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Saturday, December 22, 2007

Corruption at Emory: Opening a Pandora's Box

When Erick, at Redstate, published a piece about corruption at Emory University, I thought it was an interesting story and I published a follow up on my own blog. At the time, I had no idea the padora's box that I had opened.
Last night, I had a three hour conversation with a whistleblower by the name of Kevin Kuritzky. Kevin was 41 days from graduating from medical school at Emory University when he was expelled.

Emory claims Kuritzky was dismissed for "plagiarism, repeatedly missing required
clerkship training involving patient care, lying to his professors, and engaging in other unprofessional, dishonest and unethical conduct."But according to a complaint filed Jan. 31 in DeKalb County Superior Court, Kuritzky believes something else was a factor in his expulsion.Kuritzky claims in the lawsuit that Emory officials kicked him out after he complained about patient safety and possible health care violations at Grady Memorial Hospital and the Veterans Administration Medical Center. Both medical centers are associated with Emory's medical school.
Well, what Kevin told me last night could never be summed up in one blog post. In fact, it is ripe for a book and a movie, and so I will be featuring a series of blogs about this matter.

In my first, I want to talk about how Emory's corrupt practices lead to poor people and Veteran's receiving egregiously below standard care because it was simply unprofitable for Emory to provide good care.

Emory runs a handful of hospitals in their Emory University Health Care System. Grady is the largest however because it serves the indigent, the poor, it is also the most unprofitable. Because of this peculiar relationship in their mix of hospitals, this is what ultimately lead to what Erick described as double dipping. What this meant was that residents and attendings who were supposed to be on call at Grady and the VA hospital would leave and go to one of their more profitable hospitals like the Emory University Medical Center.

At Grady almost everyone was either on Medicare or Medicaid or even worse they had no insurance. This meant that no matter how extensive their treatment their bills were limited. In fact, Grady merely paid Emory University a one time fee once per year regardless of the services provided. At the other hospitals the attendings and residents could charge the patients for their services and since the patients were much more affluent they could afford the extensive services the Emory doctors provided. Emory would then profit much more from extensive care provided at one of those hospitals than they ever would from providing extensive care Grady or at the VA.

What this lead to was residents and attendings who were supposed to be on duty at Grady or at the VA, leaving their posts and heading over to one of the other hospitals like Emory Medical Center. As a result medical students, like Kevin, were left in charge of entire floors of patients. Kevin said that he himself was left in charge on 5 different occasions. Doing this is like leaving a flame on. Most times nothing will go wrong but it is only a matter of time before the flame catches on fire.

One night that is what happened. One time he was left in charge of the entire step down unitfrom 4 PM to 2AM. The first emergency came from one patient who was recovering from lung surgery. The patient's lung collapsed and Kevin was called in to save his life. The patient was suffocating and time was of the essence. Kevin was panicked and needed to move quick. He needed to find a chest tube, but because of his own inexperience, he didn't know where they kept the chest tubes. In a rush, he did the only thing he could think of at the time. He grabbed the dirty chest tube that had already been used on the patient and injected into their lungs.

Next, Kevin was asked to read an x ray of the patient's lungs to determine if they were stable. This is again not something a medical student is supposed to do on their own and without supervision but since their was no supervision there wasn't much choice. Kevin gave it his best estimation and determined the patient was fine however as it turns out that was just a lucky guess. This patient survived but it had nothing to do with the type of care that was provided them at Grady.

On the same night, Kevin, again being the head doctor on the floor, was asked to save a patient from internal bleeding who was recovering from a heart attack. He was first asked to perform a hematocrit level test , which measures the amount of internal bleeding and then perform a blood transfusion on the patient. Again, he did this all without proper supervision.

The most egregious lack of quality health care that Kevin documented came with patients that came in for potential heart attacks. In order to determine whether or not a patient is in fact having a heart attack doctors perform what is known as a cardiac enzymes test. Proper procedure is to perform this test within 90 minutes since of course time is of the essence in a case of a heart attack. According to Kevin's documentation, the average wait time for performing such a test was about seventeen hours.

