The following is an email response from Swedish hospital to The Seattle Times’ “Quantity of Care” investigation by reporters Mike Baker and Justin Mayo:
“Since our beginning, Swedish has always been committed to the highest quality, safest health care for our community. We often care for the sickest of the sick and work to achieve the best outcome for every patient.” – Tony Armada [Swedish CEO]
Our patient census, including the number of patients receiving care at Swedish Neuroscience Institute (SNI), has increased over the past few years due to a number of reasons, including the ACA providing greater access to care, the addition of new physicians, new highly specialized procedures, and our reputation and overall high levels of quality which have attracted more patients.
A SEATTLE TIMES SPECIAL REPORT
- Swedish CEO Tony Armada resigns
- Top Swedish neurosurgeon resigns
- U.S. Attorney’s Office launches investigation
- Providence CEO Rod Hochman apologizes
“We believe everyone deserves the highest level of care available, no matter who they are or their ability to pay. As a not-for-profit organization, we take this commitment seriously. Last year, 58 percent of patients at the Cherry Hill campus were on Medicare or Medicaid, and in 2015 Swedish devoted more than $175 million to important Community Benefit programs, including more than $17 million in free and discounted medical care for patients in need.” – Tony Armada
We are proud that SNI has a uniquely accomplished and experienced team focused on what is best for our patients.
Dr. Delashaw was selected to join SNI with the support of his colleagues and has a strong record of providing excellent care to his patients. Dr. Delashaw helped define the modern surgical treatment for hemicraniectomy, specializes in complex brain tumors and aneurysms and is sought after by patients in the most challenging conditions. Even undertaking complex surgeries, in all of the surgeries that Dr. Delashaw performs, he performs at national expectations for patient mortality, including an Observed/Expected (O/E) of .92 for readmissions for craniotomy patients and an O/E of 1.22 for mortality. These numbers fall within the expected national performance and are not statistically significant outliers.
SNI outperforms national standards in a statistically significant way. In 2016, a patient would be 31% less likely to die while undergoing a craniotomy at Cherry Hill than the national expectation. For spine fusions, the O/E was .23, substantially lower than the national expectation of 1.0. These national expectations referenced above are derived from an expansive comparative database, with data collected from 3,750 hospitals and over 130,000 providers.
SNI provides care to patients from 44 different states in the U.S. and it is also the primary Neuroscience Institute for Washington, Alaska, Montana and Idaho. Below, please find graphs that reflect total long-term data for Cherry Hill on mortality and readmissions that represent Cherry Hill’s performance against national expectations. These numbers are better than national norms statistically significant at the 99% confidence interval.
At the end of 2015, Swedish Cherry Hill was awarded the Comprehensive Stroke Center Certification from DNV GL-Healthcare. We are one of only two hospitals in Washington State to receive this certification. We are also the only hospital in Washington State to be in Healthgrades Top 100 hospitals list for stroke care.
“SNI and Swedish are committed to providing caregivers with a work environment that is safe, respectful and inspiring. We believe that our caregivers are the heart of this life-saving, life-changing patient care. To maintain a culture of safety, each and every caregiver is supported and empowered to raise safety concerns. Any concerns about quality of care are addressed immediately and thoroughly reviewed with oversight from medical committees, senior leadership and third-party experts, when needed.” – Tony Armada
We have systems to provide checks and balances and use industry benchmarks to measure our success.
Finally, as I have stated before, we take our legal and ethical obligation to respect and protect our patients’ privacy extremely seriously. We cannot answer questions that could pertain to individuals or potential patients. It is imperative that a patient provide consent before their health information is shared outside their care team.
Mary Beth Lowell
Providence Health & Services – Western Washington
The following is an email response from Dr. Johnny Delashaw to Baker as part of Baker’s reporting for “Quantity of Care”:
February 6, 2017
Swedish Neuroscience Institute is an incredible place and we are doing so many things that improve life. The surgeons and staff are a pleasure to work with and they make me proud to be part of their team. Seattle is an incredible place to be at this time. I believe we will change the world together. For example, I am firmly committed to getting stroke, MS, and spinal cord injury victims to walk again. I really do believe the wheelchair will be something we see in a museum as an obsolete device used for paralyzed victims. I am also committed to change how we educate our younger generations in medicine. We will find new methods to prevent or stabilize aging disorder such as Alzheimer’s disease. These are very exciting times and we will make a difference. I am hopeful that after careful consideration you will provide a enthusiastic news piece about our future. We can make such a difference in those with neurological disease!
