard-pressed to think of an example of a similarly high-profile hospital facing the very real possibility of losing their CMS funding as a result of safety violations.”

Ramanujam was the sole expert quoted in the story as to the singularity of the CMS report. You read his quote, and you think, “Parkland is the most awful hospital in America. It’s extraordinarily awful. I mean, a national expert can’t even think of another hospital that’s as awful as Parkland. That’s pretty awful.”

But hang on just a second. How rare are these “immediate jeopardy” CMS reports that a national expert can’t think of a single example that resembles what’s happening at Parkland? I called and emailed the regional headquarters of CMS and called the national HQ to ask them how many “immediate jeopardy” reports they issue. I got no response (that I’m aware of). Doesn’t much matter. According to this HealthLeaders report, CMS doesn’t have the information I’m after:

“These are serious citations, but incomprehensibly, neither the Centers for Medicare & Medicaid Services which issues them, nor the states whose survey teams investigate these incidents, will say which hospitals have received them, for what kinds of harm, nor will they say how many occur in a given year or in a given region. A spokesman for CMS says the agency doesn’t know because it just doesn’t track them.”

CMS literally can’t say — not by citing numbers, anyway — whether the “immediate jeopardy” report that Parkland got is extraordinary or not. Does CMS hand out 120 of these things a year? 1,120? They don’t know. But I get the impression that the number is higher than, say, 1.

In fact, an executive (who asked not to be named) at a large national hospital organization asked his company’s top CMS compliance officer, at my behest, how rare the CMS reports are that Parkland got. The CMS compliance guy said that every year 5 to 10 percent of all the hospitals in the country receive “immediate jeopardy” reports from CMS. In other words, on the high side, CMS finds that 1 in every 10 hospitals puts its patients in “immediate jeopardy,” just like Parkland. (I’ll leave it for another time to discuss how screwy the CMS hospital inspection process sounds, owing to the fact that various state agencies conduct the inspections, not CMS itself. Read that HealthLeaders report, if you want to learn more.)

In light of all this, I sent an email to Ramanujam, the Vanderbilt expert, asking him why he thought the Parkland “immediate jeopardy” CMS report was “extraordinary.” Ramanujam said he’d be happy to talk to me the following day about the matter. But as a prelude to that conversation, he wrote, “You are right that I said ‘extraordinary’ rather than ‘rare,’ the term that the former CMS official interviewed used.”

Ramanujam was being a little defensive, I believe, with that remark. We agreed to talk at 11 a.m. the following day. At 8:30 he sent an email saying, “Something just came up and I will not be able to talk with you.” He didn’t offer to reschedule. Did he change his mind about talking to me after he googled my name and saw what I’ve written previously on this blog about Parkland and the Morning News? Did he change his mind after calling the reporter he’s been working with at the Morning News? I’m sure it was neither. Ramanujam is a busy guy. Something came up. It happens.

I said Ramanujam was the sole expert quoted in the story as to the singularity of the CMS report. But alongside the story there ran a sidebar (sub. req.) headlined “National Health Experts Say Critical Report on Parkland Is Rare and Significant.” In a Q&A format, a fellow named Mark McClellan, the director of the Engelberg Center for Health Care Reform at the Brookings Institution, was quoted. McClellan is the former CMS official that Ramanujam was referring to. Ramanujam essentially said, “Okay, yeah, I used the word ‘extraordinary.’ But McClellan used to work at CMS. He said the Parkland report is ‘rare.’ Bam. Print that.”

I want you to look very closely at how Mark McClellan’s quote was presented by the Morning News. Here’s how they did it:

Q: How often do government regulators issue a highly critical evaluation and raise the threat of cutting off funding to a medical facility like Parkland?

A: Cutting a hospital’s Medicare and Medicaid funding is rare, according to CMS. Only two Texas hospitals have lost certification since 2005 — one in Houston and the other in San Benito. Both had fewer than 100 beds. Parkland has 735 beds. McClellan said: “These corrective action plans linked to immediate jeopardy, meaning ‘fix it now or funding will be cut off,’ are rare — maybe a couple a year.”

Do you see what happened there? The question is “How often does CMS issue an ‘immediate jeopardy’ report?” The answer is “CMS cuts off funding rarely.” But that wasn’t the question. Remember, perhaps as many as 1 in 10 American hospitals every year receives an “immediate jeopardy” report. But a report is not the same thing as cutting funding. After a hospital receives an “immediate jeopardy” report, it tells CMS how it plans to fix the problems. It executes that plan. CMS sends the investigators back in to see if the problems are fixed. If the problems aren’t fixed, then CMS can withdraw funding. THAT is rare.

Given that confusion, I didn’t know how to read McClellan’s quote. I wondered if it had been taken out of context. So I called his office. His assistant said that I could talk to him, but she asked me to email my question in advance so that McClellan could be prepared. I laid out my confusion about the Q&A in the Morning News and said I wanted some guidance in how to read McClellan’s quote. I never got to talk to McClellan, but his assistant sent me the following direct quote from him. I have highlighted in red the parts that I want you to read carefully.

Corrective action plans are not rare and all essentially threaten sanctions if corrections don’t result in compliance. Cutting off funding or enrollment or program exclusion are the ultimate sanctions that are usually listed among the possibilities. Again, CAPs aren’t rare, but reaching the ultimate sanction is rare because most institutions or program participants will try to comply (immediate jeopardy usually indications that patients are at risk, which CMS takes very seriously).”

