Peer Review: Judge, Jury and Executioner...

Hospital peer review is a process by which doctors can held accountable for whatever mistakes they may have made by their colleagues. Here is how it works.

Medical peer review is the process by which a committee of physicians investigates the medical care rendered in order to determine whether accepted standards of care have been met.

A Medical Peer Review is meant to provide independent medical opinions conducted by an objective group of physicians and relevant medical staff that quickly resolve complex problems that hospitals, physicians and insurance carriers face. They are often used to help solve systems problems endemic to healthcare institutions and thereby reduce legal liability associated with them. The review of chart notes and other medical reports are used to help render objective written opinions.

Unfortunately, it has been used in corrupt institutions like Grady Hospital as a means of retaliation rather than a fair and impartial method of reviewing medical performance. That's because the job of accuser, judge, jury as well as prosecutor usually falls into the hands of the same group of people. Many times peer review is a tool used by administrators as a means of retaliation against whistle blowers in their department. The watch dog group, the Semmelweis Society, has documented corrupt peer reviews.

Professional peer review is intended to protect the public fromincompetent or unethical practitioners. However, it could andoften does remove the most honest, ethical, and competentphysicians, to the advantage of unscrupulous competitors. The
Health Care Quality Improvement Act (HCQIA), which wasenacted with the support of the American Medical Association,immunizes false testimony, thus allowing gossip to be convertedinto testimony and depriving physicians of independent judicial review. The accused physician is often ruined financially. The victim must pay his own legal fees, whereas his accusers are not responsible for any legal fees, which are paid by the hospital. TheNational Practitioner Databank (NPDB transforms disciplinary actions into a professional death sentence. The abuse of the process is, unfortunately, widespread.

The article continues...

My own experience with sham peer review began in 1979. As is true in many cases of sham peer review, the attack was initiated byjealous competitors who viewed a hospital computer printout anddiscovered that I was doing approximately twice the volume thatthey were doing. Never mind the fact that I was going into thehospital, at hours when they would not, to take care of gunshotwounds and indigent patients. My numbers were larger, and they were intent on doing something about it. And thus the first attackagainst mewas launched.

The pretext concerned a 6-year-old boy who presented to the hospital at an inconvenient hour with an epidural hematoma (life threatening hemorrhage on
the brain). I prevailed upon a neurosurge on friend of mine to come into the hospital. I assisted him in the surgical evacuation of the hematoma, and the child's life was saved.Although I was only the assistant surgeon on the case, competitors brought charges against me, accusing me of operating outside of my area of competence and expertise. My qualifications, however,as assistant surgeon in this case included training at City Hospitalwhere I did 19 emergency neurosurgical cases. And in this
case,three neurosurgeons had refused to come in to the hospital to care for the comatose child before I was called. This was a true emergency,I responded appropriately, and the documentation in the chart was accurate and complete. As I soon discovered, however,truth is not an impediment to sham peer review.

The surgery department held a fact-finding meeting, which was tape recorded, and two nights later a formal peer review hearing was conducted. Since the tape was favorable to my case, thehospital CEO ordered it to be destroyed. I continued to obtain appropriate consultations when needed, and my privileges remained intact. But this was only the beginning. Other chargessoon followed. Attackers coordinated their lies and stories, and it was open season again. Often the only evidence they could offer was...it is so because I say it is so. off with his head!. It was a collaboration
between Alice in Wonderland and prestigious purveyors. The charges against me
were mounting, and the predators were moving in for the kill...

The problem is quite simple and yet it is an epidemic, pardon the pun, at many hospitals. The problem is that the same folks that bring charges against you also run the peer review as well as act as the jury. This is, of course, a stacked deck against the accused. The problem becomes even more troubling when that accused is themselves a whistleblower. If someone is making incendiary charges against hospital officials, a corrupted peer review process is a great tool to eliminate them. (in my most recent article about the fiasco at CMU I found a similar problem. The same administration that brought charges against Dennis Lennox will also be in charge of his punishment) Clearly, the medical peer review process is corruptable unless the judge, jury and prosecutor are NOT the same as the ones doing the accusing.

