UT Southwestern and Parkland:
Criminal Problems Seem To Have Emerge
I am now going to lay out the proof step-by-step, that UT Southwestern Medical Center / Parkland Hospital along with the Dallas Regional Office of the Centers for Medicare and Medicaid (CMS) violated CMS regulations. Some of this has been shown before as part of a build up, but this will constructed as a proof that local Centers for Medicare and Medicaid, Parkland Hospital, and UT Southwestern officials will have no way of explaining there way out of.
1. There is a document that the Centers for Medicare and Medicaid use when they inspect a hospital. It is called a 2567. If they find deficiencies, the hospital is supposed to fill out the column on the right. That is called their "Plan of Correction." As you can see below, other than adding the Plan of Correction, dating it and signing it, any alteration of the document should be reported to the Texas Attorney General in order to initiate an investigation into possible fraud. Click on http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8UP_foFDmI/AAAAAAAAAhw/Bs2g4H2Bizc/s1600/Penalties for alteration cropped.jpg to see the image of this document. 2. I never expected that anyone would write down erroneous material on an informed consent form. Giving someone permission to open you up and to start working on the inside of your body is a big thing. It's a sacred trust. Parkland and UT Southwestern have this relationship where the residents do the work with minimal faculty supervision, and this is backed up by testimony that Parkland CEO Dr. Ron Anderson gave during his deposition. The residents see the patients prior to surgery, and make the decisions about whether and what type of surgery, if any, the patient needs. The faculty member was less important. The residents would just write down the name of any faculty member on the consent form. I am not blaming the residents, they were just following policy. However, 25-30% of the time, the faculty member listed on the consent form as the person who would be doing the surgery was actually at home, or out of town, or out of the country. This means that 70-75% of the time the faculty member who was doing the surgery did not have permission to operate on the patient. That's illegal. Courts have ruled over and over that if you operate on a patient without having your name on the consent, you are committing battery.in order to hide the fact that more than one out of four operations were technically a legal assault and battery at Parkland, the Parkland Executive Vice President and Lead in-House Attorney, working with Ms. Leah Hurley, Chief Counsel for UTSW decided to remove the names of the faculty member from the consent form. The consent form in use changed from the one on the left, (See http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8UYCiOAiEI/AAAAAAAAAh4/316LjdLA4ts/s1600/Original Legal consent.jpg to see the image of this document.)
To the one on the right, (See
Http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8UZPOBmeJI/AAAAAAAAAiA/XhkaqaDt5Qg/s1600/illegal consent.jpg to see the image of this document.)
Where the line for name of faculty was removed. There is something important to note on the consent form on the left. It says, "Surgeon of Record, " and below that, "Name of Faculty." In other words, it is an admission that the resident, not the faculty member, is the surgeon. This is against the rules. According to the Centers for Medicare and Medicaid Services, a resident is never the "operating practitioner, " or person responsible for the surgery. As for the consent form on right, it is against Medicare and Medicaid regulations because the name of the attending must be on the consent form. The name of the resident should not be on the consent form. 3. Below left is the current CMS definition of a properly designed a consent form. What it is in the box makes it clear that, "Who" is going to do the surgery must be on the consent form. The next bullet makes it clear that the resident is not the responsible practitioner. The patient should be notified if physicians other than the operating practitioner, such as residents, will be involved. Parkland considered the residents to be the surgeon of record, or operating practitioner. The document on the right occurred as a result of surgical organizations complaining that it was burdensome to get the name of the correct resident on the consent form. Consent can be obtained days, to weeks in advance. During that time residents rotate off of the service. If you put the name of the resident on the consent form for a case that is done a few days later, chances are the resident will be somewhere else. The document above on the right (See http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8UlVEq61II/AAAAAAAAAig/7rXismNnwiw/s1600/Who should be on consent is mandatory.jpg to see the image of this document.) announced that the Centers for Medicare and Medicaid Services will no longer require the names of practitioners other than the primary operating practitioner, who