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

I’ve been meaning to update that post from last week since the day after it went up. That’s when I got an email from Bob Moos, a public affairs specialist for the Region 6 office of the Centers for Medicare and Medicaid Services (CMS), correcting an error I made in the post.

After asking the regional and national CMS offices for stats on how many “immediate jeopardy” citations it issues, and after not hearing back from them, I quoted this story, which says that CMS doesn’t keep those stats. Well, Region 6 does. After reading my post, Moos sent me the following email:

The Dallas Region 6 office of CMS oversees five states: Texas, Arkansas, Louisiana, New Mexico and Oklahoma.

There have been six immediate-jeopardy citations against hospitals (including Parkland and Methodist) in Region 6 since the beginning of the current fiscal year (Oct. 1, 2010). Specifically, there have been four in Texas, one in Arkansas and one in Louisiana. There are 957 hospitals in Region 6 — 517 of those are in Texas. During the previous fiscal year, there were two immediate-jeopardy citations against hospitals in Region 6. Both were in Louisiana.

So such “IJ” citations can be considered out of the ordinary.

Hope that helps.

Helps indeed. So despite Methodist’s getting an IJ citation right on the heels of Parkland’s, such citations are, indeed, rare. I was wrong to say they aren’t. What I don’t understand at this point is why the Morning News didn’t publish those same Region 6 numbers when it ran its big Sunday story on Parkland, instead choosing to quote experts. When I talked to Moos the day after I put up my post, I asked him whether anyone at the News had asked for those IJ stats. He said that, in fact, a reporter had called with that request after I put up my post. Moos couldn’t recall whether they’d previously asked for the numbers. I am forced to conclude they hadn’t, which is odd.

Anyway, mea culpa. I was wrong. And I learned something about Region 6.

I’ve learned something else since putting up that last post about Parkland. CMS’ IJ citation has lengthened wait times in the ER. Here’s an example a Parkland ER doc gave me:

A patient comes in — call him Fred — and he’s in pain. The doc brings Fred back to an exam room, takes his history, etc. Previously, Fred might have been sent back to the waiting room while the doc was waiting for test results. Thing is, there aren’t enough beds at Parkland for the number of people who walk (or are wheeled) through the ER doors. The doc needs to free up that bed to see another patient. Meanwhile, though, Fred out in the waiting room might get some meds to deal with the pain. In other words, technically his treatment happens in front of other patients. According to CMS, that’s a violation of Fred’s rights. Parkland docs had to stop doing that. End result: you get Fred sitting around on a bed, taking up space that a doc could be using to see another patient. Wait times go up.

How much have they gone up? We won’t get an accurate picture until next month, when Parkland will release its stats for September. That will be the first full month during which new policies will have been in place to address the CMS citation. Parkland didn’t begin making those changes until about August 22, late in the month. Still, even with these changes in place less than two weeks, here’s what has happened:

July
Treated patients: 10,248
Left without treatment (because, presumably, the wait was too long): 3.3%
Wait for patients who were discharged: 5 hrs 18 min
Wait for patients who were admitted: 8 hrs 20 min

August
Treated patients: 11,286
Left without treatment: 6.8%
Wait for patients who were discharged: 5 hrs 31 min
Wait for patients who were admitted: 8 hrs 57 min

The wait times have gone up some, yes, but look at how many people just walked out. That’s a big increase. Parkland shoots to keep that number below 4 percent. I’m guessing that won’t happen this month.

One final note. A few people in the comments here have assailed me for “taking Parkland’s side.” The thinking goes: “Aha! It’s because D Magazine takes advertising from UT Southwestern!” That’s true. We do. While UTSW docs themselves are not allowed to buy profile ads in our Best Docs issue (coming in November, by the way), the school itself usually buys a display ad congratulating the winners.

But that’s not why I “take Parkland’s side,” if that’s what you want to call it. I do it because I believe the reporters and editors at the Morning News and the brass at Parkland and UTSW really dislike each other. You know what they say about getting into a fight with someone who buys ink by the barrel. As big an organization as Parkland is, I think the hospital is the underdog here.

