Jessie Mae Ned had her leg amputated after botched knee replacement surgery at Parkland Hospital.(The Dallas Morning News)

The Morning News takes a long, hard look at hospital care in Dallas

By MAUD BEELMAN
Dallas Morning News Deputy Managing Editor
mbeelman@dallasnews.com

DALLAS—Every place has its sacred cows – individuals or institutions so prominent and respected that over time they become part of a community’s identity and culture. Questioning them is an affront to civic pride, and investigating them can be a high-stakes gamble.

The University of Texas Southwestern Medical Center and Parkland Memorial Hospital are two such icons of Dallas.

The medical center boasts of “world-class” research and residency programs that have turned out generations of excellent doctors. Parkland, which received a mortally wounded President John F. Kennedy, is the main training ground for the school’s new doctors. As a public hospital and major trauma center, it is also a safety net for the region’s most vulnerable patients.

Over the years, the two institutions have enjoyed largely positive press, some of it by design. Their leaders cultivated national profiles and courted some of the wealthiest and most influential Dallas residents, including media leaders, as advisers and donors. But after receiving a few insider tips and learning of the allegations in a whistleblower lawsuit, the newspaper decided it was time to investigate.

What we found was a system that for decades had deceived virtually all of its patients, put many at risk and, by the hospital’s own estimate, seriously and often needlessly harmed on average two people a day. Internal records from the two institutions, sworn testimony by current and former employees and federal inquiries also documented instances of a cowboy mentality among loosely supervised residents, a class-based culture of care and possible Medicare billing fraud.

Starting last March, we published on 15 different occasions over a nine-month period. Some were large packages of multiple stories and some were individual articles. We have linked everything we’ve done – stories, update posts on our “DMN Investigates” blog, video, original source documents, “ask the editor” columns – from one online site, which you can find at www.dallasnews.com/medinvestigation.

Among our findings:

• Patients checking into Parkland had, for years, not been told that the experienced UT Southwestern faculty doctors who they thought would be operating on them would not actually perform the surgery. They might not even be present in the hospital at the time.
• Most of the patient care at Parkland was delivered by doctors in training – first-year interns and other residents. Some patient care was even handled by students who had not yet graduated from medical school.
• The UT Southwestern residents at Parkland were often left to their own devices. Residents supervised and trained interns and other residents. Faculty doctors often played little role in supervising. Institutional policies allowed faculty to claim they were supervising some procedures if they were available by cell phone. When some faculty did try to exert direct supervision, residents often bristled.
• While junior staff members were tending to poorer, uninsured patients at Parkland, UT Southwestern’s faculty physicians focused on research and treating privately insured patients at the medical center’s other hospitals.
• Some doctors within Parkland and UT Southwestern had complained that the lax supervision was hurting patients and offered specific examples of that harm. They were soon ostracized, and most left for other jobs.
• Patients were harmed during surgeries by resident physicians, including a young mother whose common bile duct was severed during a gallbladder operation and a former Parkland employee who eventually had her leg amputated after knee-replacement and post-surgical care provided, in part, by medical students.
• The Parkland culture has been based on a “see one, do one, teach one” style of medical training that emphasizes resident autonomy. The head of one UT Southwestern residency program even told colleagues that higher rates of patient harm were an acceptable price to pay for doctor training.
• If patients and family ever learn they have been victims of medical error, which few seldom do, medical malpractice damage limits in Texas ensure that they often have little recourse.
• Federal regulators don’t track such instances of patient harm. That’s because, while Medicare mandates levels of supervision for doctors to follow in billing for their services, it doesn’t do the same when it comes to patient safety. There are also no accepted “best practice” standards to guard against patient harm at the nation’s teaching hospitals, which treat more than half of all patients and account for about 70 percent of all charity care costs.
• The kinds of problems identified at UT Southwestern and Parkland have occurred at other teaching hospitals around the country, especially ones in large urban settings.
• Medicare billing fraud was found at two dozen academic medical centers and teaching hospitals in nationwide audits conducted several years ago – until the industry managed to quash the federal reviews. As a result, patients have suffered avoidable harm nationally because the business and culture of medicine have resisted meaningful change.
• Alleged billing fraud by UT Southwestern and Parkland goes back decades. The institutions had previously been investigated for falsely billing the government insurance programs for the poor and elderly and are under current investigation by the U.S. Justice Department.
  
  Getting to these truths has been a huge challenge.
  
  UT Southwestern and Parkland told their employees not to talk to us, and they refused to share any aggregate data on patient outcome. Parkland’s $1.2 billion annual budget is supported almost entirely by local, state, and federal taxes, but it insisted that little if anything about its operations or outcomes should be open to public scrutiny. Even when we had signed legal waivers from former patients, who had released to us their entire medical record, the institutions refused to talk.
  
  Our knowledge and ability to tell the stories accurately and fully depended almost solely on source development and the vigorous use of open-records laws. Our reporting team read through thousands of pages of hospital and medical center records obtained under the Texas Public Information Act, as well as documents from local and state courts and from the U.S. departments of Justice and Health and Human Services.
  
  We often obtained records only over fierce, and sometimes comical, resistance by the two institutions. (Medical center officials once claimed it would cost them $1 million to produce a list of checks they had written.) The roadblocks forced us to hire a full-time public records lawyer, and the newspaper has filed four lawsuits in state court to compel the hospital and medical center to follow the open records law.
  
  In response, the taxpayer-funded institutions have hired additional law firms, including one headed by a former Texas Supreme Court justice, and developed lobbying plans to try to force the state Legislature in 2011 to weaken the Texas Public Information Act. They have also hired public relations consultants to try to create public skepticism about the findings of our investigation into what have been two of Dallas’s most-venerable institutions.
  
  The newspaper has also faced a community backlash, including cancellation of advertising by UT Southwestern. Many of Dallas’ wealthiest and most powerful residents are longtime donors and supporters of the medical center and hospital. Some key players have sought to delay, if not derail, the investigation. They have recruited key opinion leaders in Dallas and nationwide to try to discredit us. We have responded with absolute transparency, posting original research documents online at the time of our various publications and again in connection with three “Ask the Editor” columns the paper has published online to answer questions and address the criticism.
  
  Behind the scenes, our reporting has attracted the attention of the Justice Department and Health and Human Services’ Office of Inspector General. A previously unknown investigation into alleged Medicare fraud was reinvigorated after The News released internal hospital documents showing that Parkland once estimated it owed the federal government up to $50 million but had withheld information from its own auditors in order to hide it from federal investigators. The Joint Commission, which accredits hospitals nationwide, confirmed in late December it was investigating one of the cases of patient harm we revealed in November. Jessie Mae Ned, who lost her leg after a doctor-in-training botched her knee replacement surgery, contacted us after reading an earlier story on patient harm at Parkland and realizing she was not alone.
  
  But as our final major investigative story of 2010 showed, what happens in the nation’s teaching hospitals is clearly a topic the industry does not want discussed openly – despite the documented human toll. The medical community has fought for years to preserve what it calls “the privilege of self regulation,” and it spends hundreds of millions on lobbying Congress to protect that. Nobody wants to see patients needlessly harmed, but our reporting has shown that some in the medical industry see the alternative as giving up the cheap labor of residents, and others believe that new doctors can, in effect, learn only from their own mistakes.
  
  Dallas County residents, however, now have enough information to question some of these practices and perhaps prevent future problems. And there are signs that change may be underway. Hospital insiders tell us that resident supervision is being newly emphasized in some departments. There are preliminary indications that some hospital performance measures may be improving. Several key officials at the hospital and medical center have been replaced, and county commissioners are said to be quietly considering plans to alter the special relationship between the public hospital and the medical center. While encouraged by these early signs, we realize there is much we still do not know. So, our investigation continues. With billions of dollars and thousands of lives at stake, we believe we have no other choice.

