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August, 2003

Dr. Ramirez Vindicated, Marin General Hospital
Deficiencies Cited By State

After investigating allegations made by respected neurosurgeon Archimedes Ramirez, MD (Jan. 2003), the California Department of Health Services (DHS) issued a 14-page statement of deficiencies (11-0016278) identifying multiple violations of state healthcare laws at Sutter/Marin General Hospital. These violations go to the heart of quality patient care and highlight the consequences of inadequate staffing.

Background. Dr. Ramirez, Chief of Neurosurgery at Sutter/MGH, has practiced in Marin County for 23 years. After Sutter/MGH executives failed to act on previous patient safety concerns that he had privately relayed to them, he wrote them about new problems and this time sent a copy to the Marin Healthcare District that owns MGH. Among other issues, he expressed concerns about failure to carry out needed tests and to control post-surgical patient pain, and he attributed these and other failures to understaffing in the ICU because of recent staff layoffs.

Dr. Linda Remy, a UCSF health policy analyst and former Director of the Marin Healthcare District that owns MGH, forwarded his letter to DHS for investigation. At the time, she was quoted as saying, "I always feel that it's best to have an outside opinion on these things, because then it's not 'he said, she said.' There's a difference between what's legal and what's good practice, and [DHS] is only there to enforce the law." (Marin IJ, "State probes complaint about MGH", 07 Mar 2003)

William Rothman, MD, another former Director of the Healthcare District, also contacted DHS based on his separate concerns as a physician about the issues Dr. Ramirez raised.

At the Feb. 2003 meeting of the Marin Healthcare District, Sutter/MGH executives read a statement which did not address Ramirez' complaints, but instead insisted that patient safety was not compromised. While Dr. Ramirez was speaking, the Sutter/MGH Chief Executive Officer Margaret Sabin stormed out of the room and told two reporters, "The reason I left is it is so hard for me to hear a doctor lying." (Marin IJ, "Doctor praised, slammed for critical letter," 12 Feb. 2003; Pacific Sun, "The right staff?" 19 Feb. 2003)

In various public documents, Sutter/MGH executives subsequently castigated Dr. Ramirez for making his complaints public, blamed "critics with a political agenda-and inflammatory media coverage," for the hospital's problems, and expressed their "strong belief" that the DHS would "validate that the complaints were unfounded." (MGH Memo, 07 Mar 2003, 12:17 PM; Marin IJ, "State probes complaint about MGH", 07 Mar 2003; MGH Letter to employees, 13 Mar 2003)

Sutter/MGH executives also wrote an OpEd piece (Marin IJ, "MGH's priority Quality Care", 14 Mar 2003) in which they said "one physician... made allegations that are not true and suggests our hospital is not a safe place to be", reported the DHS investigation was the result of "one of the hospital's longtime critics filing the complaint based on the physician's alleged concerns," and reiterated their belief that DHS would "not support the allegations of deficiencies."

Dr. Ramirez responded (Marin IJ, "Sutter's priority: The bottom line", 18 Apr. 2003) by expanding upon his concerns about conditions at the hospital. He described how he had refused to sign a contract containing a clause that he believed would prevent him from publicly speaking out about conditions at MGH. He want on to say that Sutter had retaliated against him for refusing to sign that document and for making his complaints public. He also said, "In such circumstances, physicians are obligated to speak out on behalf of their patients."

DHS Findings. DHS cited Sutter/MGH for the following violations of state law:

Sutter/MGH "failed to ensure that nursing staff implemented the policies for reporting the results of requested laboratory work to the ordering physician."

Sutter/MGH "failed to perform and document ongoing assessments of pain and the reassessments of response to pain medication and to notify the physician of the patient's unrelieved pain."

Sutter/MGH "failed to: 1. Develop a written staffing plan for the ICU based on the patient care needs and staffing levels required. 2. Ensure that the patient classification committee reviews the staffing plan when changes are needed or at least annually for reliability in meeting the patient care needs and, 3. Ensure the committee, that is composed of direct patient care registered nurses, determined that the impact of eliminating the ICU night unit clerk position on the overall ICU staffing was based on input from interested staff and staffing data."

Sutter/MGH "failed to obtain permission from the Department of Health Services to convert beds approved for one use to another or to increase the number of beds designated for use as ICU beds."

Community Response. Upon learning of the DHS results, Dr. Remy said, "These findings again highlight the value of outside independent review when charges are made about quality of care deficiencies. Once more, we see that what is good for the Sutter/MGH bottom line is bad for patient care. Contrary to what Sutter/MGH executives would like the public to believe, Marin healthcare advocates are not 'targeting' the hospital. Rather, complaints accurately reflect Sutter's persistently inadequate commitment to quality care in favor of profits."

She went on to say, "I was appalled when I read that Margaret Sabin publicly called Dr. Ramirez a liar. The DHS citation completely vindicates him, particularly in light of the hospital's history."

The Chair of the Marin Healthcare District Board, Dr. John Severinghaus, stated, "In response to DHS citation 11-0016278, I expect Sutter/MGH to promptly correct the cited deficiencies and problems, and to provide the District a copy of their response to DHS. I also believe it would be appropriate and helpful in concluding this issue for Sutter/MGH to publicly thank Dr. Ramirez for his courageous effort in bringing these problems to the hospital management's attention."

 

 

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