In the case of Grady Hospital, court documents show that peer review was used as a retaliatory tool against Dr. Jim Murtaugh. Since his is the only case to be unsealed, we don't know how many whistleblowers were threatened with retaliation at Grady with this corrupt method.

In the case of Kevin Kuritzky, he wasn't retaliated by peer review because he was still a medical student. That said, the some corrupt process applied to his review in his case of expulsion. The same individual, William Casarella, who brought charges against Kuritzky was also in charge of the panel that ultimately decided his fate. Like I mentioned earlier, the same dynamic is in place at Central Michigan University with regard to the disciplinary action against Dennis Lennox.

A corrupt medical review process has now formally been referred to as sham peer review, and that is what it is. If the same group is not only charging you, but prosecuting you and deciding your fate, then the whole entire process is a sham. It also becomes a tool of corruption and its original purpose is twisted again beyond all recognition.

In Georgia, State Senator David Shafer is looking to propose legislation to keep medical peer review from being corrupted. The answer appears simple to me. The panel deciding a professional's fate must be independent. That means that either a panel is formed to decide all medical peer review for the hospitals in the state or at least that the panel has no ties to the hospital in question. For instance, Grady Hospital would go to hospitals in the area or state in order to form a panel for peer review. The same should be true in the case of cases like Kevin Kuritzky and Dennis Lennox. Outside panels must also be set in place in order to keep those processes from being corrupted as well.

The Changing Political Dynamic Surrounding Grady Hospital

From a purely political junkie level the current dynamics surrounding Grady Hospital are absolutely fascinating. Here is a quick run down. Late last month, the board at Grady Hospital approved a plan to go quasi private and asked, or demanded depending on your perspective, for roughly half a billion dollars in order to stay solvent. Then, not two weeks later, the JCAHO threatened to cut off Grady's national accreditation. Now, let's take each one at a time and then look at them together.

I believe the board is playing a huge political game of chicken with the Georgia legislature. I believe this plan does NOT have the best interest of the hospital in mind whatsoever. While that is certainly important, it is unfortunately a side issue in this political battle. As a friend of mine once put it

Grady can't shut down because who would take care of all the poor folks then

Without the money called for in this plan, Grady WILL shut down. The powers that be know this, and I have said as much. While Grady Hospital has had a long history of corruption and mismanagement, much of the power structure has continued to boldly and brazenly manage it in much the same way that has landed it in its current state. The reason for this is of course quite complicated, however it is due in no small part to Grady's vital role in Georgia health care system and society at large. Remember, Grady Hospital is among the largest in the world and is overwhelmingly responsible for taking care of most Georgia's poor folks. Without it all of the many "nice" hospitals in the area would have to take care of those folks.

I have fallen in love with the Latin phrase, Res Ipsa Loquitur. (The facts speak for themselves) Given Grady's long and sordid history with corruption and mismanagement, the fact that most of the power structure in Georgia never tried to really stop it tells me that most people don't much care as long as some other entity was taking care of those that no one else wanted to take care of, THE POOR. I believe the powers that be are counting on the exact same dynamic now. I believe the only thing most of the power players in Georgia want to avoid is for the poor folks to be dropped on the rest of the health care system. As long as they are Grady's problem, in my opinion, most everyone else turns a blind eye.

Thus, we have this game of chicken. The legislature doesn't want to hand Grady Hospital anymore money. They must know that the systemic problems currently going on at Grady aren't going to be solved with this plan, however without an infusion of cash, Grady shuts down. The powers that be at Grady are counting on the legislature blinking first. The legislature meets again in January so, for now, that part of the story is on hold.Enter the JCAHO. Just last week they publicly threatened to revoke the accreditation of Grady Hospital. To put this move in perspective only one hospital, King Hospital in California, has ever actually lost their accreditation. Many of allies on this story have extolled this move as pivotal. I am a lot more skeptical. There must have been the same kind of excitement when State Senator Charles Walker was convicted of 127 felonies at Grady and beyond. Yet, he, along with his daughter and the companies they ran, were the only ones that were convicted, and of course he got the absurd sentence of ten years. In 2004, the department of Health and Human Services conducted an investigation that concluded this...

the conditions at Grady Hospital pose a serious and immediate threat to the
health and safety of the patients

That was pretty damning however besides the then CEO, Dr. Andrew Agwunobi, no one lost their job as a result of this report and the power structure stayed in place despite its damning findings.Even in the late 1990's, Georgia Attorney General found Grady Hospital guilty of Medicare fraud. All of these were opportunities lost to clean up the corruption at Grady Hospital. The reason it didn't happen is also quite complicated, however I believe much of the blame goes to the media in Atlanta, headed by the Atlanta Journal Constitution.