is not a resident, to be on the consent form. Their ruling was based on the fact that the residents were not in charge, and their names really didn't matter. The faculty member is responsible for the surgery. The attorneys of UT Southwestern and Parkland had it backwards. As shown above, (See http://4. Bp. Blogspot.com/_xPeeae8LWMQ/S8UkKLeI1BI/AAAAAAAAAiY/L0DI-iN3i54/s1600/residents name shouldn't be on form cropped..jpg to see the image of this document.) they eliminated the name of the faculty, and left only a place for the name of the, "surgeon of record." According to their sworn and recorded depositions, Parkland CEO Drs. Ron Anderson, and UT Southwestern Chairman of the Department of Surgery considered the intern or resident to be the surgeon of record. The consent form that no longer had the name of the faculty member, and that no longer met federal regulations, was dated February 27. Prior to that date 25-30% of patients were taken to surgery, and a battery was committed upon them because the surgeon who was supposed to operate on them was not in the hospital, and the surgeon who was operating didn't have permission. After 2/27, due to the misguided legal advice and changes in the form executed by Mr. Michael Silhole, Executive Vice-President and Chief In-House Counsel for Parkland, and Ms. Leah Hurly, Chief In-House Counsel for UT Southwestern, it was not longer possible to take patients to the OR with a properly executed consent form. The consent form itself was fatally flawed. After that point, all patients who underwent an operation at Parkland had an operation that violated both state and federal regulations. Any attorney representing a patient in a legal action against a Parkland patient should at the very least, be able to win on the basis of lack of informed consent. 4.in order to participate in the Centers for Medicare and Medicaid Programs, you have to meet Conditions of Participation, or COP's. Below are the COP's for Surgery. There are also non-specialty specific COP's, such as no discrimination by race, color, creed, sexual orientation, religion. Racial overtones are obviously all over this complaint. But sticking to the COP's for surgery, the box on the left is not important to read. It's just part of the Federal Register that documents that I am showing you the actual rules. The box on the right says that a properly executed consent form must be in the chart before the surgery, except in emergencies. As a trauma center, there are patients where there is no time and you rush them off to surgery. But they amount to just a few percent. About 98% of patients have appendicitis, and other conditions for which informed consent is always obtained. The key is the box on the right. It says the consent form must be completed and in the chart before surgery. (See http://3. Bp. Blogspot.com/_xPeeae8LWMQ/S8UxW6IcXqI/AAAAAAAAAi4/gdqP8hbtMjc/s1600/COP number 1.jpg to see the image of this document) and http://1. Bp. Blogspot.com/_xPeeae8LWMQ/S8UyS4rWz7I/AAAAAAAAAjA/2M04BgZFPQI/s1600/COP number page 2.jpg to see the image of this document) 5. CMS no longer required that the name of the residents be on the consent form because they get shuffled around a lot. But at Parkland, since the residents were running the show, their names were now on the consent form, and the faculty members' were not. About half the time the residents, whose names were the only ones on the form, were not the residents who were doing the operation.in other words, for about 50% of operations, no one who was operating on the patient had their name on the consent form. And 100% of the time the consent form did not have a place to list the name of the faculty. Everyone was going to the OR without a properly executed informed consent. Note that in the box on the above right it says that as a Condition of Participation in the Centers for Medicare and Medicaid Program the consent form must be properly executed and in the consent form before the surgery. You cannot execute the consent form after the operation. 6. When I complained that there was no place for the faculty member's name, and only a place for the resident, and half the time that name was wrong, Parkland and UT Southwestern lead attorneys issued instruction that the consent form should not be completed until after the procedure was completed. The Texas Medical Disclosure Panel, a part of the State Health Services that was established to ensure that informed consent is truly informed, required that consent forms contain the statement, "all of the blank spaces have been filled in." You cannot leave something blank, then do it to the patient, and fill it out afterward. The Parkland Chief Legal Counsel Mr. Michael Silhol, and UT Southwestern Chief of Legal Counsel Ms. Leah Hurley inserted a phrase into the consent form right next to the name of the "Surgeon of Record, " that said it should be left blank until after the procedure. See the form below. Right below where the patient is asked to sign and agree that all of the blank spaces have been filled