Unless I’m missing something, here’s the way I see this: the CMS report that Parkland got was not extraordinary. It wasn’t even rare.

Forget the experts. As we learned today (sub. req.) from the Morning News, about 5 miles down the road from Parkland, Methodist Dallas got its very own “immediate jeopardy” CMS report on Friday. Rare indeed.

Comments

  • Sarita

    I appreciate you pointing this out. There’s been some shoddy reporting on this all around. When boring regulations and legalese are involved, reporters across the board seem to go for the “sleazy penny-pinchers are putting public safety at risk!” story. It’s more sensational than explaining that some paperwork wasn’t filed.

  • Blake

    Good work, Tim.

  • Long Memory

    And when there are two newspapers in town there’s a better chance that one paper will get it right. But, of course, that’s another story. And one you won’t read in Dallas’ (one) newspaper.

  • Ashley

    I am glad someone is pointing out the facts on this issue! Way to go Tim!

  • This type of reporting is not isolated to Parkland. I think Parkland is a story that everyone can relate to but wonder why does DMN have it out for the hospital that takes everybody who walks through the door.

    Now a TV reporter can flash a piece of paper with a line crossed out and present it as fact. An newspaper reporter can take allegations from a disgruntled employee and not even mention it. Very few people are asking local journalists and news organizations to be held accountable for what they report as fact. I appreciate this post Tim. Parkland has been getting excessive scrutiny from The News for too long.

  • Peterk

    much more fun and easier to pick on a public hospital than a private hospital. The latter is not subject to FOIA requests which means the journalists have to work that much harder to come up with information

  • @Shawn Williams: Scrutiny is fine. That’s the DMN‘s mission. The question is how the fruits of that scrutiny are presented to the public.

  • foreverhonesty

    Tim how much did they pay you to write this article I believe I have seen more than one story about all the mess that is going on at Parkland and the DMN is the only one willing not to back down on this story and I think that is great, maybe you need to write a story on what you know…

  • foreverdishonesty

    Foreverhonesty,

    How much did DMN pay you to write that comment? I seriously doubt you are any more qualified to write an article tham Tim is. Poor poor foreverhonesty.

  • Fleeting Truth

    Foreverdishonesty,

    How much did Tim pay you to write that comment criticizing that other comment criticizing his post? Did he offer you a place in the Hexter preschool program? A locker at the downtown Y? Take care before falling in to league with this nefarious journalist. Who knows what evil lurks in the hearts of Editors?

    And that makes me sad.

  • XT

    OK, it’s not extraordinary. I’ll accept that. But we’re picking nits here. So you’ve gotten them from a bottom 1% hospital to a bottom 10% hospital. Victory? I don’t know, I’m hoping none of my children are ever in a bottom 10% hospital.

  • Alan

    This DMN series really has been puzzling in its hysteria, including demanding Ron Anderson’s firing. They don’t seem to be pushing for the problems to be fixed; rather, they want the Medicare/Medicaid reimbursements to stop. Knowing that would close the hospital, is that really DMN’s aim? They’re not usually that Cato Institute-ish these days. Does Bob Decherd want the land, perhaps?

  • Doo Doo Head

    Tim,

    Does this mean the D Magazine-led advertising boycott of DMN that you mentioned on this blog is moving forward, or not so much?

    So it’s “not as bad,” but it is still bad, you say? Mmmmm, K. May I point out that Wick’s recent track record of defending the faith of his people has not been so good lately? It’s the D Magazine curse. Please don’t put the hospital on the cover, or all will be lost.

  • 70 Ladies

    70 ladies sent letters saying “Your vaginal exam equipment was not sanitized prior to use, please come have a free panel, on us!” is not exactly what I would expect from a healthcare provider. Also, probably important to report inpatient deaths to CMS in a timely manner.

  • foreverhonesty

    The DMN does not have to pay to to say anything I can ready between the lines I do not need anything Tim has we all know how he uses his job to get it I would perfer to do it the right way work for it…..

  • @70 Ladies: You are absolutely correct. As I said at the outset, Parkland needs to make some changes in how it operates. What I explored in this post was how rare it is that CMS has found a hospital that needs to make some changes in how it operates. Turns out: not rare at all. Just ask Methodist Dallas.

  • @Doo Doo Head: “D Magazine-led advertising boycott of DMN”? You’re going to have to help me out with that one. What are you talking about?

  • Tony Robbins’ Teeth

    @Tim
    This is a lot of parsing for one of many problems at the hospital. D’s business model has a strong investment in the medical community (e.g. Doctor’s issues), so while I don’t fault you for protecting that investment, I roll my eyes when I read your missives and threats.