Maud Beelman is a deputy managing editor at The Dallas Morning News, where she directs a team of investigative and special projects reporters. E-mail: mbeelman@dallasnews.com

Comments

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Glad to hear from the Deputy Editor herself Posted by Dr. Evil 01/07/2011, 08:53 PM This is one of the best pieces I’ve read so far on the Dallas Morning News investigative series on Parkland and UTSW. Ms. Beelman’s article very well details the counter efforts that Parkland and UTSW have waged to obstruct public information from being disclosed under the Texas Public Information Act (TPIA), prevent their own employees from speaking out about problems at both institutions, lobby for changing the TPIA to weaken the law for governmental bodies such as Parkland and UTSW to disclose public information, and smear the DMN, Parkland/UTSW informants, and their patients/victims with questionable dirty tricks (a la the Nixon administration.) All these dirty tricks were made in the name of covering up malfeasance, incompetence, gross negligence, and dereliction of duty. Very shameful indeed. It’s a very good read. I’m surprised the DMN is not co-opting to run the article themselves.

"World Class" Public Corruption Posted by Key Tam Sam 01/07/2011, 09:53 PM This is a very worthwhile investigative series for the Dallas Morning News and Ms. Beelman to put their best efforts into. Congratulations, Maud, for everything you have accomplished thus far. An interesting question comes up in my mind, however. How can both public, tax-payer funded, governmental bodies (in this case, Parkland and UT Southwestern) funnel public monies into lobbying efforts to change the law—in this case, weakening the Texas Public Information Act (TPIA)? Not only are there great ethical and moral conflicts-of-interest for governmental entities to lobby, on their own behalf, to change the law this way. But it may be illegal for them to do that. This may be a prime example of public corruption by two governmental entities. I would like to carefully frame the arguments and questions about these unethical acts perpetrated by Parkland and UT Southwestern. Can the Dallas Morning News find out about the ethical and legal improprieties committed by Parkland and UT Southwestern in using public monies to try to unduly influence lawmakers to change the law against the public’s interests? As far as I know, the government and governmental entities are not allowed to lobby with public tax-payer or any other monies to change the laws or unduly influence public officials on their own behalf. There seems to be good reason to cut-off both Parkland and UTSW from misappropriating public funds for this kind of unethical and possibly illegal conduct.

Dirty Deeds, Done Dirt Cheap Posted by Anonymous 01/07/2011, 10:31 PM That is a good question raised about using public, tax-payer monies for this “dirty tricks” campaign by Parkland and UT Southwestern. How can governmental entities funnel tax-payer monies into lobby plans to unduly influence law-makers and PR consultants to smear newspapers and individuals in the public forum? There must be a way to force both “governmental” institutions to divulge how they are spending public monies for such an underhanded and possibly illegal campaign. Has anyone filed a Texas Public Information Act request to Parkland and UT Southwestern to force them to divulge this information?

THANK YOU Dallas Morning News Posted by Dare to Care 01/07/2011, 11:39 PM The Dallas Morning News has done, and will continue (we hope) to do an unemotional and factual job of reporting on the shameful aspect of Parkland and UT Southwestern Medical Center's operations. No entity, not even the deservedly renown institutions of UT Southwestern and Parkland, should be considered above the law. Yet that is exactly what's happened for years in regards to these institutions. Without question, UT Southwestern excels in research and VIP patient care. They even have doctors who are on call 24 hours a day just to care for donors and community leaders while the less privileged citizens of our community wait hours for care at Parkland which is more often than not provided by trainees rather than board certified physicians. (Years ago, a Pulitzer prize winning TV reporter failed to have his contract renewed when he began a series exposing the medical center's VIP list and its practice of spending thousands of dollars for alcohol, gifts and entertaining of potential donors.) The citizens of this great city deserve to know the truth about UT Southwestern and Parkland - - the good (of which there is so much) and the bad (of which there is too much). Most of us are disgusted and disappointed that the Parkland Board, The UT System and the city leaders are too spineless to insist on a total change in management of both of these institutions. But at least we are hopeful the Dallas Morning News will work diligently to report truthfully the actions of UT Southwestern and Parkland in hopes positive change will ultimately occur. UT Southwestern and Parkland are far too valued, and too valuable, to continue to operate in such ethically and legally questionable manners. And if those who oversee these institutions can't or won't bring upon a much-needed change for the better, perhaps the honest reporting of the Dallas Morning News will attract federal entities who will. THANK YOU, Dallas Morning News. We know this has cost you sponsors, time and a tremendous amount of money. Be assured your efforts are appreciated and applauded. Keep up the good work on behalf of the tax-payers of the community and, more importantly, the current and future patients of UT Southwestern and Parkland. Our citizens, not just the "special" ones deserve the best UT Southwestern and Parkland can provide. Clearly, it's time to put an end to the two-tiered level of healthcare that has gone on for years.

Interested reader Posted by Not so fast 01/08/2011, 06:52 PM I agree that both institutions should have done more to respond to some of the newspaper's questions. That said, once the newspaper took the side of a litigant and his contingency fee attorney the crusade left out many important facts that would have better explained the story. For example, the $50 million dollar issue was part of a document published by the hospital years ago. The litigant was the supervising physician in the first case the paper profiled so lack of supervision wasn't the issue. Officials from both institutions spent hours with Morning News reporters and editors but few of their comments made it into the paper. Their written comments are relegated to the Internet. The paper's voluminous open records requests have cost tens of thousands of taxpayer dollars. While it has raised some important issues it is also clear the paper has little understanding of the issues it is writing about and less interest in educating itself or its readers. Each of these articles should have been labeled editorials.

Insular World of Journalism Posted by Just read this article 01/08/2011, 10:22 PM "They have also hired public relations consultants to try to create public skepticism about the findings of our investigation into what have been two of Dallas’s most-venerable institutions." This comment is evidence of the insular world of journalism where reporters hold up in downtown Dallas frequently view the world from a very narrow and distorted perspective. It is well known that media relations professionals at both institutions strongly recommended the release of additional information from UT Southwestern and Parkland. Journalists who had no problem criticizing others suddenly become very thin skinned when their work is critiqued. There are plenty of legitimate reasons to question the way this series of articles came together, the quality of the research and the general lack of awareness or respect for other opinions concerning complex medical and legal issues. Most newspapers including the Morning News could not afford to hire enough reporters if they had to dig up information provided for them now by media relations professionals. Your comment was not only inaccurate but it was a cheap shot.

The P.A.T.H. to reform can be found on “behalf of the king” Posted by Key Tam Sam 01/09/2011, 04:03 AM Ms. Beelman this investigative series is very worthy to be acknowledged by the Nieman Foundation. Clearly, Harvard knows great journalism when it sees it. It is so very refreshing to see a reporter talk so candidly & honestly about a story she is covering. I can tell your passion to find out the truth about the improprieties and corruption at both these institutions is very sincere & genuine. I hope your efforts are well rewarded by finding out the complete story about Parkland & UTSW. This is probably why the Nieman Foundation recognized the Dallas Morning News (DMN) investigative series on Parkland & UTSW, because it has great potential to hit the national stage in a big way on all the papers across the nation. With that said, I think I should state that my area of expertise is in Qui Tam litigation. From what you have reported, it sounds like Parkland is ripe for one of the biggest False Claims Act (FCA) lawsuits on record. Anyone who hears that Parkland’s own estimates of overbilling Medicare begins at $50 million will instantly know that their own figure alone would shatter any existing record for fines & penalties that were levied against any medical school in the 1990’s from the GAO’s PATH audits. And you state that “billions of dollars & thousands of lives [are] at stake,” which makes this case even more compelling for the DOJ to pursue. Clearly, someone at Parkland or UTSW must be smart enough to realize this that has read your investigative series. Is there anyone considering filing a Qui Tam lawsuit on behalf of the US govt for Medicare fraud at this time? Although state entities like UTSW are immune from Qui Tam lawsuits, Counties & municipalities are vulnerable to be sued under the FCA, & I understand Texas’ version is even stronger than the federal version for treble damages and fines. So, it would appear to me that Parkland is extremely vulnerable. Have you thought about educating your readers about how to file a Qui Tam lawsuit so that a Parkland or UTSW employee with personal knowledge of these billing improprieties might come forth to file a Qui Tam lawsuit? From what you have mentioned, it sounds like this kind of action is the only way to get any meaningful change in this system which traditionally resists change. From my experience, institutions with this kind of arrogance and sense of entitlement need to be dragged kicking & screaming like little children having major tantrums to get them to act responsibly to obey the law.

