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A dropper of disclosure not enough for patients

By HOWARD TROXLER
Published January 16, 2005

HUDSON - Until a few weeks ago, all seemed well at one of the busiest heart-fixin' shops in Florida, Regional Medical Center Bayonet Point in west Pasco County.

And why not? The 290-bed hospital, owned by Hospital Corporation of America, was named by U.S. News & World Report as one of the nation's 100 best in 1999 for heart care and heart surgery.

The hospital's Heart Institute, now in its 15th year, was on the list again in 2002.

But on the evening of Dec. 8, the hospital released the somewhat mysterious announcement that it had suspended nine of 25 cardiologists from certain procedures.

The one-page statement said an "independent third party" had reviewed past procedures performed at the hospital and had "identified several opportunities for improvement."

The next day, Dr. R. Vijay, a cardiac surgeon of statewide prominence and the medical director of the hospital's heart institute, shed a little more light on what was going on.

Vijay told Times reporter Collins Conner the questions included whether doctors had done angioplasties on arteries not significantly clogged, used the wrong size or type of stents, used medicines incorrectly and kept incomplete records.

Vijay stressed that the outside review was preliminary. Now the hospital is going through an internal process standard in medicine, called "peer review," to reach more specific determinations.

That's all the public knows.

The doctors' names have not been made public. We don't know whether patients who have undergone procedures at the hospital know if their doctor or their procedure is among those under question.

Neither does the public know whether these nine suspended doctors have relationships with any other hospitals in the Tampa Bay area.

You might recall that in last November's election, the voters of Florida passed Amendment 7 to our state Constitution, which says that reports of "adverse medical incidents" must be made available. So the Times asked the hospital for past records of the suspended doctors.

In reply, the hospital filed a lawsuit seeking a ruling that it did not have to disclose the information, and that Amendment 7 violated the U.S. Constitution. That case is pending.

What should the public make of all this?

First of all, the hospital should get credit for blowing its own whistle. The hospital sought a voluntary outside review, and it acted on the results.

(It's also good to remember all the other doctors, nurses, techs and staff who haven't done anything wrong, and who are suffering because the good name of their hospital is on the line.)

Second, as Vijay pointed out, these are complicated decisions. It is always easier to second-guess that somebody else shouldn't have gotten their procedure.

I can't help but think there could have been other factors at work, too. We live in an era of defensive medicine, in which doctors err on the side of doing the extra procedure in borderline cases.

What's more, today's Americans have a notorious resistance to good diet and exercise - which is precisely the prescription for early warning signs. Instead, we push our doctors into giving us the magic pill, the knife, the quick fix.

So maybe those things drove up the number of procedures.

Or heck, maybe everybody just wanted to rake in more money.

We really don't know. It is not reassuring, this idea that everybody has to just sit around and wait while the hospital investigates itself, and if there's anything we deserve to know, maybe they'll tell us. (The state and feds now have launched their own inquiries, too.)

The hospital is no doubt afraid of being sued by the doctors. But on the other hand, thousands of past patients may not know if their own cases are in question. Current patients might not know the score about their own doctor. Prospective patients have no information to guide their decisions.

So this is not the hospital's private business.

[Last modified January 16, 2005, 00:32:15]