In each of these stories, the truth is quite complicated and it was never fully explained to the citizens of Georgia. For instance, in the case of the HHS report, the report itself was damning, however how many people know the specifics of the report? Four departments were singled out: oncology, cardiology, General Surgery, and obgyn, in the report. Each of these departments had heads. None of these people lost their jobs because the specifics of the report weren't ever reported properly in the media. Furthermore, the heads of these departments had one boss, the Chief Medical Officer. His name is William Casarella and he has since been promoted within Emory University. This also happened because the media didn't properly report the specifics of the case. All people knew, if anything, about the investigation was the conclusion. While that was damning enough blame was impossible for a layman to determine without understanding the specifics as I now explain them.

In the case of Medicare fraud in the late 1990's, three departments were also identified: cardiology, obgyn, and oncology. Again, these departments have heads and a Chief Medical Officer above them. All of them including the CMO should have been and would have been fired if the media had properly exposed that case. As you can see the same departments are now coming up in multiple reports. No one outside the Grady structure knows this because the media, either through incompetence or worse, doesn't report the specifics of each case.There is one other case that the media did an atrocious job of reporting. That is the case of Dr. Sam Newcom. He was for about a year, the head of Oncology at Grady Hospital and Emory University Professor. He tried to speak out about the corruption and poor patient care at Grady Hospital and he was fired and ultimately paid off and silenced, but before that he wrote an article entitled Fighting Class Cleansing at Grady Memorial Hospital. You won't find this article in any mainstream Atlanta publication. As head of Oncology, you would be right in concluding that much of his indictment centered on his own department. In other words, oncology is the subject of a great deal of indictment from people of varying motivations and knowledge.

Nothing much has happened to clean up the oncology department and that is because the media has been asleep in reporting the specifics of what is going on at Grady.Then, there is Emory University. When the heat gets hot on Grady, Emory does a great job of distancing itself. In fact, they are doing their own disappearing act now. The truth is that they are for all intents and purposes one and the same. Each of these departments indicted by several different groups was run and almost fully staffed by staff at Emory University. The Chief Medical Officer, Dr. William Casarella, during much of this malfeasance has since been promoted within Emory. In other words, when there is sytemic problems at Grady Hospital, the blame must be laid at Emory University since it is staffed overwhelmingly by Emory professors and students. When Dr. Newcom indicted oncology, he was indicting his own colleagues since oncology is overwhelmingly staffed, like most of Grady Hospital, by Emory University personnel.

Now, what about the JCAHO findings? We know they are threatening to cut off accreditation however why? That, we don't know because for reasons unknown (I plan on calling the JCAHO on Monday for further explanation) the specifics of the findings aren't known. We can assume that multiple specific departments are the cause of it. It might be oncology, General Surgery, obgyn, cardiology, etc. The heads of any of the departments involved must be removed. If your department contributed to an investigation that ultimately lead to the accreditation of your hospital being threatened, THAT IS GROUNDS FOR REMOVAL, in my opinion at least. The current chief medical officer, Curtis Lewis, must be removed. If you are overseeing a hospital and the hospital is threatened with the removal of its accreditation, THAT IS GROUNDS FOR REMOVAL. The Current CEO of Grady Hospital is Otis Story, Sr. He must be removed for the same reasons. In fact, the entire board ought to be removed, however the board is overseen by Vernon Jones, and anyone that knows anything about Jones knows not to expect that to happen. Of course, how many Georgia folks know the real story behind Vernon Jones? That would require the media in Georgia to actually competently report the whole truth.