Interested Reader Posted by Interested Reader 01/09/2011, 11:52 AM Had the Morning News done a more balanced job covering the story you would understand whether such a suit had been filed, whether a federal investigation is mandatory following such a suit (whether or not there is anything to the allegations) as well as the relationship between the Morning News, the litigant with an ax to grind and an open wallet to fill and the entire series. Sorry for the run on sentence.

Dallas Morning News Posted by shaking head 01/09/2011, 04:51 PM The DMN has not struck any sense of balance in pursuing this story and in the process has trashed the reputation of institutions with alegacy of caring for the most vulnerable patients in our community. While the topic of proper supervision of trainees is a valid one, the DMN displayed no balance in their writing. Conspicuously absent were details of the countless hours spent by attending physicians teaching and supervising the care of patients at Parkland- I know this because I am one of them. There was no attempt at examining what other hospitals in Dallas do regarding training, and the fact that our trainees do an outstanding job overall in caring for the patients. Instead we get the "cowboy culture" from the DMN, as if anything that exists in Texas must be simplified to a these-are -the-people-who-invaded -Iraq stereotype. More recently the DMN has refused to publish data from organizations such as the University Health Consortium, which has shown that Parkland is well above the quality of care provided by average academic safety net hospitals. Similarly when a lawsuit by a disgruntled faculty member against UT Southwestern, which was the nidus for the initial DMN articles was literally laughed out of court last month the DMN conveniently decided not to cover the decision. There is also a suspicion that the DMN is being egged on by a private hospital system in Dallas with which the Belo Corporation has longstanding ties, and which is threatened by the emerging health system at the University of Texas Southwestern Medical Center. Just today there is another front page story with the breathless headline that the rights of complaining patients at Parkland were violated. And what was the offense? Was privileged information sold or care denied? No..the patients who complained (there were 6 of them) didn't get a written response within 10 days. While this is not proper, it clearly does not rise to a rights vilation worthy of such a headline on the front page of the newspaper.

Dirty Deeds, Done [not so] Cheap Posted by Anonymous 01/10/2011, 03:06 AM I have to praise the efforts of DMN’s venerable Deputy Editor of Investigative Reports, Maud Beelman. This is very good reason why we still need hard-hitting investigative journalism like this in this country. I think some of the negative bloggers to this piece pretty much verify what Ms. Beelman and the rest of the bloggers have been asserting about Parkland’s and UTSW’s “dirty tricks” that are being used against the press, Parkland and UTSW employees, and patients/victims to both institutions. This is prima facie evidence that Parkland and UTSW seem to have some sort of bullying smear campaign against anyone that threatens their interests.

Posted by You Proved My Point 01/10/2011, 10:10 AM The last comment proves one of the point many of us have been trying to make. Is the unique culture of journalism questions about the accuracy, fairness or content of a reporter's stories is seen as an affirmation that the reporter is on the right track. Pissing off leaders is considered a badge of honor. That makes it extraordinarily difficult to get a fair hearing once reporters and editors have made up their minds about an institution or story. They simply ignore or downplay any contradictory information. Often, as is the case here, they misrepresent events, claim credit for information that was already available to the public and pile on by including unrelated events in an effort to make their stories appear more significant than they really are. Parkland and UT Southwestern didn't help matters by not doing a better job of telling their stories. No individual or organization is as thin skinned or defensive as members of the news media when their tactics or competence is questioned. Ironic, isn't it?

Dirty Deeds, Done Dirt Cheap[shots] Posted by One of many Parkland and UTSW informants and extremely credible sources 01/10/2011, 01:05 PM This is an absolutely terrific job that the DMN has done to date, and the Nieman Foundation deserves great credit for its vigilant awareness in finding and recognizing tremendous journalistic talent from all over the country. Maud you deserve all the accolades that Harvard is bestowing upon you, and the citizens of Dallas are proud of the job that the DMN and you have accomplished to date for our fair city. To the DMN’s defense, no one from Parkland or UTSW, including Parkland President & CEO, Ron Anderson, and UTSW President, Daniel Podolsky, will not talk to the DMN. Even you, [Tim Doke, the official spokesman for UTSW] refused to talk to the DMN or allow any other employee from the DMN to talk to the press. So, what exactly are you getting at with your insinuations of getting a “fair hearing” or being “thinned skinned” and “defensive”? As someone once famously said, “You can’t have your cake and eat it, too.” The wall of silence and oppression that Parkland and UTSW have put up to any public disclosure does anything but downplay what you termed as being “contradictions”. This is especially contradictory and extremely “ironic” for two governmental, tax-payer funded institutions to conduct themselves in such a closed and secretive manner. We, as citizens of this great country, insist at all times to complete transparency about the affairs of our government and the acts of public officials and public employees at all times. That includes complete information about what governmental entities, such as Parkland and UTSW, do with our hard-earned tax dollars. To state the famous lines of one of Texas’ most venerable laws: “The people, in delegating authority, do not give their public servants the right to decide what is good for the people to know and what is not good for them to know. The people insist on remaining informed so that they may retain control over the instruments they have created.”

Another view Posted by In training 01/10/2011, 10:05 PM I am a resident at Parkland and am amazed that nobody has spoken to those of us on the frontline. We have lots of autonomy but we are also heavily supervised, especially when it comes to caring for the sickest patients. I am glad I chose to do my training at Parkland. The Morning News series doesn't give the whole story. It's unfair but more importantly from the standpoint of investigative journalism it's inaccurate.

The Hippocratic Oath & “Primum non nocere” or “First, do no harm” Posted by One of many Parkland and UTSW informants and extremely credible sources 01/11/2011, 01:22 AM It happens I am a graduate from UTSW’s residency program and did most of my training at Parkland; therefore, I was a resident at UTSW and Parkland. So, someone has spoken to “one of us” on the frontline. There are many services from many different departments in which UTSW faculty never see their patients, and only “consult as needed” for unlicensed and uncredentialed residents, who see the patients all by themselves and act as their own attendings. In many cases, the attendings don’t even document their involvement in the patients’ care at Parkland. Funny things is the Parkland Medical Staff Bylaws state that Medical Staff—who are licensed, board-certified, and credentialed physicians largely made up of UTSW Faculty Members—are only allowed to see patients by themselves “autonomously”. Residents-in-training—who are considered only House Staff—do not have these credentials and privileges to see patients all by themselves without direct supervision. That’s what the purpose of licensing, board-certifying, and hospital-based credentialing is for—to assure that doctors already properly have the training, knowledge in their specialty fields, and competence to see patients all by themselves “autonomously”. This case of an unlicensed, second year orthopedic resident going to surgery on his own for Jessie Mae Ned, without her consent to be her surgion-of-record, in a “Bait-and-Switch” scam (switching the attending surgeon, Frank Gottschalk, right when she gets anesthetized and with no attending supervision in the OR) is appalling. This resulted in the resident cutting Ms. Ned’s artery, leading to foreable complications after complication until she had to get her leg amputated on Christmas eve in 2009. Unbelievable! And this has happened time and time again as it has been revealed that Parkland has always been trying to save money by using only residents to see patients with no supervision by licensed and credentialed physicians. There are no inaccuracies here. This is just very good investigative journalistic work with corroboration from many different sources. What is the most important doctrine in Medicine? It’s “first, do no harm!”—not “see one, do one, kill one!” Nor is it, “See no evil, hear no evil, speak no evil.”

length of rounds Posted by shaking head 01/11/2011, 07:24 AM To the above, this is absolute nonsense. One of our major problems is that we spend so much time rounding with the residents that we are constantly in danger of keeping the post-call residents in the hospital past the 1PM time when they must go home by ACGME regulation. Rounds with residents routinely start at 8AM and last 4-5 hours a day on many services. Don't know why such a broad brush suggesting the residents are on their own has gone unchallenged. When they are on call residents usually make rounds again in the late afternoon. Easy to check this out if you are interested in painting an accurate picture- the above must have trained a long time ago.

