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Medicine

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

By Tim Rogers |

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.