This whole case proves why the first amendment, the free press, is first not second or tenth. I hope everyone sees what happens when the media itself cedes its own freedoms and doesn't bother to report the whole truth. In order for this cycle to stop, the whole truth of the JCAHO findings must be reported by the media in Georgia. The media must keep the pressure on until all parties are held responsible. That is what has to happen.

Here is what will probably happen. There will be no more then a few more articles in the AJC about this report. Anymore reporting will be on the eventual deal made between Grady and the JCAHO, a deal that will no doubt be made in some back room. The major media in Georgia will NOT reveal the specific departments responsible for this latest investigation. They won't name names and they won't demand for heads to roll. Finally, they won't call Emory out when they distance themselves. Emory University will throw its significant weight around the Georgia Legislature and no one will report it. Grady will be given a golden parachute and none of the obvious systemic problems I have pointed out will ever be reported on or addressed. I hope I am wrong and I will be watching.

For more information on this case, please read this article. Also, please read the recommendations that my colleagues have come up with and compare them to the current plan.

Who is the Real Sociopath (Updated)

Introduction: For anyone who hasn't been following my work, let me give you a quick recap. A few weeks back I passed along a story about purported corruption at Grady Hospital with the potential of Emory University staff, who account for most of Grady's staff, being in the middle of it. After that story was published, I was contacted Kevin Kuritzky. He maintains that he blew the whistle on much of the corruption at Grady Hospital and beyond. He was expelled from Emory Medical School with forty one days left in his final year. He claims it was in retaliation to his whistleblowing while Emory claims it was due to tardiness and other offenses. He has a civil suit against Emory University currently in the appeals court. I should point out that Kevin has been a source for several stories and I have also done a radio show together with Kevin Kuritzky.While I in no way hide whatever biases I have, I believe that in the case of what follows the latin phrase, Res Ipso Loquitor (the facts speak for themselves), applies. Now...

A couple of weeks ago I received this UNSOLICITED email.

Mike, Just wanted to let you know that you shouldn't get taken in by Kevin Kuritzky. The guy is a pathological liar and I have personally been taken in by his stories only to realize that he was flat out lying. I also know numerous other people who have experienced the same. It is quite sad because he is a very charming, intelligent person. He just uses these skills to manipulate people. Don't get taken in by him.
Mike--

Michael Ward MD,

MBA

Resident

Physician

Department of Emergency Medicine

University of Cincinnati

So, who is Michael Ward MD etc, etc...and what is he talking about? According to the chic professional networking site, Linked In, Michael Ward MD etc., etc... is in fact a member of the staff at the University of Cincinnati. It appears that his path crossed with that Kevin Kuritzky a few years back at medical school at Emory University. If what Dr. Ward says is true, it makes the basis of a lot of my reporting suspect to say the least. In fact, my first comprehensive piece on this subject was based largely on the testimony of Kevin Kuritzky. I say this so that my natural biases are clearly laid out as I continue with my analysis.



The reason that I reveal this email now (about three weeks after I got it originally) is because through the grapevine I am told the P.R. arm of Emory University has been making similar claims to Mike King of the AJC. (in that case I believe the word sociopath was used in describing Kuritzky) It is also consistent with the comments of the mysterious pseudonym John in response to this story.

I was in Kevin’s class at Emory (well at one point as it took him several years
to complete one academic year), and the allegations by Emory concerning his
behavior, ethics and morals are accurate. He should not be taking care of
patients plain and simple.

Ironically enough, the term sociopath is one which most of my friends have told me I have a disturbing and obscene fascination with. (Given that two of my favorite shows, 24 and The Sopranos, each delved into the topic at roughly the same time, "I had no choice" or I just couldn't help myself, potato... but to get interested in it) Anyone who has read my work knows that I have had personal contact with my fair share of sociopaths and and I see several of the world leaders and our enemies as sociopaths as well. While this by no means makes me an expert, I will use my experience with the phenomenon to try and separate fact from perception in this situation.



One thing is clear. There is no doubt that one of these two side is certainly sociopathic, which in simplest terms is an individual devoid of empathy (in other words they are so selfish that nothing but their own self interest becomes relevant to them). Either Kevin Kuritzky has decided to lie pathological for his own self interest or his opponents want to paint him as such for theirs. Since, in this story, there is no middle ground we are absolutely dealing with sociopathology on one person's part.