Excuses, excuses Posted by One of many Parkland and UTSW informants and extremely credible sources 01/11/2011, 08:49 AM Who are you fooling? You are talking to someone who went through the system. Not all your residents are on call at the same time. They are rotated and staggered every 4-8 days depending on the service they are on and their rotation. So, the majority of residents aren’t post-call. Some are not even on an inpatient ward when they are on call. Besides, if the resident has to go home because of ACGME limitations after being post-call, the attendings can round on patients by themselves since the ACGME does not limit attendings to the same rules as residents. Or have you forgotten how to see patients all by yourself? That’s just an excuse for not taking any pride or responsibility in the profession you have chosen to be your own. It’s just unprofessional. There nothing wrong with an attending seeing patients independently to verify patients that the residents are taking care of. That’s still supervision. The point is patients have to be seen by a licensed, credentialed physician. That’s the law. How do you even answer the charge that no licensed surgeon was in the OR at any time when this second-year resident botched Ms. Ned’s knee replacement surgery, completely unsupervised (even up to three days post-op)? And you bill the patients as the attendings when you don’t even see them. There’s a word for trying to get paid for work you don’t do, and it’s called fraud.

Where's the analysis? Posted by teachable moments 01/11/2011, 10:38 PM Three things: in the article on Jessie Mae Ned, a major teachable moment was completely lost on Brooks Egerton. The large photo showing an ashtray full of cigarette butts indicates Ms. Ned is probably a smoker. If so, she was already at a much higher risk for surgical complications (I know that doesn't address the original error, BUT, it could definitely impact her healing). Why didn't Mr. Egerton help educate the readers that smoking isn't just bad for lungs....it's bad when you have any invasive procedure. Secondly, in that same article, the DMN published tables that clearly showed Parkland outperforming some of the private hospitals, yet there was only the briefest mention in the body of the article. Most readers don't have the time (or the critical thinking skills, unfortunately) to assess the data on their own. Where is the uproar over Presbyterian Hospital having a death rate THREE TIMES HIGHER than Parkland's for heart attack victims? But Texas Health Resources has a new TV ad campaign bragging about their heart care??? Parkland and UTSW are excoriated for having a PR firm; why not go after the PR people for the private hospitals who don't meet Parkland's standards? By the way, my primary care physician is at Presbyterian, and I've considered Presbyterian to be my hospital of choice...until I saw that data. In the most recent article about patient complaints not being answered (in writing)in 10 days, there is so little information about the validity of those complaints that it is impossible to know if the staff had any chance at all of addressing them. It seems that some of the complaints may have been simple misunderstandings on the part of the patient (was the "needle in the arm" actually a heparin lock?). I will feel much better about the intentions of the DMN if they will investigate the "dirty deeds" at ALL the big Dallas hospitals. After all, those private hospitals are getting millions of dollars from our insurance companies. Those dollars we pay in premiums are worth the same as the dollars we pay in taxes.

Know your History and Physicals and never go by "see one, do one, kill one" Posted by A community doctor 01/11/2011, 11:25 PM Well, under Social History of the History and Physical, the doctors are supposed to ask if the patient smokes, drinks, or uses drugs, so Parkland knew this and yet still went ahead with the surgery with no licensed surgeon in the OR, which the Texas Medical Board should investigate. Who's not doing their jobs? That's what an H&P is for. Someone from Parkland (namely Dr. Gottschalk or this resident) should have done one. This resident only introduced himself to the patient before she fell unconscious from the anesthesia, which Ms. Ned replied, "You're not my doctor!" She protested that before falling unconscious. This is medical assault. It's not up to the patient to know all the medical risks and make the medical determinations. That's the doctor's job. Why don't you answer why this unlicensed resident went to surgery all by himself (without Ms. Ned's consent) with no licensed surgeon even seeing Ms. Ned even up to three days post-op?

Know your hep lock IV Posted by The IV expert 01/11/2011, 11:37 PM You never send a patient home with a peripheral IV (ie in the arm). Those things get clotted up in 3-5 days even in the hospital, and there's a big risk of sepsis since there now an access way into the bloodstream if it gets infected. The patient had no clue how to even take care of it, so obviously no one talked to him/her about what it was for. That patient would have had that IV in him/her for weeks if not months, waiting for a septic infection. The only types of IV accesses that are even sent discharged home are central catheters (ie not in the arm) or AV shunts (which are surgically implanted). And doctors have to give very clear instructions to patients about what they are for and how to take care of them. Nothing but gross negligence.

Open up the records Posted by Truth Finder 01/11/2011, 11:55 PM Well, if you want to find out more about those cases, then you should open up those records to the Texas Medical Board, CMS, and the HHS OIG so they can investigate them thoroughly for improprieties. Otherwise, it's hypocritical for you to say that we should find out more about these sample cases that were randomly selected by the CMS if you're not willing to disclose those cases to governmental oversight agencies.

You did not take into account Selection Bias or other statistical biases Posted by Basic Med School Epidemiology 01/12/2011, 03:56 AM Dear teachable moments: This is reckless of you to report that Presbyterian Hospital is automatically a more dangerous hospital to go to than Parkland because the mortality rates are three times higher for heart attacks. Ever heard of statistical biases in Epidemiology, such as selection bias? This is just selective and misleading use of statistics for your own self-serving purposes. The higher mortality rate may have to do more with other factors, such as the differences in demographics of the patient populations between two hospitals, rather than patient safety issues. For instance, take the mean age of the patient populations of two different hospitals. For example, a children’s hospital will always have a much lower mortality from heart attacks than a hospital serving senior citizens. The higher mortality in heart attacks has more to do with the differences in ages of the patient populations than on patient safety. The children’s hospital may be a much more dangerous hospital, but the statistics are misleading because a conclusion can’t be accurately drawn from one category of mortality based on heart attacks which may have much less to do with safety than with age. From your track record of inaccuracies, deceptions, and mistakes so far, I can’t believe anything you are saying without full disclosure of all the information and data. You have no credibility whatsoever. Everything you have said is either wrong or misleading. Completely shameful and disgraceful!

"My" track record Posted by teachable moments 01/12/2011, 07:42 PM I'm not sure why "Truth Finder" and "Basic Med School Epidemiology" think I have any power over Parkland and UTSW, because I don't work at either place. To "Basic Med School Epidemiology" I did my research, now you do yours. Why don't you check http://www.dallasnews.com/sharedcontent/dws/img/08 ... This is the chart I referenced in my original comment, though I see I should have provided the link instead of assuming someone would bother to check it on their own. Quote from the DMN: "The rates are risk-adjusted, meaning it takes into account factors uncontrollable by the hospital, such as patients' age and gender, severity of illness and risk of mortality." I believe that risk-adjustment would also include income and education levels. So, unfortunately for those of us who always considered Presbyterian Dallas to be top-notch, this data was extremely distressing. I had no reason to make up the data. I was shocked by it, and even told my spouse, "If I were the CEO of Texas Health Resources, I'd be thanking my lucky stars the DMN is going after Parkland and not us!" Shall I wait for your apology on the condescending lesson on statistics?

