Harmed Patient Deplores Failure to Investigate Bad Surgical Outcome

Medical mistakes are a fact of life, and they’re always troubling. But the problem’s compounded when an adverse outcome has been reported and no one bothers to investigate.

That’s what happened nearly four years ago at the Cleveland Clinic when government inspectors investigating a claim threatened to sever the renowned facility’s right to receive Medicare payments because, according to a story on ModernHealthcare.com, they were stonewalled by hospital officials.

David Antoon, a retired Air Force colonel, had accused Cleveland Clinic of failing to investigate when he claimed that someone other than his authorized surgeon had performed the prostate cancer procedure that left him seriously injured.

Hospital personnel, according to reports from the Centers for Medicare & Medicaid Services (CMS), would not make available to the feds all of the notes in Antoon’s complaint file, and the doctor who said he performed the surgery would not talk about how the hospital handled the case.

Before his surgery, Antoon was a commercial 747 pilot. The operation left him incontinent. He’s bewildered not only that the hospital compounded the problem of its own making, but that there’s no oversight agency in medicine similar to the one in his profession, the National Transportation Safety Board, that addresses safety failures.

“You cannot keep things concealed in aviation,” he told Modern Healthcare. In medicine, “They’re just gathering data points from patient complaints. And every data point is a damaged life or a death.”

Like many hospitals, Cleveland Clinic Health System has a track record of burying patient complaints. As Modern Healthcare reports, in 2012, CMS inspectors threatened again to slam the door on nearly $1 billion in Medicare reimbursements when hospital officials acknowledged their failure to investigate a complaint that surgeons had implanted a heart stent without having the patient’s consent.

Last summer, Cleveland was threatened with suspension from participation in Medicare after its officials told a patient there was no evidence that a surgeon failed to remove a needle used in a procedure. The truth was that the hospital had an X-ray clearly depicting the needle.

Although the hospital wouldn’t make anyone available to be interviewed by Modern Healthcare, it defended itself in an email: “Cleveland Clinic sees more than 5 million outpatient visits per year, has nearly 160,000 admissions and the highest acuity [the sickest of the sick] of patients in the country. We are committed to providing the best care and safest environment for our patients.”

The clinic also blamed deficiencies in the state’s inspection system for the high number of CMS deficiencies.

It’s true that pure numbers don’t give a complete picture of a hospital’s treatment and safety success; those with sicker populations necessarily will have poorer outcomes, in terms of pure numbers. But the troubling thing about this situation is the denial – of a problem, of access to information.

Modern Healthcare examined tons of federal inspection reports showing that, between 2010 and 2013, Cleveland spent 19 months on “termination track,” the term for a facility skating on thin Medicare ice because of patient complaints and insufficient follow-up.

Cleveland has lots of company; as reported in the magazine, the clinic “is far from alone in facing the only sanction the CMS can apply to hospitals when serious safety problems and violations of informed consent rules are brought to light by patient complaints. An analysis of Medicare inspection data found that between 2011 and 2014 there were at least 230 validated serious incidents … that led the agency to threaten hospitals with losing their ability to serve Medicare patients unless they immediately fixed the problems.”

During that window, at least 9,505 complaints were lodged with the CMS, involving 1,638 hospitals. Only the most serious complaints result in threats of being cut off from government funding, and only rarely do the feds make good on them.

The problem endures because of regulatory limitations: Unlike with nursing homes, the CMS doesn’t have the authority to levy fines against hospitals that violate the rules.

“The absence of meaningful sanctions,” says Modern Healthcare, “provides a loophole for officials at some hospitals to engage in prolonged negotiations with CMS inspectors when confronted with patient-safety complaints, which typically conclude with the hospital promising to revamp policies and beef up staff training. The result, safety advocates say, is a regulatory system unable to respond to problems in a manner that ensures the problems won’t happen again once the inspectors have left the premises.”

One reason we have advised consumers to approach hospital ratings with a wary eye is because sometimes, serious incidents and responses to individual cases aren’t reflected in a hospital’s overall ranking. They don’t seem to have much impact on accreditation by the Joint Commission, the voluntary organization funded by hospitals and whose only enforcement power is to withdraw accreditation. “The commission, whose inspection reports are not made public,” Modern Healthcare reports, “has consistently awarded the Cleveland Clinic good quality-of-care ratings.”

Cleveland eventually corrected each problem cited by the CMS. Antoon, the former pilot, has become a vigorous patient-safety advocate who has an ongoing medical-malpractice case against the Cleveland Clinic and his physicians there. But, as he told Modern Healthcare, no amount of money can repair his physical or emotional damage.

“This stopped being about me a long time ago. This is about a fraudulent, broken medical system where patients are injured and nobody is accountable. The airplanes are still crashing. Doesn’t anybody care?”

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