  • Susie

    I heard from my friend and former features editor at a major newspaper about these “contest pieces”. Okay team, what screaming headline can we put beneath the mast head so that SOMEBODY will buy a paper because nobody subscribes anymore, that’s for darn sure. Well, how about healthcare? Ok. Be sure to pick a big enough target or the public won’t register the appropriate alarm — enough to read this kind of so-called new$. Now, team, listen up, we build the story outline that we intend to “discover” and then sent a team of reporters out to put it together. Be sure you interview the “right” people and ONLY the “RIGHT people” (heh, heh). We don’t want someone with conflicting info to our agenda to have a voice — squelch ’em! History marches on. In the words of Joseph Pulitzer (remember “Yellow Journalism and the Spanish American War? — if not, look it up!) The era where Hearst and Joseph Pulitzer were competing news entities willing to invent the news in order to reach 1 million readers a day. “. . .You furnish the pictures (of the USS Maine), I’ll FURNISH THE WAR!” Therefore, a biased (one-sided) story such as this is not journalism, it is yellow jaundice. It isn’t a perfect world and Dr. Anderson, I have have heard, is a extraordinary manager, particularly with the difficulty of managing a public hospital. It’s unfair to the “targets” of the “contest essayists” and it’s especially unfair to the public who do not get an honest reporting of the facts, some of which may be that errors were made. Don’t invent our news or the only place we will read it will be outside of so-called major newspapers! I quit subscribing because I don’t own a bird cage.

  • @Tony Robbins’ Teeth: Do you also believe that when we champion DISD it is because teachers are buying ads in the magazine? Nice try.

  • @Susie: I don’t believe that the scenario you describe matches the one unfolding at the DMN. The managers there have devoted a lot of resources to this story. The reporters have worked hard on it. They all want to believe it’s a Big Important Story. And it is. But sometimes when you want something too much, mistakes happen.

  • Dawn

    I am an employee at Parkland, and I can say that the DMN absolutely has it out for us. It’s not a perfect place to work by any means, but that paper has written so many lies and half truths about us in the last few years that I can’t even read it…and my father worked for them for 25 years.

    The CMS survey has brought about some much needed change and has shed some light on downfalls left in the system for too long. Hopefully what will emerge from this is a stronger, better Parkland. I can personally attest to the work ethic at the hospital, and none of those downfalls were spiteful. They’re all a product of overworked staff members and too much strain on the system. I know in my heart that we’ll get through this intact. Thank you for publishing a fair article without the “burn them at the stake” commentary.

  • FoolToThink

    Thanks for this article Tim. The DMN seems to only want to publish negative things when it comes to Parkland. I thought surely, they must be putting a negative spin on it again when I read the paper last Sunday. I wonder how much of interviews were left out to give the writer the appropriate angle.
    I, like Susie, have heard rumors of a reporter seeking an award for his/her articles about Parkland. I wonder if there is any truth to that?

  • Stephanie

    Good article. Its good to see the actual circumstances discussed instead of constant Parkland bashing. I have already cancelled my subscription to the Dallas paper for that reason.

  • April

    I have worked at Parkland and worked or have done clinicals at every major hospital in Dallas. All hospitals have issues- Parkland is a county hospital that provides care for anyone and everyone, even after other hospitals “stabilize” the pt and discharge them, instructing them to follow up at Parkland. It is not a perfect hospital nor a perfect system but it does the best job it can with the available resources. More importantly it takes care of people that no other hospital wants to. You are at risk for medical errors and adverse events and infections everywhere, including your private physician’s office. DMN needs to call off the lynch party and face up to reality- parkland is not the best but certainly is not the worst and in certain injuries and situations I wouldn’t want to be treated anywhere else. And if i am in an accident and my life depends on it, take me to Parkland please.

  • Tony Robbins’ Teeth

    @Tim

    I’m not following your non-sequitor, but I believe your company championed DISD primarily as a counterpoint to the DMN’s coverage. But I digress because of your digression.

    Is Mr/Ms. Doo Doo Head referring to this post? http://frontburner.dmagazine.com/2011/05/11/mayoral-candidates-support-parkland/.

    This reads like a veiled threat by you, not the harsher characterization implicating your business. That was a over-the-top.

  • Hard Working Nurse

    Finally!! Someone with some true and constructive information for the public to ponder on!! I also am employed at Parkland and I’m utterly ashamed of the DMN. Shame on them for constantly bashing an organization who works so hard and does so very much for the community of Dallas. Without Parkland, many would have no one to care for them, and I don’t mean in a medical sense! Our nurses are some of the kindest and hard working people I’ve ever known. Thank you Tim for the research!!!

  • edward

    Please read the following:

    The 2010 official U.S. Census Dallas-Fort Worth Metroplex population at 6,371,773.

    The Monday-Friday circulation of the The Dallas Morning News: 251,510 Monday-Friday; 362,969 Sunday.

    Is there any reason needed why the DMN is desperately trying to attract ANY interest in their miserable excuse for a “newspaper”????

    They quote circulation of 404,951 Monday-Friday….however that circulation includes the following rags:
    #1 “Briefing” a FREE, home-delivered quick-read.
    #2 “Quick” a FREE entertainment tabloid.
    #3 “Al Dia” a Spanish-language daily in North Texas.
    #4 “Denton Record-Chronicle”

    They have to give papers away-free!!!!

    In 2004, The Dallas Morning News admitted it had underreported circulation losses, and overstated Sunday circulation by 11.9% and daily circulation by 5.1%. The decline of the DMN continues……

    Lastly, if Parkland Hospital is such a “dump”….I wonder why the wife of the CEO of Belo Corporation was transferred DIRECTLY to Parkland Hospital when she was involved in an auto-pedestrian accident. She was taken to Parkland Hospital to receive the best available care possible.
    Google: Robert Decherd wife and Parkland…

    And they wonder why no one subscribes to the DMN?????