If Kevin Kuritzky is himself a sociopath, then his compulsive lying would be a standard trait. There could be several reasons of self interest for his lying. He may have decided to get revenge at Emory for real or perceived wrongs. He may have thought that given the incendiary nature of his lies that they would bring him fame, or money, or both. There are in fact any number of self interest reasons for Kuritzky lying in this case.



On the other hand, if Emory University and their cohorts are sociopathic, they would look to smear Kevin because they know he is a threat. If in fact what he says is true, then their own sociopathic nature would have every reason to eliminate him. Remember, if Kevin is telling the truth, he is a hero. He is then trying to expose some of the worst corruption, leading to fraud, horrible patient care, and outrageous waste of tax payer money. Emory University along with several other people and groups are the targets of his accusations. If he is telling the truth, then a sociopath would have every motivation to use every single means available to eliminate, marginalize and demean him.



Obviously, knowing the truth beyond all doubt is impossible, however in this case, it is my opinion that the truth beyond all reasonable doubt is pretty easy to decipher.



First, we know that Grady Hospital is now in such financial turmoil that it will likely need hundreds of millions to survive. We know that State Senator Charles Walker used Grady Hospital and other entities to commit an obscen amount of corruption. (He was charged with 137 felonies, convicted of 127, flipped on no one, and yet only got ten years in jail. Oh, and no one else, besides his daughter and the companies they ran were even charged)



We know that in the mid and late 1990's Grady Hospital was the subject of an investigation and ultimately prosecution and settlement for Medicare fraud.We know that in the mid and late 1990's Grady Hospital was the subject of an investigation and ultimately prosecution and settlement for Medicare fraud. We know that in the beginning of this millenia Grady was subject to an NIH investigation. While the investigation ultimately didn't lead to any arrests, fines or convictions, we do know that four Emory professors were ultimately paid off for their silence. We also know that 2004-2005 HHS conducted its own investigation. Here is the conclusion of that investigation.

there is an exteme and immediate threat to the health and safety of the patients

There is even evidence that in the case of one paid off professor, Dr. Jim Murtaugh, Emory and Grady paid him off without receiving permission from the board of trustees. Finally, even in the current civil case between Emory University and Kevin Kuritzy there is some questionable behavior on the part of Emory University. Court records show that Emory University couldn't produce hundreds if not thousands of documents in the case. In many instances, Emory even admitted to destroying certain documents.



The problem for Emory University, in my mind, is these are all clear characteristics of sociopathic behavior. Sociopaths remove every threat in the way of their goal. Between paying people off, expelling others, destroying documents, I believe they have exhibited that behavior in their goal of running a corrupt hospital. Given all of this evidence it makes Kuritzky's claims well within the pattern of evidence that anyone can discover by simply mastering the art of google.com. The only evidence that Kuritzky is a sociopath come in the accusations of Emory and their cohorts.



Even in the case of the email of Michael Ward, MD, etc, etc, there are no specific accusations. In our exchange by email upon receiving it, I invited Ward to give me specifics and I even emailed him my cell phone number. He never responded with any examples. In the case of the mysterious John it is also vague and unspecific allegations. Emory many times points to Kuritzky being expelled as evidence. Keep in mind it was Emory that expelled him. If they are the sociopaths, his expulsion would fit the behavior pattern of a sociopath to a tee.



In order for Kuritzky to be a sociopath, the pattern of behavior that Grady and Emory exhibited (keep in mind while the two entities are separate Grady is almost entirely staffed by Emory personnel and in many cases Grady higher ups move onto positions with Emory a la William Casarella) was either an anomaly or either a condition that was fixed in a few short years between the events I described and the time period of Kuritzky's accusations. Even that would be hard to believe because the HHS report coincided with the time period of Kuritzky's investigations. If you were to believe that, you would then have a very hard time explaining the current financial crisis at Grady Hospital.