in, it says to leave the name of the Surgeon of Record blank until after the procedure. The problem here is so obvious as to not warrant explanation. Plus the consent form did not tell the patient, "Who" will do the surgery, and the only names on the form were the names of the resident, and the attorneys were instructing the residents that part blank until after the procedure, the whole concept of informed consent at Parkland was fatally flawed. See. Http://1. Bp. Blogspot.com/_xPeeae8LWMQ/S8UtNSC4arI/AAAAAAAAAio/FpdV4IbsLmc/s1600/consent sign after procedure with box.jpg to see the image of this document) The above decision; that the consent form should not be filled out until after the surgery is already over, has to rank as one of the most bone-headed mistakes in legal reasoning. Anyone can see that you cannot insert a sentence saying to leave something blank right below a sentence asking the patient to swear that all of the blank spaces have been filled in. 7. Now it's time to prove that the Region VI Office of the Centers for Medicare and Medicaid Services, located in Dallas, in collusion with Parkland Memorial Hospital and UT Southwestern Medical Center, committed a fraud. 8. The Centers for Medicare and Medicaid Services did an unannounced inspection of Parkland on 9/22/08. They found, as one would expect, that Parkland did not meet the Conditions of Participation for Medicare and Medicaid, for two reasons. Number one, the residents were performing surgery without proper supervision, and number two, they did a random evaluation of charts, and found that 100% of the time a properly executed consent form was not in the chart prior to surgery. How could it be otherwise, when the Parkland and UTSW attorneys told everyone to fill out the permission to perform surgery after the surgery had been performed? Also, since no one had ever thought to fill out a consent form after the operation was completed, almost every time, people forgot to do it, and the consent form was never filled out. 9. The results of the inspection are shown below http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8VA46tbjbI/AAAAAAAAAjI/qmsTDivnFqU/s1600/Informed Consent Lack.jpg and http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8VCSRD9iJI/AAAAAAAAAjY/Mfb9uDdklDk/s1600/Informed 2Consent Lack Cropped.jpg In earlier blog posts I have showed internal CMS documents to their employees about how to handle the news media blitz when it was learned that Parkland was going to lose its accreditation. When that happens, the government replaces people like CEO Dr. Ron Anderson, John J. Shannon, Michael Silhol, and pretty much the whole lot of people who voted them selves to receive $2 million in end of year bonuses because they were doing such a great job. The doors are never closed, and patient care is never interrupted. You just get a better hospital. I won't re-post them here, they are on this blog on earlier posts, but we're getting close to the smoking gun. 10. With Parkland being charged with an EMTALA violation in the Fall of one of the most severe infractions that that can be charged against hospitals, and a visit by the Joint Commission for the Accreditation for Hospitals around that time that said that the care at Parkland was, "so poor that any patient who steps their foot through their ER doors is placing their life at risk, " and now getting ready to be booted out of the Medicare and Medicaid program. With all of this occurring within a few weeks of a $1.2 billion dollar proposal to increase taxes to pay to expand Parkland, they could not let this get out before the November 4 vote. So, the EMTALA violation was never reported until I dug it out of them and put it on this blog a year later. The Dallas Morning News wasn't able to report the Joint Commission violations until January of over two months after the vote. I am just now getting the Medicare and Medicaid fraud that was partially covered in the Dallas Morning News a few weeks ago, published on this blog. But here is where it is not possible for them to get out of it. 11. On October 23, one month after the visit that found that Parkland didn't meet conditions to participate in the Medicare or Medicaid program, which is another way of saying they don't deserve to care for the poor, the elderly, or the disabled, they sent their officials to meet with the leaders of the Region VI directors of the Centers for Medicare and Medicaid, conveniently located in Dallas. Parkland left with the following document. Compare it with the one above. It says that during the 9/22 visit they found nothing wrong. (See http://2. Bp. Blogspot.com/_xPeeae8LWMQ/S8VID3kreXI/AAAAAAAAAjg/1SZtMPnICXA/s1600/CMS unsubstantiated cropped.jpg for a image of this document). I made my complaint in the summer of 2008. The inspection was done in September. They had a duty to call me with the results, but never did. Knowing that government is slow I waited until May and called the Region VI Office of Centers for Medicare and Medicaid for an update of my inquiry. The person the