  • ER RN

    Despite what is said about Parkland…in the ER alone we had 200 patients checked in at one time to receive care. Not the entire day–but at 8 PM. 200 patients. As a nurse in the ER for 6 years at Parkland, I can say numbers that high are hard to manage. but we do our best to see each and every patient and do what is necessary to treat them fully. What other hospital in Dallas can handle that load? Anyone? 15,000+ patient ER visits a month. Anyone?

    We do our best with the resources we have. With what we are given to work with. And we provide excellent care. CMS can put us in “immediate jeopardy” all they want–we save the lives of those who are in “immediate jeopardy” daily. That’s how we roll.

  • April

    @ER RN- well said

  • Jennifer Cross

    Thank you thank you Tim for your fair and balanced reporting from all of us at Parkland Hospital! You brilliantly concluded what all of us at Parkland have long been trying to prove. You’ve made me a believer again that there are moral and classy reporters out there.

  • Susie

    Okay, look it up. DMN won a prestigious 1st place Texas Associated Press IRE (Investigative Reporting Editors) award in 2010. I didn’t know that when I posted earlier. I just decided to look it up. Sometime in 2011 you will be able to look it up for yourselves. I’m sorry, but I have little faith after hearing from a seasoned reporter that they do, in fact, do CONTEST PIECES. This looks like one to me. In a few months, you can look up the TX AP awards and find out if this story is the 1st place winner for DMN. It I’m right, this is pathetic weighed against the good these dedicated employees do for people who have nothing and no one to care for them.

  • Jennifer Cross

    @ER RN- Thank you so much for all that you and every ER staff member does for our hospital. As a stroke team first responder, I’m in the ER a lot and see how well you care for the hundreds of patients who walk through our doors every day despite the demographic and logistical obstacles you often face. In the last couple of weeks you all have really risen to the challenge that CMS laid in front of you and for that I’m so proud! Keep thinking outside of the box and forging ahead…we all have your backs.

  • Mike Ramsey
  • Not so much

    Looks to me as if he will still be an active part of the organization – and rightfully so. However, I prefer this link: http://frontburner.dmagazine.com/2011/08/30/ron-andersons-role-at-parkland-is-changing/

  • Friendly Area Healthcare Compliance Professional

    I think the DMN has been irresponsible with this story, but there’s no way 5-10% of hospitals a year get “immediate jeopardy” status from CMS. Your guy just conjured a number. It’s definitely less than 2% and probably around 1%. That Methodist got hit at the same time is a remarkable coincidence.

    The stories of the guy who was in the ER who died without being seen and the former employee who ended up losing her leg are horrible. But give me five years of patient encounters at any one of the best hospitals in the country (Mayo, Johns Hopkins, wherever), and I’ll find some terrible mistakes, bring them up in every story about the institution, and build a narrative.

  • Dallas Citizen and Parkland Nurse

    Thank you Tim! Finally, a story that tells the facts and does not depict our hospital as a horrible facility. As a nurse for this FINE institution, I can attest to the AMAZING, SAFE and COMPASIONATE care we provide daily to the citizens of DALLAS and the surrounding counties (even though it is meant for Dallas County citizens, that is another story) that pass through our doors each and EVERY DAY. I have also been a patient at this wonderful hospital. If at any point any person in my family or myself had a traumatic accident, burn, gunshot wound, head injury, or is pregnant please take us STRAIGHT to PARKLAND!! The employee’s choose to work for PARKLAND for the RIGHT reasons because working at PARKLAND is not a stroll in the park, it is work. We do not come to work and expect to sit on our bottoms at the nurses’ station and eat cookies while catching up on TV shows on the internet; WE COME TO WORK AND CARE FOR OUR PATIENTS. The employees want to provide excellent care for the Dallas citizens and the patient’s that other Dallas hospitals turn away and send to PARKLAND. WE DO NOT TURN OUR BACKS ON PATIENTS or SEND AWAY PATIENTS TO ANOTHER FACILITY BECAUSE THEY ARE THEIR PATIENTS!! One thing to remember about PARKLAND, it was good enough for our president to go to when he was shot and our hero’s of the law enforcement agencies and fire departments come to PARKLAND when they need our help. PARKLAND’s annual emergency room visits are 108,707 and clinic visits are 983,820. That is a whole lot of patients! The scary thing is knowing these problems happen in other facilities and hospitals but the public and their patients never hear about them because we are a government entity and held to a higher standard because we get so much assistance from the government. PARKLAND did not try to cover up our flaws or lie about them, we agreed they happened now what can we do to fix them so they do not happen again. It would be nice for once to hear a great story from the DMN from some of the many patients we give great care to over the years that are so happy to have a place to go for health care instead of focusing on drawing negativity towards our facility. Thanks again Tim for a neutral article that allows the audience to decide their own opinions of our facility.

  • XT

    I’m confused. It’s a Bottom 10% hospital. It’s a bad hospital, verified by an an independent rating agency.

    Can someone please explain how DMN caused that? I’m not defending DMN, I don’t read it, and have no axe to grind against Parkland, I’m just looking at the facts that it is a Bottom 10% hospital. Whether or not DMN has journalistic integrity is another point entirely.

  • Parkland Nurse

    @XT- who exactly decided Parkland was bottom 10%? You? The DMN? What makes either of you qualified?

    Parkland garnered two AAA ratings from Fitch Ratings and Standard & Poor’s. With these ratings we became the only AAA-rated hospital in the country – public or private.