Thus, in conclusion, those that I am accusing can say I have a bias, however I believe I have laid out a solid case for who is the sociopath here. While I must admit that I enjoy an obscene and disturbing amount of fun in delving into the condition of sociopathology, this question is central to what is going on. If Kuritky is the sociopath, then we need not worry about infusing Grady with more money because their administration is fit to receive it. If, on the other hand, it is Emory, Grady and beyond, that are the real sociopaths, then it is time for full fair and open hearings before even one cent is dolled out to what would be the very people that caused the mess.



If my supposition is right, then the likes of Kent Alexander, William Casarella, Ed Renford, Robert Brown, Vernon Jones, (and maybe even State Senator Charles Walker if that can be arranged) as well as those that would be the heroes in this mess: Kevin Kuritzky, Ron Marshall, Dale Cardwell, Joyce Harris and even all those that were paid off, need to be put under oath, on television, to answer truthfully their involvement in this crisis.Finally, I invite the powers that be at Emory, Mike King, Dr. Ward, and even the mysterious John to respond at their leisure if they feel I have been inaccurate.



UPDATE:If you are picking up the story of the Grady Hospital crisis anywhere in the middle, you are likely to get quite confused. This maybe happening if this particular story is your first exposure to the crisis. Thus, 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.

Why is This Man Working (Updated)

Dr. Andrew Agwunobi took over at Atlanta area hospital South Fulton, a fairly small hospital specializing in providing services to poor folks. in mid 2001. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued its first report toward the beginning of his tenure. This report was critical of South Fulton however they did give the hospital a passing grade though with conditions. The JCAHO issued the final report of his tenure a few months after he left in mid 2003 and this report (August 7, 2004) did not just find South Fulton to be sub par in some areas but in fact no longer in compliance with their standards. Here is a list of the policies and procedures that South Fulton was no longer in compliance with.

1)Competence to perform job responsibilities is assessed, demonstrated, and maintained.

2)The leaders develop and implement policies and procedures for care,
treatment, and services.Informed consent is obtained.

3)The organized medical staff oversees the quality of patient care,
treatment, and services provided by practitioners privileged through the medical staff process.

4)Medications are properly and safely stored throughout the organization.

5)Emergency medications and/or supplies, if any, are consistently
available, controlled, and secure in the organization’s patient care
areas.

6)Medication orders are written clearly and transcribed accurately.

7)There is a process for granting, renewing, or revising setting-specific
clinical privilege

8)Medications are safely and accurately administered.

9)Patients are reassessed as needed.

10)The organization fulfills the expectations set forth in the Universal
Protocol for Preventing Wrong site, Wrong procedure, Wrong person surgery and associated implementation guidelines

In layman's terms, he took over a fairly subpar hospital and by the time he left the sub par hospital had turned into a hospital that could no longer meet governing body standards for compliance.

As a result of his performance at South Fulton, he was rewarded with the CEO position at Grady Hospital, the largest hospital hospital in Atlanta, one of the largest hospitals in the country, and also a hospital that specialized in providing health care to the indigent. His tenure ended as a result of the conclusions of yet another government report. I have no doubt that medical professionals will look to pick apart my analysis of his tenure at South Fulton and try and spin his performance in a more favorable light. That is fine, however there is no spinning the conclusions of the report of the Center of Medicaid and Medicare Services (CMS) of the Department of Health and Human Services leaves absolutely no doubt. (I couldn't find the report online though I have one in hard copy) Here is the conclusion of this report.

Based on the findings, we believe that the conditions at your hospital (Grady Hospital) pose an immediate and serious threat to the health and safety of your patients.

The specifics were broken down into four different categories.

1) Serious medical errors and complications resulting in deaths or adverse outcomes were not investigated and the Chief Medical Officer, William Casarella ignored them

#2) The Governing Body of the hospital was ineffective and ignored quality assurance standards mandated by law.

#3) There was a lack of accountability and required supervision of medical staff that resulted in deaths and serious adverse outcomes.

#4) There were violations of medical note/record keeping rules and
standards.

In other words, the leadership Agwunabi, was totally absent in fulfilling any of the responsibilities of being a leader. If we are keeping score, Dr. Agwunobi took over one hospital that was sub par and left when the hospital failed to meets its requirements for even being in compliance. After that he took over a hospital that was deemed to pose an immediate and serious threat to its patients.