operator connected me with in the Dallas Office was not present at the October 23 meeting, so he didn't know the results had been changed during the October 23 meeting. When I asked him for the report he sent me the original eight page report listing multiple the deficiencies, and that Parkland did not meet the criteria for participation in the Medicare and Medicaid Program. I have already posted it on this blog.in June I met with WFAA channel news. After showing them what I had, they said they would run a four night special on the corruption at Parkland and UT Southwestern. They went to the Dallas Office of the Center for Medicare and Medicaid around September to ask some questions about the infractions, and were handed the document above, saying that the inspection found no infractions. I received this surprised reaction from the reporter: (See http://4. Bp. Blogspot.com/_xPeeae8LWMQ/S8VkKVZLqUI/AAAAAAAAAj4/CDCDs2lREuk/s1600/Shipp's what the heck jpeg.jpg for an image of the document). The Dallas Office the Center for Medicare and Medicaid Services did not know that the employee who was not at the October 23rd meeting, and didn't know that they had altered the report, gave a copy of the original one to me. Otherwise, this whole issue would have been buried, and would never have seen the light of day. 12. As you can see below in their Plan of Correction they promised to make multiple changes in the consent form, and in their credentialing procedures, that would take place in October and November, one and two months after they 9/22/08 investigation that documented these infractions. You can also see that on 12/18/08, three months after the consent was deemed invalid, a new consent form went into effect. It now listed the "Name of Faculty, " and no longer had a place for the resident's name. The part that said, "leave blank until after the operation is completed" was removed. See http://4. Bp. Blogspot.com/_xPeeae8LWMQ/S8VqotKGfMI/AAAAAAAAAkQ/5pHK-P2Pw5w/s1600/Plan of Correction for Consent-1 with boxes.jpg, http://1. Bp. Blogspot.com/_xPeeae8LWMQ/S8Vtluu7EMI/AAAAAAAAAko/vT2TWPAYZUo/s1600/Plan of Correction for Consent with boxes-4.jpg, http://1. Bp. Blogspot.com/_xPeeae8LWMQ/S8VuLZGIx_I/AAAAAAAAAkw/bKuTjZiBQTw/s1600/Plan of Correction for Consent with boxes-4.jpg and http://3. Bp. Blogspot.com/_xPeeae8LWMQ/S8Vo2b-C5oI/AAAAAAAAAkA/Yt4opFS_ajk/s1600/latest consent.jpg. 13. CMS was obliged to go back to the hospital in 90 days and to conduct a full inspection to ensure that all of the infractions had been addressed. However, they never went back. Parkland simply met with them on October 23rd, gave them the above plan and promise that they would fix things. On the basis of Parkland's promise, the Regional office of the Centers for Medicare and Medicaid Services violated their own regulations. On the date that these changes went into effect and they had conducted their 90 day thorough inspection to prove it, and verified that all of the components of the Plan of Correction had been implemented, they should have issued a new bulletin announcing that Parkland was now in compliance, and is restored into participation into the Medicare and Medicaid program. However, there was a $1.2 billion bond election coming up in less than two weeks. I have already posted internal CMS documents indicating that reporters were asking CMS about a failed inspection about Parkland that would cause them to lose their accreditation. As Parkland had promised to fix these problems over the next few months, Mr. David Wright then crossed the line. He decided to change the findings of the original inspection that said Parkland was out of compliance, and changed it to the one that said no infractions were found on 9/22/08, so that Parkland would have a clean bill of health going into the election. When the media would ask Parkland or CMS about rumors that they were going to lose their accreditation they would wave around the altered document, saying that the 9/22/08 inspection found nothing wrong at Parkland. Remember, the first document that I posted was that if anyone alters a 2956 form other than to add in the Plan of Correction and sign it, it should be reported to the Attorney General's Office. Mr. David Wright did just that when he altered it from "findings are substantiated" to "findings are unsubstantiated" based on an October meeting where Parkland merely said they would fix things over the next few months. If they fixed the consent problem in December that does not change the fact that when the inspection occurred in September, the findings were substantiated, and Parkland was out of compliance. Dr. John Jay Shannon, Dr. Robert Rege, and others are on record as saying that nothing was found on the 9/22/08 inspection. The next post will display Mr. Wright's attempts to explain this all away, which are all futile and ridiculous. Plus, he does admit that the altered document was wrong, and Parkland did not meet criteria to participate in Medicare and Medicaid.
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