  • Parkland Nurse

    @ XT- And…
    Parkland Memorial Hospital in Dallas, TX is ranked nationally in 2 adult specialties. It was also high-performing in 4 adult specialties, as shown below. Parkland Memorial Hospital is a 672-bed general medical and surgical facility with 41,364 admissions in the most recent year reported. It performed 7,127 annual inpatient and 9,522 outpatient surgeries. Its emergency room had 147,197 visits. Parkland Memorial Hospital is a teaching hospital. It is accredited by the Joint Commission (JC).

  • Parkland Nurse

    @XT- One more thing…
    If you’re referring to the UHC morbitiy and mortality results for Parkland (specifically Oncology and Neurosurgery), our rates are high because our hospital is a referral base for other smaller area hospitals who send patients here for a higher level of care (i.e. they don’t have the appropriate physicians or ability to care for them). We receive so many transfers from outside hospitals of really sick patients with complex medical conditions that no one has any idea how to treat. I can’t tell you the number of times we have received patient’s in the process of dying that outside hospitals transfer here (that we know are going to die) but we accept them anyway to see if we can give them a fighting chance when no one else will. How many other hospitals can say that? Very few. Can’t think of any actually. So you can say what you want about the UHC results, but the data is skewed…especially when taken out of context as it so often is.

  • Troubadour

    Thank you @Parkland Nurse, I was going to point out the exact thing. And @XT, “verified by an independent rating agency” means absolutely nothing. A bottom 10% hospital would not receive consistent recognition (ex: http://health.usnews.com/best-hospitals/area/dallas-fort-worth-tx), would not be a place the Dallas Cowboys- one of the RICHEST franchises WORLDWIDE would send their employees (http://sports.espn.go.com/nfl/news/story?id=4127852), and furthermore, be the place your own doctor probably trained to be the MD he is today. People of DFW, you need to take a moment to try to imagine Dallas without Parkland. Parkland is a county hospital that takes care of the incredibly sick, the underpriveleged, uninsured, and poor on a daily basis. The government will absolutely mandate private hospitals across Dallas to have to take these patients. Think about what this will do to your own healthcare. Your wait in the ER will be longer, less bed availability (Labor & Delivery floors watch out!), overworked and overburdened medical staff… the list goes on. It is unfortunate that Parkland’s issues have come out in such a public light, however the DMN’s dogged approach to crucify Parkland has become more spectacle than investigative journalism at this point. Dallas County- you absolutely do NOT want Parkland to fail. We know changes need to be made, but we need your support, now more than ever.

  • Pittsburgh Platter

    The best comment to Tim Rogers’ article above that I’ve found is at http://frontburner.dmagazine.com/2011/08/31/leading-off-83111/ for August 31, 2011 at 1:11 PM.

  • Pittsburgh Platter

    Really Tim, loading up the comment section with Parkland employees, media bloggers, and administrators. How can you stand in all this, waist-high, without a shovel?

    This entire phoney debate about the CMS tag of “immediate jeopardy” being “extraordinary” versus “rare” is a non-issue that nobody is debating or cares about. It was fabricated out of whole cloth by Tim Rogers and his friends at UT Southwestern.

    See the comment at http://frontburner.dmagazine.com/2011/08/31/leading-off-83111/ for August 31, 2011 at 1:11 PM.

  • not so much

    @Pittsburgh Platter: As opposed to the DMN bloggers who are on a constant attack and have, apparently, plenty of time on their hands to write outrageous blog posts anytime any story about Parkland is published? T
    he reason you see more employees and “pro-Parkland” comments on this site is because we all no longer subscribe to the DMN and cannot comment. This site allows posting regardless of subscription status – now THAT’s free speech. I have not seen anyone post “Parkland is perfect.” They are only asking for a fair description of the actual events as opposed to a highly skewed version that chooses some facts, while not mentioning others that may negate their own preconceived conclusion.

  • I, too, work at Parkland. Why are we responding to this? Because we are proud employees of a wonderful, caring establishment that has been treated as if it were the “waist-high” you refer to. Parkland does not deserve the personal affronts that DMN has made about Parkland, our leader, Dr. Anderson, and us – the employees who work there. Dr. Anderson took a much smaller hospital and helped it grow to a world renown hospital that has won numerous awards for the work that we do. Hopefully, you will never need care from us and hopefully That person at DMN won’t need care from us, but “guess what!!!” If you do, you will receive the care that you need regardless of what either of you have said about us. Bear in mind, that none of us are perfect and we make mistakes but they are not malicious nor planned. DMN’s attacks on Parkland and those of us who work there were planned and they were malicious. If their only thoughts were to make us better, they would not have exaggerated single events into multiple situations. They would have encouraged and supported us.

  • no kool aid thanks

    What about the lack of the “culture of safety?” The accepted patient to nurse ratio in the Parkland ED was 7:1. Completely ridiculous. Then, the CNO cites a spring-time nurse exodus as a reason for the nurse shortage. Really? Did anyone ask why?

    As a nurse, my heart is broken. Why does it take an legislative act to make a not-for-profit organization do the right thing for their patients? I guess healthcare is immune from any Union Carbide learning… Acknowledge your behavior, take responsibility, institute changes and move on!

    Take a close look at the top management at both Parkland and Methodist Dallas. Do you see many health care clinicians? Probably not. Maybe the healthcare staff has chosen to dring the kool-aid the upper management was serving!!!!