Johnny Delashaw. MD
Chairman of Neurosurgery
Swedish Neuroscience Institute
I read your email to me and have responded accordingly.
The issues covered in the stories are complex and nuanced, and not conducive to questions over email. We need to have a conversation, so we can explore follow-up questions and discuss questions and answers that need further clarity. This will allow me to better understand your work.
That said, to elaborate on my previous message to you, here are some of the broad themes and primary issues we are covering:
-In the last few years, SNI has undergone a dramatic shift toward a high-volume, high-revenue model. During that process, there has been wide-ranging concerns that Providence/Swedish is prioritizing money over patient care. Staffers have expressed significant concerns about you, including issues of patient safety, inadequate care, a lack of accountability for post-op complications, and the appropriateness of surgery. There have been dozens of QVR reports filed about you.
In the last three years SNI has undergone remarkable growth. This growth has led to a change in culture. Not all individuals working at Swedish wanted the culture to change. Some have become disgruntled and some of these health care providers have left. In addition to growth, we have improved are evaluation of outcome data including morbidity and mortality to be sure we are providing great care. I am happy to report that we are at or better than national standards in every category. We also have a team within our department carefully monitoring postoperative complications to assure accurate reporting. When there is a change in culture it is commonplace for individuals to complain through the anonymous complaint system (QVR). The QVRs are vetted and dealt with effectively as necessary.
-You also faced issues in your previous jobs. At OHSU, you faced 12 lawsuits over the span of 14 years. At UC Irvine, there were internal concerns raised by a variety of doctors about a variety of cases, from brain tumors to aneurysms to how you handled a patient who was an undocumented immigrant.
As Professor and Vice-Chairman of Neurosurgery at OHSU I had a very large practice in a teaching hospital. I was actually at OHSU for almost 20 years and performed approximately 13,000 operations. I built a reputation in dealing with the most complex brain tumors and aneurysms. I have an extensive CV of publications and have been interviewed on 60 minutes, 20/20, and the Discovery Channel as a result of my expertise in the treatment of stroke and aneurysms. A significant part of my practice was for the indigent (30%) and I received no financial rewards for taking care of these individuals. However, it is what we do and I am very proud of being able to provide the highest level of care regardless of ability to pay. I am unaware of 12 lawsuits but certainly a relatively small number of claims were made against OHSU, resident treating physicians, and me over the years. Importantly, none resulted in any findings of culpability or breach of the standard of care. A few (I remember 3) lawsuits in which I was named as one of several defendants were settled with small payments. Most were dropped or my name was removed from the case because of lack of responsibility. I am very proud of my practice at OHSU and very proud of the staff and residents. All of the health care providers provided exemplary care to innumerable patients. It is a terrific health care institution and I keep in contact with many of my colleagues to this day. I left OHSU in very good standing for a promotional opportunity as Chairman at University of California, Irvine.
I am quite surprised at your statement regarding UCI. As Chairman at UCI we markedly improved our service in quality and volume. Aneurysm treatment was sparse in number, but we quickly became the leading treatment center in Orange County. The open vascular service and the interventional service eventually were placed under my direction to improve outcomes and quality. Prior to my arrival at UCI they had treated in one-year 42 aneurysms with surgery or coiling techniques. After I arrived, the service grew 4 times in size because of quality and expertise. Brain tumor treatment also markedly increased in number due to the development of a national reputation. Everyone does not always appreciate growth and success. The former neurosurgery chair and the chairman of radiology were unhappy with and envious of our success, all too human frailties, as it had not been achieved prior to my arrival.
Finally, the comment of the undocumented immigrant is very concerning. I think the individual you may be referring to came into the emergency room and I did emergency surgery to save his life. Because of privacy rights I can say only that there was a successful medical outcome.
-To maintain volumes, concurrent surgeries at SNI have become commonplace, and staffers have expressed concern about how they are being handled and how much time surgeons are spending in the operating room.
Surgeries at many institutions such as ours occur in concurrent rooms by a team of surgeons. These surgeries are staggered so that the attending of record is present for at least the key portions of each procedure. Other attending surgeons are available if needed. We do not have residents at Cherry Hill in neurosurgery. Our surgeons that work with the attending for the most part have admitting privileges and are board eligible. Therefore, we have usually more that one board eligible or board certified neurosurgeon working on each of our patients. Outcome data has been thoroughly reviewed within Cherry Hill and have no measurable differences in outcomes have been identified between the surgeons staggering rooms and those that choose one room. This finding has been replicated at other facilities and was recently published in the Journal of Neurosurgery. As I have remarked before, not all staff are in favor of change and will express concern when it is different. I can assure you that quality is our number one priority and we have great data to back us up.