Primarily, though, I sympathize with Parkland because I know doctors who work there now, and I know doctors who have worked there in the past. They’ve told me what’s happening. And I sympathize with Parkland because I once trailed an ER doctor for a 12-hour shift, and I saw with my own eyes what happens there. The workers at Parkland perform a nearly impossible task, and they do it with scant resources.

I believe that Parkland’s operations can be improved. But I also believe they are not the disaster that the DMN has tried to describe.

Comments

  • Vseslav Botkin

    The important thing here is that Tim was wrong for the right reasons and that while the DMN was right, they are meanies … allegedly.

  • DGirl

    But the DMN’s woes are as bad as Parkland might want them to be.

  • Collosus

    I’m going to start referring to D Magazine as “The Cooler.” It’s taken high profile positions in recent years supporting The Trinity Tollway, DISD and now Parkland and has ended up retreating on each issue. The DISD retreat has been more quiet. There’s nothing wrong with being wrong, but it often feels like the magazine is following more often than leading, or you are simply acting as a counterweight to the Dallas Morning News.

    • @Collosus: How have we retreated on DISD? Besides for the fact we can’t do a special issue every year.

  • Wylie H.

    In other words, Parkland’s Woes ARE as Bad as the Dallas Morning News would have us believe…

    But compliance with one of the government’s many requirements could make things worse for a small group of ER patients if Parkland’s management complies in a less than well thought-out manner…

    …so the DMN is off base?

    Ow, my head hurty…

  • Slavens14

    I can answer that, Zac. Tim was a pretty consistent DISD proponent until 1) he moved one of his kids to private school and 2) L’Affair d’Hexter. Aside from Tim’s activity, or lack thereof, I see few if any posts on DISD anymore.

    That, sir, is a retreat.

    • @Slavens14: I think we’re all still proponents of DISD here. The two of us who have kids of school age have them (well, mostly, as you point out) in DISD. There may be fewer posts recently. There may well be more posts in the future. That has less (read: nothing) to do with policy as much as it has to do with time and whatever else there is to write about.

  • Slavens14

    Oh, I look forward to reading about the Rogers family’s experience with a DISD middle school.

  • Compton Broders

    I am a part time physician in the ED at Parkland and have been so for over 20 years. I also have a great deal of experience with other emergency departments. Parkland may be the best run Public Hospital in the country. Sure there is need for improvement but the picture painted by DMN is grossly inaccurate. One example they reported was that Childrens Medical Center was one block away. A block is a long way. The truth is that the CMC ED is one inch away from Parkland-down a short hallway and thru a doorway. Parkland is an invaluable resource to the community trying the best it can. Why the witch hunt?

  • Pittsburgh Platter

    Let’s see, even Bob Moos of CMS Division 6 states: “[S]uch ‘I[mmediate] J[eopardy]’ citations can be considered OUT OF THE ORDINARY.” In other word, the “IJ” citations can be more simply put as being “EXTRAORDINARY.” So what were you even arguing about Parkland’s “IJ” citations being “rare” versus “extraordinary” in your previous article?

    Even I don’t appreciate the distinction between Parkland being that “rare” bad hospital vs. it being an “extraordinarily” bad hospital. Who cares about splitting hairs on a semantic debate that is only going on in Tim Rogers’ head?

    What I do appreciate is that Parkland, by the CMS “IJ” citation and by the statistics they give, shows that it is among the worst of the worst in terms of being a threat to patient safety, among all hospitals not only in Division 6, but among all hospitals in the country.

    Now, how do you conclude from this red herring that, “Parkland’s woes [are] not as bad as [the Dallas] Morning News wants to believe?” The “IJ” citation is still the worst citation that CMS can impose on a hospital, before pulling all Medicare and Medicaid funding. It doesn’t and can’t get any more worse than that.