  • JoJo

    If you need life saving care, you better hope they take you to PARKLAND! I am a nurse at Parkland and if my husband needed his life saved, the first place I would take him is Parkland!I am proud of my hospital and would encourage anyone who has doubts to come and take a look for yourself.

  • Observant RPh

    I think everyone needs to take a look at the bigger picture. The reason there are ANY issues at Parkland, or any facility that takes care of indigent patients, is because as a society, we are unwilling to provide the resources necessary to make sure everyone gets good care. Whether the problems are super-severe or just severe or whatever, this is a symptom of a bigger problem. County hospitals, and hospitals in general, are being squeezed to provide more and more care with less and less reimbursement. We all want the county hospital to provide premier care to everyone that comes through their doors, but is anyone willing to see their property or sales taxes go up? Anyone? . Parkland Nurse and ER RN and others are alluding to this same, very real issue: Parkland and its employees are doing the best they can with the resources they have. But as a society, we don’t want to pony up the resources, just criticize the people who step up and try to make the little we are willing to spend work for everyone who needs it. The root cause of many problems experienced in hospitals is a lack of people. Studies demonstrate that medication errors drop when patient-to-nurse ratios are below a certain threshold; fewer physician mistakes make it to patients when there are enough other clinicians involved in a patient’s care in a team-approach. Residents make fewer mistakes that affect patients when there is adequate attending supervision. But every one of these things require money. Until we are willing to step up and adequately fund the values we profess to have, these types of problems will persist.

  • Parkland Nurse

    @Observant RPh-
    You hit the nail on the head. Every hospital (not just Parkland) feels the pinch. Increasing the nursing staff in the ER and throughout the house is a must. Expanding residency programs and having the presence of more residents in the ER and other critical shortage areas would be a Godsend. Obviously beefing up the residency programs would be a more long-term goal but hiring of more nurses could start now.

  • oldrn

    I agree that DMN has been “after” Parkland and Dr Anderson for many months…and their reporting is far from objective. Many years ago, I received my education at PMH and worked there as well. There is no finer institution. Yes, as long as we are taking care of incredibly high numbers of very sick people there will always be room for improvement. The care Parkland’s staff delivers was and is caring, knowledgable, and effective….and regulators will always find areas in need of improvement. Dallas Morning news should recognize the diligent efforts being made by PMH staff to correct current conditions instead of continuing their biased reporting. Neither DMN biased reporting or the current problems will define Parkland, it’s rich history, or it’s current leadership. I am thankful for the education/experience Parkland provided for me….it was a very solid foundation for my professional life. I have faith that the caring staff and leadership will work their way through the current issues and will continue to provide the excellent care they are known for.

  • The best ‘D’ taco in Dallas

    Apparently, the words, “fair, objective, and balanced reporting,” means being oblivious to the presence of the 6-ton white elephant in the room–in other words, not saying anything bad about Parkland and UTSW.

    Why is everyone on this blog drinking the cool-aid that Tim Rogers is serving? You people seriously need professional help. You can’t be functioning in life, living in such denial and holding on to these delusional fantasies.

    Get a clue, you Parkland and UTSW losers! Buy one or steal somebody else’s if you have to! But at all costs, get a clue!

    Just in today, UTSW was forced to pay $1.4 million to the US Department of Justice and the Texas Attorney General to end a Medicare fraud probe that implicated Parkland Hospital. Before that, CMS (not CMMS as Tim Rogers would ignorantly like to call them) declared that Parkland is an “immediate jeopardy” to all patients that come to that hospital and is imminently being threatened to lose all Medicare and Medicaid funding.

    In addition to these issues, Parkland and UTSW are both dealing with whistleblowers from within, angry patients and concerned employees complaining to regulatory boards, bad news media coverage (other than just the DMN), reports of victims coming forward publically from Parkland, an upheaval of their executive leadership, an mass exodus and defections of their own talent, problems from other independent regulatory agencies (JCAHO, DSHS, HHS OIG, etc.), criminal FBI investigations, a loss of confidence from the County Commissioners Court and the Parkland Board of Managers, and the loss of the public’s trust.

    It’s time to wake up people! What I read in this blog is not in touch with reality–not one bit. Stop drinking the cool-aid! Your leaders and Tim Rogers are pouring you a glass of red-colored lies mixed with sugar and fruity deceit.

  • Too Bad

    @ Best ‘D’ Taco-
    It’s really unfortunate that you appear to be propagating the inaccurate information and half-truths the DMN has been reporting. Not only did the allegedly fraudulent UTSW billing have very little (if anything) to do with those of us employed at Parkland working in the trenches and pouring our heart and souls into our jobs, but it ALLEGEDLY happened so long ago. However, it sounds as if it was settled by UTSW…so why beat a dead horse? Parkland denied any participation in what was alleged (but I repeat SETTLED between UTSW and the feds) and was not required to pay any part of the fine. To cowardly come on here under an alias and slander the hardworking, compassionate employees of Parkland and UTSW by calling us “losers” when we neither engaged in or had any knowledge of any wrongdoing is something you should be ashamed of. You sound like you’ve been drinking the DMN kool-aid. Parkland was, is and will continue to be an upstanding institution that has complied with everything federal surveyors have asked in the last few weeks. Parkland leadership and staff members are committed to continuing the culture of change that was istituted in CMS’s wake. It’s quite a different place already. Moreover, Parkland leaders are continuing to look at additional ways our institution can provide excellent care to our patients in this ever-changing healthcare climate. To echo the sentiments of many level-headed, kind and dedicated healthcare workers who have commented here: Dallas and surrounding counties we need your support, ideas and encouragement now more than ever.