Examining the data on Parkland, the DMN accounts of Parkland being “middle-of-the-pack” are accurate Posted by Basic Med School Epidemiology 01/12/2011, 09:30 PM Well, now that we see the data, Parkland’s performance is mostly middle of the pack and in many categories, below average—if not near the bottom of the pack—just as Maud Beelman and the DMN has reported. The only categories they did well in were pneumonia and heart attacks, which only makes my point about selective highlighting of one point, while hiding all the rest of the information. It’s deceptive and misleading. (See http://www.dallasnews.com/sharedcontent/dws/img/08 ... You intentionally selected the hand-picked the single data of heart attacks and compared it to the highest mortality point for Presbyterian to make Parkland look good. That’s very self-serving and deceptive. You failed to disclose that Parkland is near the bottom of the pack in GI hemorrhage and acute stroke, and mediocre in congestive heart failure. It looks like from the data, Baylor is the hospital to go to in Dallas. They outperformed Parkland in every category, except pneumonia. The DMN was accurate in their assessment of Parkland. It’s middle of the pack in most areas with some areas underperforming near the bottom of the pack and others doing well. And that’s the whole truth and nothing but the truth, which is what credibility and transparency are all about. That’s the teachable lesson you should take home.

Credibility comes from being completely open, honest, and trustworthy Posted by Truth Finder 01/12/2011, 09:56 PM Point is well made. “Middle-of-the-pack” is not the same as "world class". This point about complete honesty and transparency of revealing “all your cards” seems to confirm that the DMN is accurate, honest, and fair in their reporting on Parkland and UTSW. The evidence seems to confirm that the DMN is very credible, accurate, and fair in their reporting on Parkland and UTSW in this investigative series. This is the “teachable moment” that Parkland and UTSW should take to heart because we haven’t seen any level of transparency, openness, or candor from these two public, tax-funded, governmental entities.

Honesty Posted by Teachable moment 01/12/2011, 10:58 PM Of course I chose one data point; just like the DMN is choosing to highlight negative cases over and over. And, I gave you the link to the article so you could analyze it yourself. No, Parkland is not at the top of the heap, and I challenge you to find anywhere in my prior posts where I called Parkland "world class", Truth Finder. But, I think even you, Epidemiologist, might be somewhat concerned about some of the private hospital data....at least if you are paying insurance premiums. Those of us who pay property taxes in Dallas County AND insurance premiums through our employers should have information about what goes on at private hospitals as well, don't you think? I'm certain there have been more than a few serious medical errors at every hospital in Dallas. I want just as much as anyone to have my friends and family members receive good care no matter what institution they use, but the continued DMN bias against Parkland and UTSW is wearing thin.

Stop the game-playing Posted by Basic Med School Epidemiology 01/13/2011, 12:59 AM Well, that’s part of your problem, young man. If you choose not to give the complete picture with full disclosure of all the information, then you create some sort of bias and distortion that does not reflect an accurate and complete picture, and no one will believe you because you just shot your credibility right in the heart. You appear to be a little too defiant, deceptive, and a little too self-righteous for your own good. It appears as if you are trying to hide something. You never pick out one aspect of data, manipulate it, and exploit it for self-serving purposes to make far-reaching conclusions that aren’t supported by all the data. It’s deceptive, and people see right through that kind of ploy. Frankly, I don’t know what your agenda is to throw other hospitals in Dallas under the bus or even the DMN. It seems extremely desperate. The DMN has been honest all along stating that Parkland performance was “middle-of-the-pack” all along. And the other hospitals in Dallas don't have a stake in your beef. So, why throw them under the bus? If you were honest, forthcoming, and transparent about answering your critics without all these deflections, misdirections, and deceptions, Parkland and UTSW may not have an investigative series running on them. The cover-ups, retaliations, and game-playing are far more damaging to Parkland and UTSW than what the DMN is actually writing about them concerning patient safety. Remember the most important concern that a patient has about his/her doctor is whether the patient believes his/her doctor is honest, forthcoming, and trustworthy enough to entrust with his/her very life. Frankly, the responses I have seen from Parkland and UTSW fall far short of those expectations. That’s the teachable moment you should take home.

another view Posted by observer reader 01/13/2011, 08:19 PM From the Dallas observer this week: - In a comprehensive annual ranking of quality and safety across all patient types, including measures of safety, mortality, effectiveness, patient centeredness and disparities of care, Parkland ranked in the top third of 98 university hospitals across the country in 2010 and was the second highest performing safety net hospital. - Among over 100 university hospitals submitting data to UHC from across the country, including the majority of those on the US News Honor roll, Parkland ranks at or above the top quartile in outcomes related to cardiology, cardiac surgery, medical and surgical oncology, neurosurgery, trauma care and overall surgical care. - Parkland achieved low rates of post-operative complications relative to a comparison group of 15 large academic public hospitals performing more than 100 total knee joint replacements over the last year. Parkland also has an active and effective quality and safety program, whose innovations have been highlighted in our collaborative quality improvement projects and annual meetings. These include successful projects to recognize patients whose condition is deteriorating, to reduce emergency room waiting times and to reduce unplanned readmissions. Parkland's use of UHC's patient safety reporting system referenced in the articles was highlighted at our annual quality and safety meeting this past fall, attended by representatives of 93 university hospitals. The safety team at Parkland showed outstanding results in acting on safety reports to make systematic improvements. At the time of their presentation, they had gone 69 days without a serious safety event as defined by the National Quality Forum. The picture we at UHC hold of Parkland, based on extensive data and years of collaborative work, is of an organization achieving superior results and committed to continuous improvement in the care of some of the most challenging patients in the nation. Can America's healthcare system do better? Yes it can. And the road to improvement will be to follow the lead of hospitals like Parkland. Sincerely yours, Mark A. Keroack, MD, Mark A. Keroack, MD, MPH is Senior Vice President and Chief Medical Officer of University HealthSystem Consortium, an alliance of 112 major academic medical centers and 254 of their affiliated hospitals representing more than 90 percent of the nation's non-profit academic medical centers.

Put all your cards on the table (Part I) Posted by Truth Finder 01/13/2011, 08:44 PM Here is a repost of another blogger’s comments from the DMN on 1/4/11 on the missive written by UHC’s Dr. Mark Keroack: 6:11 PM on January 4, 2011 I think it’s clear why Dr. Keroack and the UHC were reluctant to release the data they have compiled about Parkland Hospital to the DMN. We all know they have the data in question; however, we also know that the UHC has a cozy relationship with Parkland that raises some suspicions about Dr. Keroack’s ulterior motives in writing such a disingenuously glowing and highly defensive letter on behalf of Parkland Hospital. Parkland Hospital and other hospitals like it financially support the UHC. The UHC [and Dr. Keroak] is therefore not an independent and unbiased source that the public can trust at its word. Parkland’s President and CEO, Ron Anderson, also sits on the Board of the UHC. Clearly, this questionable relationship points to serious conflicts of interests for Dr. Keroack to be open, honest, and transparent about his motives in writing a letter on behalf of Parkland and releasing a one-sided report of only “selected and hand-picked” data about Parkland’s safety record and performance measures. Anyone who is reasonable and rational can see through this guise as a serious affront to objectivity and transparency and an insult to one’s intelligence. If anything, the reluctance to be open, honest, and transparent about Parkland’s safety and performance data shows UHC, Parkland, and UTSW have, if anything, something seriously damaging to hide from the public. Obviously, it has data to support the claims that Parkland is underperforming in many critical area which Parkland and UHC themselves deem to be harmful and damaging to their reputation of Parkland and UTSW if that data were disclosed to the public. This, therefore, only demonstrates an inherent dishonesty, lack of trustworthiness, and lack of transparency by the UHC and Parkland to address serious concerns over their own safety records.