    In addition, Parkland achieved its remarkable decrease in ER waiting times because CMS found that they were “dumping” children with emergency medical conditions onto Children’s Medical Center’s (CMC) ER, without first screening those patients for life-threatening medical conditions, and discharging other patients either home without being seen by a doctor, or to their Urgent Care Center (UCC), also without proper medical screening.

    Any ER “dumping” patients against the nation’s emergency medical care laws, EMTALA, would see their ER waiting time drop dramatically; however, doing that is a dereliction of duty and against the law. Ironically, Parkland President & CEO, Ron Anderson, helped implement EMTALA into law, so he knew what Parkland was doing all that time.

    In the case of Parkland “dumping” its ER patients onto other more responsible ERs and clinics, who are willing to actually see patients where Parkland was not, it creates a burden on other ERs and places all Parkland patients in immediate danger. Also leaving these incapacitated patients to their own devices with some map to navigate up to an eighth of a miles walk in Parkland’s maze of hallways to find the next hospital’s ER is outrageous.

    Many of those patients didn’t make the “walk of death” while CMS inspectors were watching. Many became lost, and others couldn’t make it because they were too weak to go forward. Those inspectors actually had to stop what they were doing to help save these patients from dying on Parkland’s floor.

    That makes, “PARKLAND’S WOES AS BAD AS CMS WANTS YOU TO BELIEVE!”

  • @Pittsburgh Platter: You’ve made this mistake a couple times, both here and in the previous post. I didn’t argue a distinction between rare and extraordinary in the previous post. I argued that the IJ citation was NEITHER rare nor extraordinary. As I think I’ve made clear here, I was wrong about that.

  • Taxpayer

    When taxpayer’s have to pay for something, like Parkland, they expect it to be well- run.

    They may be seeing lots of ER patients, but that does not excuse the fact that when patients die in your ER waiting room, they MUST report it to the Federal Government. Parkland did NOT do this. This is against the law. Yes it IS that bad.

  • XT

    Funny, it sounds different when I say I’m wrong. You say your wrong, but then go on to say why you’re not wrong.

  • Jack Hoff

    Tim,

    I think ER waiting times are always going to go up whenever you’re forced to actually see and treat patients, instead of dumping them to other ERs or abandoning your duty as a doctor by discharging them home without being evaluated.

    Yes, dumping decreases wait times in the ER, but it also means patients die without being properly evaluated and treated for life-threatening medical conditions.

  • Jack Hoff

    Now that Tim Rogers admitted he is wrong, yet again. Let’s all drink some Kool-Aid from Parkland’s creative media services (AKA Parkland’s bloggers), and make a shameful retreat on other issues with our tails between our leg, like Hextergate and the DISD.

  • Anyways….

    Back to Colossus’ point, you folks have a questionable track record in recent years when it comes to advocating civic initiatives. I agree that “retreat” is the right choice of words for the three topics in question.

    My heart wants to believe your magazine is simply picking the wrong horse to win, but head says that you are not in tune with the changing dynamics of our city. You are following more often than leading.

  • I’m very thankful for Parkland. I accidentally walked into the Children’s ER and was seen almost immediately in one of those little child’s examination cubes. I was quickly whisked over to the adult ER. And with in no time there was a panel of doctors saying “Hello and welcome to the cardiac unit.” What the heck? Cardiac Unit? I’m 43 for crying out loud! Turns out I have a very rare congenital heart defect that has only recently become a diagnosis and affects roughly 1 out of 100,000 people. The doctors at Parkland figured out this needle in a hay stack.

  • Caramel

    Thank you D Magazine for helping people to see the other side of this very biased DMN report. It’s strange to me how one person from a government agency can prance in and push such a large hospital down so easily. Since I am a Parkland ED employee I see how these CMS changes are, for the most part, hurting the patients and department as a whole. There are some positive changes…but for the most part parkland is being bullied. It’s frustrating having to hear the negative biased stories. Thank you for giving a preview from the other side.