  • Critics wake up

    Parkland critics wake up and get a clue…

    I’m not a healthcare employee and do not work at Parkland but a family member does (not in leadership mind you either). I heard that Parkland’s deeming agency JCAHO (who helps the hospital remain CMS compliant) never found half of the issues that CMS did so one has to wonder why. Could it be that the recent ridiculous media spectacle swayed CMS surveyors a little bit? Surely an institution couldn’t go from being JCAHO accredited with a glowing review from them to wildly deficient per CMS in a matter of months…could they?

    As one former surveyor recently commented on the Healthleaders website:
    “wilcox (8/30/2011 at 6:26 PM) I am a former surveyor, and after many years of contact with both federal and surveyors, I can confirm that the discrepancies among surveyors are real and astounding. Some surveyors base their findings of deficiencies on their own preferences and interpretations, despite a lack of supporting evidence of how a practice fails to comply with professional standards of practice. In some instances, surveyors themselves, are not knowledgeable about certain practice. This is not meant as a criticism, rather it should give each side an opportunity to share information. Of even greater concern regarding state surveys (which are contracted by CMS), is that there are well-known facilities with political connections that are often able to have their citations reduced in scope and severity, or eliminated altogether. Or some surveyors simply develop a fondness for certain facilities, and then find it difficult to cite those facilities.”

    Also ponder this everyone has an agenda…even the DMN:

    “The Dallas Morning News has been accused of inflating its circulation numbers to keep advertiser revenue high.[citation needed] In the mid-1980s, the paper was sued by the rival Times Herald, charging that the News was overstating circulation increases. In 2004, long after the Times Herald had ceased printing, The Dallas Morning News admitted it had indeed underreported circulation decreases, and had overstated Sunday circulation by 11.9% and daily circulation by 5.1%. The Morning News promised to pay advertisers US$23 million in restitution. The circulation problems worsened parent company Belo’s financial condition. In late 2004, Belo Corporation laid off 250 workers, including 150 at the Morning News. Two years later, The News offered a voluntary severance package which was taken by more than 100 staffers. The newspaper has continued to lay off employees, most recently in October 2008 and April 2009.”

    I’d like to think that people are innately good and ethical and perhaps many are, but there are just as many who aren’t. I would be wary of those who are out to squash entities like Parkland because they are not perfect. There is no perfect hospital. We should expect them to try to be and that is what Parkland is doing.

  • Pittsburgh Platter

    Well as far as I can see, these are all headlines and statements by the newspapers and the federal government just within this month. Not sure what the “Kool-Aid drinkers” are talking about that it happened a long time ago.

    I see that Parkland has until the end of the month to find out if CMS will pull all federal funds for endanger the safety of its patients. THAT’S HAPPENING RIGHT NOW–NOT A LONG TIME AGO!

    Personally, if you are stupid enough to drink the Kool-Aid that Tim Rogers and your leaders are asking you to drink, you should do us all a favor and go away.

    Look at the title of this article even, “Parkland’s woes not as BAD as the Morning News wants you to believe.” Rogers is still conceding your hospital is BAD, and you think it’s a complete vindication and redemption?

    MORONS!

  • Too Bad

    @ Pittsburgh Platter-
    Perhaps you could refrain from the high school name calling and engage in intelligent adult conversation for a moment. The issue I was referring to which allegedly occured “a long time ago” was what the DMN reporter wrote about in this morning’s paper and again in his blog above. He inaccurately implied Parkland was implicated along with UTSW in the fraud charges brought against UTSW in 2007 which is not the case. Parkland was neither implicated nor required to pay any portion of the fine UTSW had to pay and yes it was recently settled this week (why the current headline) however it allegedly occured in the past and is not currently occuring as you erroneously stated. So again I ask, why keep bringing that up when that has nothing to do with Parkland’s CMS survey. Two completely un-related issues. Oh wait I forgot…because the DMN said it was relevant therefore it must be.

  • Too Bad

    @ Pittsburgh Platter-
    One more thing: I don’t see a single post on here that states any of us believe this article provided “complete vindication and redemtion.” We merely applauded Tim for providing an article laced with more facts and less agenda fed bias.

  • Medworker

    The bottom line is CMS found some deficiencies at Parkland- severe enough that Anderson was transitioned to another position. Severe enough that they had to come up with a plan to correct them. People died as a result of PMH negligence.

  • Medworker

    I noticed an earlier comment about Methodist Dallas which CMs also sanctioned. The problem found at Methodist had to do with ER overcrowding which as anyone who has worked at PMH knows is what contribute to a death there in2008. Parkland set the precedence-

  • Pittsburgh Platter

    Really? Splitting hairs in determining whether CMS’s “immediate jeopardy” status for imminently shutting down a hospital the size of Parkland is “extraordinary” vs. “rare.” Really!!?!

    This is how you are spending your day in trying to defend the indefensible actions at Parkland that CMS observed with their own eyes? The only question I have to your point of making a distinction between “extraordinary” vs. “rare” is: Who cares?