Put all your cards on the table (Part II) Posted by Truth Finder 01/13/2011, 08:48 PM I strongly disagree with Parkland about one key point about this public institution’s responsibility to the public, and that’s honesty. This inability and deliberate unwillingness to be open and transparent about its patient health care operations by sharing even the most basic data about its patient safety record and performance measures with the public will more swiftly bring about Parkland’s and UTSW’s demise than anything that their critics can argue on their own. The cat’s already out of the bag about the lack of patient safety at Parkland, so what is preventing the UHC and these so called “trusted” public, tax-payer funded institutions from coming clean about even the most basic patient data? That kind of honesty and openness at this point can only help the beleaguered institution in regaining some of the public’s trust that they have so pitifully whittled away. This reluctance to be open and transparent about their governmental mandated reporting of its public affairs again poses the same question in the public’s mind: What ELSE are you really hiding that you don’t want the public to know, Parkland and UTSW? --from a blogger named Parklands Doctor Evil Unless “all the cards are put on the table” with completeness, openness, and transparency, we consider selective and hand-picked statements and data such as those from the UHC and Mark Keruack (listed by observer reader) to be incomplete, a distortion of the truth, and misleading. What are you hiding, and what are you afraid of? Put all your cards on the table.

Credibility = open + honest + transparent Posted by Basic Med School Epidemiology 01/13/2011, 09:29 PM It’s a very wise decision not to take Dr. Kerouac's comments at his word from the UHC. If they take money from hospitals like Parkland, have Parkland's CEO and President, Ron Anderson, on their board, and are only going to release selected positive data and comments about Parkland, then clearly, there are major conflicts of interest there. You can't decide what the truth is unless you have all the information and data available. I have to agree. In order for Parkland, Ron Anderson, Mark Keroack, and the UHC to have any credibility, they have to put all the cards on the table for the public to examine.

Under the bus Posted by Teachable moment 01/14/2011, 08:00 PM Basic Med School Epidemiology, you make interesting assumptions. I'm not young, and I'm not male. I have no agenda other than getting a clear picture of medical care in the North Texas area. The DMN implies that their agenda is to be sure patients are safe and our tax dollars are well-spent. I just wrote a check for my Dallas County taxes. Approximately $1,000 of that check will go to the Hospital District; in comparison, we spend over $8,000 per year on health insurance premiums through employers. My health care has always been at private hospitals in North Texas, and my guess is yours might be, also. I would hope the DMN cares about the safety of patients at other hospitals, and about being certain the health care dollars they spend on behalf of their employees are well-spent. I don't want to "throw other Dallas hospitals under the bus," I USE them. But I do think the DMN focuses so much on Parkland that they ignore potentially serious problems at hospitals that serve tens of thousands of Dallas County residents. And, if someone appears a bit defiant and self-righteous, you might check the tone of your own posts.

Put up or shut up Posted by Basic Med School Epidemiology 01/14/2011, 10:13 PM If you won't answer any questions about Parkland or UTSW, then it’s obvious to everyone that you’re being evasive and deceptive. The deflections, the pitiful excuses, and the misdirections aren’t fooling anyone. I’m tired of this game-playing. Why does Parkland routinely and deceivingly run this bait-and-switch con-game where attending surgeons are switched for unlicensed and uncredentialed residents in the OR without telling their patients? That’s deceitful, immoral, and completely unethical. And why aren’t there any licensed and credentialed surgeons in the OR supervising these residents in the OR? There’s no licensed doctors in the OR or anywhere else in that hospital. Who’s running the show down there? The guards or the inmates?

I can't answer Posted by Teachable moment 01/15/2011, 02:33 PM Basic Med Epidemiology: I CANNOT answer for UTSW and Parkland! I am a citizen of Dallas, not an employee. I'm beginning to wonder if you're a cardiologist at a hospital that doesn't perform well in crisis situations. (Remember, that data WAS risk-controlled.) I want balanced reporting from the only newspaper in town. I want to know why DMN only focuses on the problems at Parkland and UTSW, and doesn't give information about patients who have been saved. I want to know that the thousands of dollars the insurance companies collect are paying for good medicine at other area hospitals. That's it.

Today's outrage Posted by Tired of it 01/15/2011, 06:02 PM There is a front page article today in the DMN about the 3 year old daughter of the editor of D magazine allegedly getting special treatment to get into a pre-K program for at risk kids. As the article says on an inside page no rules were broken. So why is this on the front page? The Childs father has been critical in print of the DMN coverage of Parkland. The DMN seems to have learned it's standards from H.R. haldemann not Ben Bradlee

You got caught red-handed, so put all your cards on the table because I did Posted by Basic Med School Epidemiology 01/15/2011, 07:15 PM Actually Teachable moment, or whoever you are, I am one of the many key informants against Parkland and UTSW. So, I do work at Parkland and UTSW. And like many of the other commenters on this blog, I have personal knowledge and a pile of evidence of the improprieties that go have gone on at Parkland and UTSW for decades. And it’s pretty clear, you do too, but don’t want to admit it. You are clearly not an ordinary Dallas citizen. Stating that you’re not an employee is disingenuous, and only shows Parkland and UTSW have something very damaging to hide. Trying to argue with me and other doctors about Epidemiology in Medicine (especially in selectively pointing out one risk-adjusted mortality risk data point to make Parkland look good when the data only shows Parkland to be “middle-of-the-pack”), pointing out surgical risks of smoking, and trying deceptively pass off one patient’s complaint of a “needle in the arm” as a harmless “heparin lock” (when in fact it’s far worse to be discharged home with a peripheral IV) suggests you work for Parkland/UTSW’s PR machine, and are being advised by their incompetent advisors to try to “spin” these unfortunate incidents as pitiful excuses. What a surprise! Even their experts at Parkland and UTSW, who advise you on medical issues for PR work, can’t get the facts right. This reinforces what Maud Beelman’s article states. Clearly, the Dallas Morning News has been reporting the truth accurately, honestly, and transparently, which is the primary goal of any investigative piece—getting to the truth first. They have also been fair in other articles in praising whatever newsworthy findings or achievements the Medical Center has achieved as well, but a reporter’s duty to the public is to get to the truth first—something you have woefully tried to distort, manipulate, and hide from the public. Put all your cards on the table; otherwise, the readers will dismiss your credibility for either not knowing the fact or trying to deliberately misinform them. Stop the games and the lying. The cat’s already out of the bag. Parkland has been coning their patients, regulators, insurers, tax-payers, and the government for decades and has put the public in serious jeopardy in regards to their safety with these kinds of scams for what may be decades. Who knows? Maybe John F. Kennedy may have survived his gunshot wounds to the head, like Gabriel Giffords, if he had gone to a different hospital in Dallas. Nice PR work there, buddy.

What I am Posted by Teachable moment 01/16/2011, 06:06 PM I went to pharmacy school a long time ago. Although I no longer practice, I still read a lot of medical stuff just because I'm interested in health care. I have always had a strong interest in the effects of smoking after working in a hospital that had a significant number of lung cancer patients. I'm also interested in cardiovascular health, obstetrics, and skin cancer. Yeah, I know, kind of weird to have those things as hobbies, but, that's where my interests are. Keeps my brain engaged as I age. I don't get paid for pursuing any of my interests by anyone. No one has coached me on anything, medical or otherwise (thus, I suppose it's possible no one goes home with a heparin lock anymore; sorry, I did after a surgery long ago). I am working on the same information any other reader of the DMN has. I have used other medical sites to check death rates, etc. I'm not going to participate in "dialogue" with you anymore, because, quite frankly, your level of anger is starting to scare me.

Oh what a tangled web we weave when we first practice to deceive. Posted by Truth Finder 01/16/2011, 11:17 PM You need to go back to school because your medical knowledge is not up to par. It's reckless to try to pass off wrong facts as the medical standard of practice. Show where you get your facts and your research; otherwise, you have no credibility, and you're making Parkland and UTSW look very bad. (That's if you're telling the truth, which so far you haven't.)

