In response to an investigative report published by the Seattle Times, the Oregon Department of Health is scrutinizing the operations of Cherry Hill, a hospital operated by Swedish Medical Center.
Technically, the state health department is not mounting a new probe into the Seattle healthcare facility. Instead, they are reopening an investigation that took place about a year ago after an anonymous whistleblower alerted regulators about problems at the hospital, including unwarranted surgeries and increased rates of surgical site infections and other complications. The preliminary investigation was reportedly wrapped up in two days, after the health department determined there wasn’t enough evidence to go further.
In addition to the investigation of the hospital, Oregon’s Medical Commission is looking into specific complaints against Johnny Delashaw, MD, a neurosurgeon who is at the heart of the explosive Seattle Times story.
The Times article alleges that the compromised care was a result of an aggressive increase in the number of procedures performed by brain and spine surgeons at the facility. Physicians were encouraged to take a high-volume approach to scheduling and were further given added financial rewards for the sort of particularly complicated procedures the could boost the hospital’s reputation. Some of those surgeries were more invasive and risky than medically necessary, according to the Times.
The more robust surgical schedule naturally led to a commensurate swelling of the hospital’s bank accounts. According to the report, Cherry Hill saw a 39 percent increase in net operating revenues compared to three years earlier and led all hospitals of at least 150 beds in Medicare reimbursements per inpatient visit.
The question is whether all that extra patient traffic has also led to compromised care. The article cites statistics gathered by federal agencies to note that Cherry Hill has high rates of surgical complications in recent years. There has also been an evident strain on other parts of the facility, with intensive care unit staff stretched particularly thin by the high number of patients sent to their corner of the hospital to recover from invasive surgeries.
The Times connects the culture shift to the recruitment and subsequent elevation to a leadership role of Delashaw. A surgeon renowned for his heavy case loads, Delashaw reportedly covered 661 inpatient cases during his first 16 months at the facility alone. That production translated to over $86 million in billings. Concurrently, Delashaw’s approach was reportedly raising concerns among his colleagues, leading to dozens of internal complaints.
In a written statement, Delashaw responded to the newspaper’s allegations of a toxic work environment accompanying the increase in caseloads.
“While I expect excellence and unswerving commitment to our goals I am not a bully and have not produced an intimidating atmosphere,” Delashaw wrote. “Swedish has investigated claims and I am unaware that it found any substantial evidence of this alleged behavior.”
Delashaw also maintains that some of the practices identified in the Times article as worrying examples of negligence, such as overlapping surgeries, are fairly standard across the field.
“Surgeries at many institutions such as ours occur in concurrent rooms by a team of surgeons,” Delashaw writes. “These surgeries are staggered so that the attending of record is present for at least the key portions of each procedure. Other attending surgeons are available if needed.”
Delashaw further notes that the outcome data has been evaluated and the hospital has determined “no measurable differences in outcomes have been identified between the surgeons staggering rooms and those that choose one room.”
Although the determinations of the state regulators are obviously some some time off, the reverberations from the investigative report have seemingly resulted in one major leadership change already. Tony Armada, the CEO of Swedish Health Services, recently announced his resignation. He was was immediately replaced by R. Guy Hudson, MD, a veteran of Kaiser Permanente, Henry Ford Health System, and Advocate Health Care. Hudson is officially designated as interim CEO.
In making the personnel announcement, Swedish Board Chairwoman Teresa Bigelow emphasized the importance of returning to “physician leadership” at the highest level.
“Tony created a strong culture of teamwork during a time of great change across the industry,” Bigelow said. “He also put the needs of our patients and caregivers first and was deeply committed to quality, affordability, and access for all.”