    Let’s just say for arguments sake, for the moment, that your argument is correct that the “immediate jeopardy” status is only “rare” versus being “extraordinary.” How exactly does that trivial distinction make any difference for “Parkland’s woes not [being] as bad as the Morning News wants you to believe?” Really, what difference does it make by splitting semantic hairs about how “rare” vs. “extraordinary” this shameful CMS distinction is?

    The answer is: It doesn’t make any impact on CMS’ findings on Parkland, whatsoever. In either case, “immediate jeopardy” is still the worst violation that CMS can cite a hospital for before cutting off all federal funding. And the point I am making is that Parkland is still posing the same “immediate jeopardy” threat to all its patients.

    You and all the Parkland/UT Southwestern bloggers (AKA their zelous flunkie propagandists) on this website are missing the point completely–in fact you’re trying to deliberately mislead and deceive your readers with this pointless and distracting red herring.

    The point still remains that CMS concluded that Parkland is an “immediate jeopardy” and a “serious threat” to the health, well-being, and safety of any patient that walk into that hospital. This idiotic distinction between “rare” and “extraordinary” wouldn’t lead anyone to logically conclude otherwise that “Parkland’s woes [are still] not as bad as the Morning News wants you to believe.” You failed to make any argument to prove that Parkland’s level of care is any less worse from what CMS had reported in their own findings.

    Parkland is still a very bad hospital that provides “extraordinarily” substandard to completely negligent health care to all its patients, as you, yourself, have finally come around to admit.

    Parkland has been found to be “dumping” seriously ill and injured children and adults with emergent and life-threatening medical conditions who come to their ER, without any appropriate medical screenings or treatments, and giving them maps with up to an eighth of a mile’s walk to find their own way inside Parkland’s elaborate maze of halls to the next ER in Children’s Hospital or to Parkland’s Urgent Care Center. This violates the nation’s emergency medical care laws, EMTALA, which Parkland’s soon-to-be ex-President and CEO, Ron Anderson, ironically helped implement into law.

    Other patients they discharge from the ER without even being given any form of medical evaluation or screening to rule out any life threatening emergency medical conditions. While even others they let sitting around indefinitely (up to a day) in the waiting room without any assigned nurse or any monitoring and without ever being seen by a licensed doctor. In other cases, Parkland was found to have failed to wash their hands, dispose of unsterile equipment and clothing, change beddings, keep proper hygiene protocols for infection controls, and keep out-of-date medications from being used on patients. In fact, many of the seriously ill patients in Parkland’s ER had to be helped by the CMS inspectors, themselves, while they were conducting their surveys at Parkland. That’s pretty [email protected] and shocking evidence against any hospital.

    This is truly a horror show for any hospital to have exposed in the public eye.

    It seems you are now backpedalling from your original stance a while back that there was nothing wrong at Parkland at all, and that this was all a “fishing expedition” and a “personal vendetta” by the DMN against Parkland and UT Southwestern. At least today, you are admitting there are serious problems at Parkland, as the rest of us in Dallas have known for some time. But let’s face it, this ever backtracking stance you are taking to defend Parkland and UT Southwestern is on a steep slippery slope leading right up to the edge of a perilous fall into the bottomless pit of hack journalism and lost credibility.

    And what about these wacky and delusional robotic flunkie bloggers from Parkland above who think your article admitting that Parkland is still very troubled is some kind of complete vindication and redemption for Parkland?

    “Thank you Tim! Finally, a story that tells the facts and does not depict our hospital as a horrible facility. As a nurse for this FINE institution, I can attest to the AMAZING, SAFE and COMPASIONATE care we provide daily to the citizens of DALLAS and the surrounding counties (even though it is meant for Dallas County citizens, that is another story) that pass through our doors each and EVERY DAY.” –from Dallas Citizen and Parkland Nurse on August 31 at 12:08 AM.

    Really? Do you really think Parkland was completely vindicated by Tim Rogers’ article above? REALLY!!?! How delusional can a person get?

    If Tim Rogers want to stay “revelant” in the field of journalism, he should find topics of discussion that are relevant to issues on the minds of Dallas’ citizens, instead of fabricating insignificant arguments out of whole cloth that nobody is debating or cares about.

  • Cheryl

    In 2009 I ended up in DOCTORS HOSPITAL with pneumonia. While there I was getting Heparin shot in my stomach to prevent blood clots. One day nurse forgot to use an alcohol pad to clean the area. It happened to quick to say anything and it alarmed me. A few days after I was discharged I started having very tender skin on the area right below my naval. I went to my PRIMARY doctor and PARKLAND to find out what was wrong. They said it was Cellulitis. They gave me antibiotics and it got better. About a week later my left leg started turning very red, was extremely swollen and painful. So I went back to my primary doctor at PARKLAND to see what was wrong. Supposedly Cellulitis again. I was admitted to the hospital for serious antibiotics to be treated for turned out to be health care-associated MRSA. Since then, I’ve been hospitalized with it 3 more times. The moral to this story is: the supposedly good hospitals aren’t perfect either. They aren’t always as clean as they should be and improper handling of patients do occur too. People need to stop bashing Parkland. Give them a break. Parkland is a Godsend to the masses that have no other place to go for healthcare.

  • Harsch Medcricker

    Ha! Ha! Months later Parkland and UT Southwestern are in deeper doo-stuff. Methinks the feds was already working on exposed them, and that the DMN helped bring it all into the public eye sooner. That’s a purpose of a free press!