Whew Posted by Teachable moment 01/16/2011, 11:59 PM OK, TruthFinder, did you even read the post above? I "laid my cards on the table." I really don't know what else to do. I obviously got under the skin of the anti-Parkland and UTSW people, and there's nothing else I can do. I'll leave y'all alone with your anger. And, calling me a liar repeatedly should be getting y'all canned from this blog. There has been no cause for personal attacks (well, except that I don't agree with you, apparently).

Transparency, transparency, transparency...it's about transparency! Posted by Truth Finder 01/17/2011, 04:06 AM Well Teachable moment, You have no credibility whatsoever to "teach" anyone about any "teachable moments" since you don't even have your facts rights or a grasp on what the DMN has been reporting. If you look at your post from 1/11 at 11:25 PM, it's full of speculation, distortions, manipulations of partial truths, outright lies, and inaccuracies. All done in a self-serving way to make Parkland look good. Address the issue head on in a honest, forthcoming, and transparent way. That's the teaching moment you, Parkland, and UTSW should go away with. That lesson will never sink in with any of you three which is such a shame.

Truth squad Posted by shaking head 01/29/2011, 07:13 PM A Message From Parkland's Chair of the Board of Managers After 69 Public Information Act requests over the last nine months (including requests for the telephone numbers and home addresses of each of our employees, requests for the personnel files of at least eight employees and pictures of newborn babies), The Dallas Morning News on Jan. 29, created a story that gave the impression that the Board of Managers was being "ousted" and that Dr. Ron Anderson, Parkland's president and CEO, was leaving. Nothing could be further from the truth.As chair of the Parkland Board of Managers, I want to assure you that we stand together: board members, hospital leadership, physicians and the greatest health care employees in America. We provide critical health care services to the people of our community who need it most.Yes, five members of the Board of Managers may be replaced in the coming weeks. Newly-elected Judge Clay Jenkins and Commissioner Dr. Elba Garcia have chosen to appoint Debbie Branson and Patricia Rodriguez Gorman, respectively, as their representatives to the Parkland board. That is their legal right and responsibility and is customary for new elected officials. Board member Alan Walne, appointed by Commissioner Mike Cantrell, has reached his term limit and may be replaced. In addition, the Commissioner's Court also names two members of the board collectively and they may chose to name members other than Dr. Chad Park and Louis Beecherl. This is a regular process and not, as The Dallas Morning News would have their readers believe, unusual and vindictive.In fact, Dr. Anderson shared an e-mail with me that he received from Judge Jenkins who wrote, "You have my full support and I appreciate your service to our community and your nation. I want to work with you to build a world class, state-of-the-art new Parkland. As you know, this new hospital will be the largest in the free world, and the project wouldn't have been possible without the belief in Parkland's mission by the public. Their decision to fund this project two months after the fall of Lehman Bros., in some dark and unsteady times, was and endorsement of leadership and vision."It is a disgrace for The Dallas Morning News to take my concern for Dr. Anderson and his family's health (which should be of no interest to The Dallas Morning News) and turn it into innuendo that Dr. Anderson has near-term plans to leave Parkland. I am aware of no such plans or intentions initiated by the Board of Managers or Dr. Anderson.Finally, think about what has been accomplished: Parkland is one of this country's most financially sound public hospitals, we are funding the construction of the clinic building without relying on bonds and the University Healthcare Consortium has named Parkland one of its elite hospitals. The truth is, The Dallas Morning News had to wrap up its year-long attack on Parkland in order to meet its Feb. 1 deadline to submit their application for the Pulitzer Prize. They didn't let truth get in the way of writing their stories, nor do we expect this attack to stop. We may see an increase in personal attacks against the people who remain at Parkland, and those who are loyal to it. We have all chosen to serve Parkland and its patients because of our inherent beliefs and values.Thank you for your continued support of Parkland as we serve the patients and community who depend on us.Thank you for your support, Lauren McDonald, MD Chair, Parkland Board of Managers

Nothing but more denials and lies from a desperate woman trying to hold on to her power (Part I) Posted by The State of Denmark 02/33/2011, 08:32 PM Dear shaking head, Gee, Lauren McDonald has been keeping careful count of how many Public Information Act (PIA) requests that the Dallas Morning News (DMN) has been making (a real sexy 69 to date according to her) and is paranoid about revealing telephone numbers, home addresses of public employees, and pictures of newborn babies? What in the world is she rambling about? Does she really believe the DMN is some kind of strange perverted sex stalker or something like that? It sounds like famous last words from a paranoid schizophrenic just before being committed. The really important question that comes to mind is: Did Lauren McDonald wrap aluminum foil around her head and lock up her “lucky charms” so no one would steal her thoughts or her “lucky charms” from her when she wrote this crazy rambling and ranting diatribe? When six different investigations from four different oversight agencies (JHACO, CMS, HHS OIG, US Dept. of Justice) and a major newspaper (the DMN) are all simultaneously investigating your hospital’s questionable business practices and patient safety record, the defiant, arrogant, and belligerent approach of continued denials, outlandish counter-accusations, and personal attacks against the messenger (the DMN) might not reassure the public about your hospital’s trustworthiness, integrity, and competence—or your sanity for that matter! In fact, it tends to ramp up the public’s suspicions about the charges and allegations that are being bandied around, and makes you look like a raving lunatic. We’ve seen how well this strategy of defiant denials worked for President Hosni Mubarak of Egypt. So, it begs to ask the question: Why would Parkland’s leadership unwisely decide to emulate this disastrous strategy for all to see? What kind of PR consultants are you hiring at Parkland? Do you want the public to lose all faith in you? Let’s go over, point-by-point, the insanity of this “looney” message from the (what I predict will soon-to-be former) Madam Chairman of Parkland: • Replacing 5 of 7 Board members in one fell swoop is a “regular process” and is not sign of serious concern? It looks in all appearances as a major coup d’état and a firm vote of no confidence in the leadership at Parkland. Kicking out virtually the entire Board does not look like “business as usual.” (to be continued…)

Nothing but more denials and lies from a desperate woman trying to hold on to her power (Part II) Posted by The State of Denmark 02/33/2011, 08:33 PM • McDonald threw Judge Clay Jenkins under the bus by revealing that he has been two-faced with the public. Jenkins has been calling for major reforms and more transparency at Parkland. Yet, McDonald states that Jenkins gave full support to Anderson. Revealing that kind of hypocrisy is not going to make the voters very happy. Nor is invoking the ominous comparisons of building the extravagant new Parkland hospital for $1.27 billion with the fall of Lehman Brothers going to reassure public bond-holders of the stability and financial soundness of this opulent and needless project. I understand that Jenkins was so mortified by this betrayal that he fell from the shock of McDonald’s statements and broke his leg today. • To state that: "It is a disgrace for The Dallas Morning News to take my concern for Dr. Anderson and his family's health (which should be of no interest to The Dallas Morning News) and turn it into innuendo that Dr. Anderson has near-term plans to leave Parkland,” is kind of manipulative on McDonald’s part since she was the one who told the DMN that he had no enthusiasm for the job anymore and that he was dozing off in Board meetings. It sounds from McDonald’s own accounts of Anderson that he was ready to move on into retirement, if he wasn’t going to be forced out. • It’s also strange that McDonald only harps on Parkland being “one of this country’s most financially sound public hospitals” and is still clinging on to the discredited UHC endorsements, despite it having been pointed out that its Sr. VP, Mark Keroack, was prodded by Ron Anderson (President & CEO of Parkland who also sits on the UHC Board) and Parkland (who contributes a substantial of money to the UHC) to make such a embarrassing crony endorsement. Talk about conflicts of interests. Yet, nothing is mentioned about addressing problems inside the hospital—again denials, denials, denials. Also, you might not want to point out how financially lucrative your public hospital is (against the overwhelming trend of public hospitals sinking and being in the red in this country) when there is a massive federal probe into Medicare fraud by the Dept. of Justice. (It tends to make DOJ investigators more curious about your finances.) (to be continued...)

