Op-Ed

Ky. voices: Disclosure key to curbing medical errors; UK board should demand it

Dr. Kevin T. Kavanagh of Somerset is a physician and board director of Health Watch USA.
Dr. Kevin T. Kavanagh of Somerset is a physician and board director of Health Watch USA.

I must admit up front that I am not the biggest basketball fan. I know this approaches sacrilege in Lexington but it is true. As a medical professional, I measure the University of Kentucky by the performance of its health care delivery system. And, although it is often depicted as world class, I have become more and more concerned about its quality and direction.

There are growing indications that the University of Kentucky Chandler Medical Center has significant safety problems that the Board of Trustees, its governing body, has not engaged.

Although U.S. News and World Report, whose rating system is heavily based on reputation and not patient safety, continues to give UK one of the highest rankings in the state, other organizations disagree. Consumer Reports gave the Chandler Medical Center only a 47 out of 100 on patient safety and ranks it in its lowest category for surgical complications (adverse events). Similarly, the Leapfrog Group gave the Chandler Medical Center a "C" rating compared to "A" ratings at Baptist Health, Lexington and St. Joseph East.

The non-disclosure of problems and adverse events at UK hospital would be comparable to UK not providing basketball scores for badly played and lost games and instead issuing a press release stating: "We played well, all the fans want to know is (to paraphrase Dr. Michael Karpf) that we're committed to doing the very best we can." Or the athletic department stating: "We would release the team's statistics, but they are too complicated for fans to understand." The Big Blue Nation would tolerate neither statement in lieu of the data.

What is truly remarkable is that a pediatric cardiac patient's family was reportedly advised by a UK physician to go to the University of Michigan, an institution which embraces a policy of full disclosure and as a result has reduced its malpractice costs per claim by 50 percent.

It is ironic that the policy of full disclosure was first implemented by Dr. Steven Kraman, a professor at the University of Kentucky, some 25 years ago at the Lexington Veterans Administration hospital but UK seemingly prefers non-disclosure.

Although many have pointed their fingers at Karpf, UK Healthcare's CEO, the true head is the Board of Trustees. Ultimately the board shoulders the responsibility. According to the Centers for Medicare and Medicaid Services, the Board of Trustees is the governing body of the hospital and should have full access to all information which surrounds patient safety events. Excuses about HIPPA or other federal laws shielding these problems from them do not hold water.

No policy of non-disclosure can exist without at least the board's tacit approval. Such policies are inexcusable in a state institution. At a minimum the board should tie administration staff bonuses to achieving safety goals. In addition, trustees need to be trained by an outside organization such as the Institute for Healthcare Improvement and not by UK employees. Consideration also should be given to having the quality assurance arm of UK's health care system employed by and reporting directly to the Board of Trustees.

There is little doubt that UK has a rough road ahead. Over the last decade, UK did not set up a regional network of employed physicians and satellite facilities. Instead it undertook a billion dollar building campaign; its two new towers are half empty and its referral network is fast becoming the employees of its competitors.

The culture of safety at UK is in question. Last year problems in UK's research arena resulted in a professor accused of research fraud and sexual harassment obtaining another job at a high school and the whistle blower losing his job at UK. This latest debacle risks the continuing loss of safety-conscious faculty and staff and the retention of those willing to look the other way.

Unless UK reverses course, it may never fill the new towers of the billion dollar Chandler Medical Center. Although UK on Friday released its pediatric heart surgery mortality rates after intense national pressure, its lawsuit against a medical reporter over her open records request has cast UK in a negative national spotlight.

As I said, I do not follow basketball closely, but I know that such a performance involving the Big Blue basketball team would not be tolerated and would be dealt with swiftly.

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