-Medical staffers have described an environment of intimidation and retribution, led by you. That has made staffers reluctant to raise concerns about patient care.
Change can produce anxiety and misperception. I have recruited a number of surgeons with national reputations to work here at Cherry Hill. I am very proud of them. Some of the surgeons working at Cherry Hill prior to the influx of highly talented and committed colleagues have perceived them sometimes as competition and have expressed anxiety over the changes. While I expect excellence and unswerving commitment to our goals I am not a bully and have not produced an intimidating atmosphere. Swedish has investigated claims and I am unaware that it found any substantial evidence of this alleged behavior. It is not insignificant that in almost 25 years at OHSU and UCI I have never had any complaint such as this made about my leadership style.
-Patients have undergone invasive procedures at higher rates, such as aneurysm clipping procedures. Data shows spikes in aneurysm clippings when you arrived at UC Irvine and later to Swedish.
Cerebrovascular disease is a passion of mine. I am deeply committed to the successful treatment of aneurysms, avms, and stroke. In fact, the current surgical treatment of large strokes (hemicraniectomy) was first described by me in the journal called Stroke in 1990. It was not well received at first, but now is considered standard of care in large strokes with edema. The procedure I described more than a quarter century ago has saved thousands upon thousands of lives. Word of the success prompted the television news show 20/20 to years ago air a segment on hemicraniectomy years giving the procedure even more national recognition.
I have a national referral practice and wherever I go, complex vascular patients follow. It was natural and expected to see a rise in vascular surgeries with my arrival in Seattle. SNI has also recruited a world-renowned endovascular surgeon Cameron McDougall to Cherry Hill. SNI is doing great things with its vascular team and designated stroke service. Today, a team of surgeons prior to implementing an approach to care reviews all aneurysm patients at Cherry Hill. We are in an era that continues to improve with techniques in aneurysm treatment and the providers at SNI are on its forefront.
-Data suggests there are issues with patient care. That includes federal benchmarks on surgical complications, billing data on surgical misadventures and aneurysm patients with high rates of stroke.
I am very concerned by this statement. Our data does not agree with your comments above. SNI is a designated stroke center and has just been renewed. Our volumes are higher and we cover a large segment of Washington State. Without knowing what data you are referring to it is difficult to respond. I am sure that Swedish can provide you with accurate and precise data.
-We are examining the stories of patients, in particular one of your patients who was a 23-year-old woman from Oregon who died.
I am not at liberty to discuss the care of a particular patient as this runs contrary to HIPAA regulations.
-I want to be clear that this story does not rely on just a couple anonymous complaints and info from a few lawsuits. We’ve examined thousands of records, including internal records at Swedish. We’ve also analyzed federal and state databases and interviewed dozens of your current and former colleagues.
It appears that this story was generated by individuals who are unhappy and have an agenda directed at causing harm and embarrassment to Swedish, SNI, several colleagues and me. They have misrepresented both the situation and the data. You have contacted many people from UCI and Swedish who have not commented. This is policy. The media departments at both institutions are supposed to handle these inquiries. That is their job. The job is of health care providers is to provide excellent care and we are doing that. I hope you report your article carefully because the information I have received in this letter is extremely inaccurate. As a reputable source of information, I am sure the Seattle Times and you want to get the story straight. You are not there.
We are doing such great things here at Cherry Hill. I am so proud of our physicians, nurses and staff. They are exceptional. It is too bad you are not focused on the great things we do. It is disappointing that misinformation for an agenda beyond what you appear to understand is being used. It is also disappointing that you are allowing yourself to be used as a puppet for their gain.
Perhaps you should come to Cherry Hill for a tour, observe the great things we do and learn from the exceptional health care providers we have. I would love to show you the positive things going on at our campus. Since I am not authorized to extend an invitation myself I hope that you will reach out to those that hold that authority before you print what is at present a very inaccurate and misleading article.
I strongly encourage you to sit down with me to go over all these matters to ensure that you have every opportunity to address what will be in the story. Again, in order to have time to incorporate your comments, we need them by the end of the day on Monday.