Now, the details of the report are of course more complicated. For instance, the report laid most of the blame on this man, William Casarella, who was Chief Medical Officer at Grady and in charge of all of the clinical departments. (as you can see from the link not only was Casarella not reprimanded but in fact he has since been promoted) Of course, ultimately, as the head person, which Dr. Agwonabi was, he takes the responsibility for everything anyway. That also gets into semantics and speculation. The bottom line is that this report was scathing. The hospital wasn't merely run poorly. It wasn't just below average or even failing to meet requirements for being in compliance with standards set by a governing body, but rather it was in such bad shape that...

the conditions at your hospital pose an immediate and serious threat to the health and safety of the patients.

If you are in charge of a hospital, as Agwonabi was, it doesn't get any worse than that indictment. Since he was the only one that faced any punishment as a result of this report, some could speculate that he took the fall or fell on the sword if you will. That may or may not be true, but at this point it doesn't matter. If he took the fall and he was the only one, then his employer, through their actions, said that he was the one responsible for...

the conditions at your hospital pose an immediate and serious threat to the health and safety of the patients.

Thus, an honest observer would expect that after such a finding that Dr. Agwunobi's career could and should be over. One could say that for Dr. Agwunobi, his future career path could be describe by these famous words from A Few Good Men

teaching typewriter maintenance at the Rocko Clubbo School for Women

One would be wrong. Agwonabi then resurfaced as the COO of St. Joseph's Hospital System a fourteen unit conglomerate of hospitals in California. That's right everyone after being ultimately responsible for the scathing findings of two separate government inquiries, this man was essentially given a promotion. He moved from a small hospital in South Fulton, to a large hospital in Grady, to a group of hospitals at St. Joseph's. In other words, whoever was in charge of hiring either read this...

the conditions at your hospital pose an immidiate and serious threat to the health and safety of the patients

and was impressed, or just simply didn't bother to find out how the hospital was run when Agwunobi was there.

While I still haven't gotten the whole story here, his career path takes another curious route. He left this conglomerate after about a year or so and is now in charge of the AHCA in Florida. The reason this is curious is because he moved cross country from Atlanta to California to a job that paid well. It seems odd that after only a bit more than a year he would uproot his family again and move back across the country one more time.

Now, what is the AHCA you might be wondering? Well, the AHCA is a Florida bureau part of the Department of health whose goal is to provide quality health care to poor folks. That's right, all you Floridians, the man in charge of the government bureau who's purpose is to provide quality health care for the poor has run two separate hospital's that specialized in providing such health care, and both of those hospitals were the subject of scathing government reports relating to his tenure there. How did he get this job? Only the powerful know, however this is interesting. It turns out Dr. Agwunobi's ran Florida's department of Health under Governor Jeb Bush.

I know what some of you cynics are thinking right now. That is just how the game works, Volpe. True, however, it doesn't have to. Things don't have to work out so that someone fails and fails and constantly has that failure rewarded. It doesn't have to work out like this and we can start here.

Is this the best we can do? Is this how things work among the powerful? Perform your job in a totally incompetent manner and you eventually get rewarded with promotions? I don't know, but I would like to find out. If the good people of Florida are happy to have someone running the department that provides quality health care to the poor despite failing to do it when ran two hospitals for the poor, then don't read any further. If you are happy having your tax payer money go to this incompetent don't read any further. If you aren't then please make your voice heard. Here is a link to the Florida Department of Health, and here is another one to the Governor of Florida, Charlie Crist. Please ask them how running two hospitals into the ground qualifies anyone to run a department dedicated to providing quality health services to the poor.

UPDATE: For the most part the story behind the mess that now engulfs Grady is extremely confusing and complicated. Thus, if you were to find your way to any of the many stories I have written on it, and it was your first exposure, you would likely get confused. I don't believe this is one of those stories. You should be able to follow this one regardless of your exposure to the mess in general. If not, let me know. That said, 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.That way, you can see how Dr. Agwunobi fits into the entire nightmare. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.