Nothing but more denials and lies from a desperate woman trying to hold on to her power (Part III) Posted by The State of Denmark 02/33/2011, 08:35 PM • I also didn’t know the Madam Chairman was such a journalism junkie. Surprise, surprise! How would she know that the Pulitzer Prize deadline is on Feb. 1? This sounds like an idea that was bandied about in a PR “crisis management” strategy session to try to bait and ambush the DMN in a feeble attempt to discredit them. The fact that McDonald’s response went up on Parkland’s servers within minutes of the DMN article on the ouster inside Parkland’s leadership makes this message even more suspicious. It takes days for official statements to get out because of the number of reviews, revisions, editing, and legal considerations involved. • Finally, to whom was this message really meant for? Your employees or to the other newspapers and the public? We know that there are significant grumblings inside Parkland to oust the current leadership. To say in the very least, Parkland is not a happy place to work for these days. So, do you really think all of Parkland stands together in one united front? That’s doubtful. Something is rotten in the state of Denmark. This has all the appearances of a calculated PR stunt by Parkland to try to ambush the DMN.

to above Posted by shaing head 02/34/2011, 12:12 AM Well the DMN fell for it hook, line, and sinker. Do they give prizes for being gullible as a journalist? This entire story has been handed to the News on a silver platter and they keep shooting themselves in the foot with half truths and sloppy reporting.

Posted by The State of Denmark 02/34/2011, 11:49 AM Well, the backlash will be on Lauren McDonald because she again deliberately mislead the public. She has no credibility whatsoever, and just signed her own death sentence in the Board. Just more lies, manipulations, and grifting from the Madam Chairman and Ron Anderson. It figures.

Lauren McDonald's worst enemy is Lauren McDonald (Part I) Posted by The State of Denmark 02/34/2011, 10:32 PM Obviously, Lauren McDonald has a selective memory about her interview with Brooks Egerton of the Dallas Morning News. (See http://www.dallasnews.com/news/community-news/dall ...She is either delusional, has dementia, or is just outright lying, but clearly she is not forthcoming, honest, or accurate in her own statements. This is exactly what she stated to Mr. Egerton: “he [Anderson] is NO LONGER WANTING to do the full-time CEO job.” How else is this supposed to be interpreted? It most definitely seems like McDonald is portraying her partner-in-crime, Ron Anderson, as being on the way out by these statements. There is no question about what she was implying, and then to come back on the same day as this article to defiantly deny this in her own separate press release is absolutely insane, if not absurd. There’s no ambiguity here. McDonald was the original source who suggested that Anderson was to retire—plain and simple. Now she’s angry and defiant that the DMN is inaccurate and wrong in reporting her previous contradictory statements? Completely, unbelievable! What an outrage! How can one person be so hypocritical? Lauren McDonald has no credibility whatsoever, and it appears she is just another two-faced public official who only serves her own needs and not that of the public’s. She was the only one who in fact suggested to Mr. Egerton that Anderson is on the way out. She also describes Anderson as going through a “personal crisis.” Apparently he is suffering from diabetes, has a wife who is battling cancer, and also Anderson is alarmingly dozing off at Parkland Board meetings. Here is the most damaging statement from McDonald’s own mouth, “There’s no movement on the Board’s part to say he’s [Anderson’s] got to go, but right now, IT’S A DAY-TO-DAY THING.” How else could this statement from McDonald’s own mouth be interpreted by Mr. Egerton, except to say that Anderson’s job is in profound jeopardy? (to be continued...)

Lauren McDonald's worst enemy is Lauren McDonald (Part II) Posted by The State of Denmark 02/34/2011, 10:34 PM In addition, McDonald revealed that the Board decided to review Anderson’s performance now quarterly instead of annually, as they are concerned about Anderson’s job performance. It sounds like his position at Parkland is in profound jeopardy according to McDonald’s own statements. And then McDonald has the nerve to go on at lengths to say, “We’re hoping to have almost an emeritus position” for him. “We’re hoping that HE [Anderson] WILL TRANSITION into more of a political role, a policy-making role.” Despite this unbelievably delusional fantasy, it still sounds like Parkland is moving Anderson out. So, why the denials now? McDonald mentions in her separate press release that the Pulitzer Prize submission date is February 1. Who would even know that? Sounds like something thought up of in a PR “crisis management” strategy session. Obviously, this was a set-up by Lauren McDonald herself to ambush the DMN in a vile attempt to try to discredit them. What she didn’t anticipate was that her own words would come back to condemn her. Her follow-up statements of defiance, arrogance, and denials undercut her own arguments. This sounds like the most hypocritical and contradictory statements from the Madam Chairman, who has yet to date, been at all honest, forthcoming, or transparent in any of her dealing with the public about any of Parkland’s problems. Nice try, but shame on you, Madam Chairman. This obviously shows that you are unfit for public duty, and not to be trusted by the public. This latest move to remove 5 of 7 Board members in one fell swoop (although applauded) also can have some negative impact on the reforms at Parkland. As the only Board member who has been fighting with Lauren McDonald, outgoing Board member Chris Luna has stated: “Some of the reform efforts could be sidetracked or delayed. We might not have time for delay.” What we need to do is keep Chris Luna on the Parkland Board, elevate him to Chairman, and remove the less-than-truthful and delusional Lauren McDonald from Parkland’s Board. Keep up the good work DMN. We need a watchdog to keep a close eye on Parkland and their less-than-trustworthy leadership.

This is a disgrace Posted by Dr. Evil 02/35/2011, 08:23 PM These are very good points made about inconsistencies & contradictions in Lauren McDonald’s statements. In rereading the DMN article again & looking over her previous statements, it seems that Lauren McDonald is in fact the very source that created all the outrage over the “ouster” article printed by the DMN on January 29, 2011 about Ron Anderson leaving Parkland & the County Commissioners’ overhaul of virtually the entire Parkland Board. So, what is McDonald getting at about the outrage & inaccuracies about the DMN article in her latest press release? The DMN was very fair & accurate in their assessment about the embattled hospital in that article from what she directly stated to them in her own words. Lauren only has herself to blame for the reasonable conclusions that the DMN reported. From every indication, the DMN was only reporting McDonald’s own assessment of the situation. She stated Ron Anderson’s job was in serious jeopardy, & she implied Ron Anderson was leaving soon. The DMN didn’t create a story; however, McDonald did unfairly malign the DMN with her own hypocrisy. The only disgrace I see is Lauren McDonald’s inability to get her own stories straight & tell the truth. This is not what transparency is all about, & this is not the first time we caught Parkland’s leadership in a lie. In fact, I see McDonald’s statements from January 29, 2011 will create huge liabilities for Parkland in any future lawsuits against the embattled hospital. Clearly, lawyers will depose McDonald & impeach her about her truthfulness through this official public statement against what she told the DMN. She appears to be completely contradicting every statement she has made & will lose her credibility with any jury in the first 5 minutes on cross-examination. Doubt will be in any person’s mind who sees these contradictions. I think the commenters are correct in stating that McDonald has put her entire credibility & reputation (& possibly her career) in serious harm’s way with these latest statements. Who will ever believe what she says now? Instead of being so eager & rushed to ambush the DMN in what is clearly an elaborate trap, she should have gone through the long series of careful legal reviews & revisions with lawyers before putting out this erroneous statement impugning the reputation of the DMN. Now, she has put her own job in serious jeopardy with possible libel & dishonest statements that will come back to haunt her & Parkland.

McDonald's motives finally revealed Posted by Dr. Follow-Up 07/209/2011, 12:21 AM Of course, as we all know now, shortly after this, and she knew it was coming, the story broke about how Dr. McDonald falsified her credentials, lied about doing research as a scientist by fraudulently listing on her resume research that was done by a scientist in Utah who just happened to have the same name as her, and she was under federal investigation for falsifying information for lying in order to avoid having to pay back her student loans. All published, with original source documents, in her own handwriting, and with federal reports, in the DMN. That's what she was trying to hide. Jump to top of list