Cooper: As if it couldn’t get worse

Imagine being young, artistic, energetic, excited about life and the only thing stopping you was a condition called Ehlers-Danlos Syndrome (EDS). EDS manifests in the person afflicted by having “looseness in ligaments and other connective tissues leading to unstable joints and persistent pain.”

The description is from a Seattle Times investigative piece called “Quality of Care” (Feb. 12, 2017) that details this young woman and her family’s hope, trust and reliance on a renowned neurosurgeon and Swedish Medical Center’s Neuroscience Institute to perform the delicate and complex procedure that would stabilize her spine.

I recommend that you read the report if you haven’t. You will feel the enormous sorrow about the system of care that failed this young woman and resulted in her death.

At your most forgiving, you will come away with serious questions around how the system became so misdirected from its essential mission of saving quality of life and lives.

At your least forgiving, you will be outraged that our healthcare system was so market-driven that the quality of life and, indeed, the life of this young woman was secondary to volume and productivity of service that grows money that falls right to the bottom line.

At the end of the long piece, we learn the renowned surgeon had since been promoted to chairman of neurosurgery despite complaints of complications.

The Seattle Times reporter, Mike Baker, spent a year on this story. If the paper and he had not, we would not know the story and the system would chug along papering the boardroom with glory and money.

The CEO, who has resigned, would still be there and the renowned surgeon, who has resigned, would still be there wandering in and out of surgical suites while surgical fellows performed procedures on spines and brains.

Leveraging our chance for good health

Perhaps the most confounding aspect of this story is that other surgeons, other physicians, nurses and other staff were registering complaints nearly from the beginning of renowned surgeon’s entry into the system. The now interim CEO was quoted as saying, “It is clear to me that caregivers at Swedish have not always felt heard …”

How’s that for a strong stand on the horrendous quality assurance and patient safety system failures spawned by, shall I say it, greed or mellow it a bit, by a market-driven healthcare system? Those caregivers not only felt not heard; they weren’t heard!

Right now, our Congress is designing and promoting a market-driven approach to the purchase of healthcare insurance that will eliminate any controls on coverage and cost and eventually be applied to Medicare.

What possibly makes us think that for-profit everything in healthcare will result in anything than more of the same, the same assembly line surgery exposed at Swedish, which is nonprofit by the way. Smart companies leverage their products and streamline processes and staff to make more profit.

When did risking a misstep on someone’s brain or spine become an acceptable risk in leveraging the skill of a willing renowned surgeon?

Deregulating businesses for sake of business

The other plan being promoted is to reduce regulations so businesses can function more freely. I have written several times about the need to reduce regulations in healthcare so, I agree.

My guess, though, is that those who are all a twitter about reducing regulations and I will differ on what regulations to keep and what to toss out. One regulation I would change is reimbursement regulations that values volume over the patient-doctor relationship and treatment at the expense of prevention.

Some may not realize that the Affordable Care Act (aka Obamacare) includes provisions that shift reimbursement to outcomes instead of encounters, diagnostic tests and procedures.

I believe that the makers of imaging machines and surgeons, maybe business savvy neurosurgeons, do not agree and have joined the chorus to repeal Obamacare. The businesses that benefit substantially now don’t want a change in the system and have the money to effectively lobby for their position.

The question to be asked is — should healthcare be lumped in with all businesses: automobile makers, bakeries, home building, landscape artists, Pepsi Inc., vacation cruises, Apple, Facebook, entertainment venues, restaurants, wheat growers, to name a few?

Will healthcare succeed in its mission if it is driven by sterile market forces and deregulated to make it easier to benefit from an unaccountable system? Wouldn’t the chances for more revenue enhancing practices such as those practiced by Swedish’s Neuroscience Institute increase exponentially with more deregulation and less accountability?

After all, the current system of accountability did not work to either catch or correct assembly line surgery that allowed the patient to slip off the line into an environment lacking proper oversight and response to complications.

The article tells us that more than a year ago, state surveyors of hospitals came in and spent two days in the Neuroscience Institute as follow up on a complaint about the service. The complaints were “not substantiated due to lack of evidence.”

Swedish Medical Center’s website reports, “All Swedish campuses are fully accredited by organizations deemed by the Centers for Medicare and Medicaid Services (CMS), namely Det Norske Veritas-Germanischer Lloyd (DNV-GL) and The Joint Commission (TJC).”

Where were those esteemed oversight organizations? Critical important questions need to be asked and answered before healthcare goes headlong into market-driven reimbursement and deregulation.

It can get worse.

The local angle and yours

Olympic Medical Center (OMC) has a contractual relationship with Swedish which caused one of my friends to write to an OMC board member expressing her concerns about people from our community being referred to Swedish Neuro-science Institute.

The board member sent her concerns onto Eric Lewis, CEO of OMC, who responded:

“We will continue to monitor this closely. OMC is a local owned and operated healthcare system. We (have) an affiliation with Swedish which is a contractual relationship. One key is that our physicians are not required to refer to Swedish and they can and do refer their patients to the best physician/hospital based on the patients’ needs and wants.

OMC physicians refer to UW Medicine, Virginia Mason and other organizations in addition to Swedish. Physicians usually make their referrals based on knowledge and experience with the surgeon. This local connection with a physician helps to assure Clallam County residents are well taken care of by referred-to physicians and organizations. We have had excellent outcomes with referrals to Swedish.

As to how this will affect our ‘relationship’ with Swedish, it is too early to know. The board and senior leaders with be discussing this later this month. OMC will continue to focus on providing quality and safe care for our patients including when we refer to other organizations.”

OMC should and is taking the quality care issues and concerns of our community seriously. We, as patients, should too. We are the final decision-makers about our healthcare and healthcare provider.

I realize in writing about this story just how angry I am. We can only have one primary purpose in providing healthcare that is first, do no harm, second, save lives and limbs and third, this person is loved by someone, if not you, so save them, their dignity and quality of life to the best of your ability.

Bertha D. Cooper is retired from a 40-plus year career as a health care administrator focusing on the delivery system as a whole. She still does occasional consulting. She is a featured columnist at the Sequim Gazette. Reach her at columnists@sequimgazette.com.

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