There is really only two reasons why a test that needs to be done in 90 minutes would be done in roughly 17 hours. The first is simple negligence. The doctors just didn't care or maybe they were incompetent which is also possible since as I documented many times the doctors in charge were themselves medical students.The second reason is even more nefarious. If it is determined that someone is having a heart attack, then there needs to be a battery of tests, surgery, and weeks of recovery. This would cost a lot of money for the hospital and by extension Emory University. Since the patient on Medicare, Medicaid, or worse without insurance altogether, has limited funds, it is much more cost effective if that patient died.This is only the first in my series. Anyone that wants to speak with Kevin themselves please contact me and I will get you his information.

UPDATE:I have put together a summary of the entire fiasco that tries to put all of its moving parts together in one piece. Please read it for guidance. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.

2 comments:

mike volpe said...

because of "technical difficulties", I dropped my old blog, www.proprietornation.blogspot.com, and started this one. I moved all of the old content here. I do continue to get some comments there, though I can't publish them. I do receive them in my email. Here is one such comment and it is quite important...

I am a resident at Emory who has worked at Grady for some time now. I cannot say one way or another whether any of the things alleged by Kuritzky are true, but I can say that patient care at Grady is lacking to a degree that amazes and disgusts me. This is the natural consequence of one fundamental problem faced by Grady for years: lack of funding. Nurses will page a doctor to inform him that a patient's blood pressure has dropped to half of what it was a few hours ago, but will do nothing for 5 hours after being given the simple order to give the patient some IV saline to boost the blood pressure while further measures can be taken on the patient's behalf. Lack of money means a Nurses can get away with any degree of incompetence because Grady cannot hire anyone to replace them. Simple tasks like checking lab results can take double or triple the usual time because computers so old the letters have been worn from the keys and the exhaust fans have died run so slowly that it is often easier just to call the lab. Replacements are totally out of the question and calling the IT HelpDesk is an excercise in futility. Residents whose pagers run out of batteries have to replace them by going out to buy new ones, instead of having them replaced quickly like they would be at any other hospital.
Perhaps more sickening is the behavior of the Doctors. I am shocked and disappointed by the way patients are treated. If it is not the reason someone came to the hospital, it is ignored. Patients who come to the clinic for pelvic pain and are found to have Pelvic Inflammatory Disease, a complication of untreated STDs are given the Rx for antibiotics and sent out without being offered HIV or Hepatitis testing. Patients who are cleared for suspected heart attack stemming from Cocaine abuse are kicked out the door as soon as the Team is reasonably assured the patient is not immediately dying without even being told that there are Substance Abuse Counselors on the 13th floor who might be able to place them in residential treatment facilities that might cure their homelessness and substance abuse and prevent them from returning next week with more chest pain.
You should know that when a Resident takes longer than 15 min to see a patient, they get yelled at. This is after paying around $50k per year for Medical school, during which time you are expected to absorb any amount of abuse in exchange for the "privilidge" of your education. You paid $450 for the 1st part of your medical licensing exam, another $450 for the second part, over $1000 to take an exam in 1 of 5 cities where you "Treat" actors who can pass or fail you on a whim, and countless hundreds more for interviews and travel. That's if you were one of the lucky few who got in to medical school to begin with instead of being "weeded out" by college professors jealous of your talents. The doctors who teach in medical schools are no more professional than the doctors in the hospitals. They went through med school in an era when it was far easier to be accepted and to pass through and although they worked longer hours in residency, they were not expected to do nearly as much for the far fewer patients they saw. Now they feel entitled to collect their salaries while working fewer than banker's hours and taking credit for the work done by interns who graduated from medical school less than a month ago. While in medical school, I saw medical errors leading to a child's death and a woman's unknown fate after her colon was accidentally burned during surgery and the OR covered it up.
If you think the meager problems at Grady are noteworthy, you are missing the forrest for the trees. Medical education has become a gigantic industry that charges thousands and thousands more each year and delivers less and less education. The credentialling process for MDs is a similar story. I learned nearly everything I know about medicine on my own, abandoning the classroom before the first 6 months of my first year. I am trying my best to not become yet another bad doctor, but hardly any of the doctors in charge of my training in medical school and now residency has shown the least interest in teaching me anything. You are right to be concerned enough about the situation at Grady that you are reading this, but unless you are concerned enough to educate yourself about the way doctors in this country are trained and hospitals are run, you are well and truly doomed.

Unknown said...

Blogs are so informative where we get lots of information on any topic. Nice job keep it up!!
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