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I read the Washington City Paper article “First, Do No Harm” (8/18) with astonishment. Because I know fully that your reporter, Stephanie Mencimer, was given detailed rebuttal in several of these cases, I was amazed that she chose to present disinformation, misinformation, and petty lies. As regards Dr. Norma Smalls, Mencimer insinuated that after the wrong-site surgery was done, the medical staff attempted to ignore it and subsequently elected her president of the medical/dental staff, and that furthermore she is “today” head of quality assurance for the hospital’s Department of Surgery. The article also states that Dr. Smalls was sued in the case of Darryl Kelley, a patient who sustained a gunshot wound to the face and subsequently expired. The facts are: Dr. Smalls has been over quality assurance for the Department of Surgery since 1994. It was she who insisted on the completion of the sentinel-event review after the wrong-site surgery was done. She advised your reporter that substantial support exists for these facts, yet your reporter chose to present misinformation.
Furthermore, I was surprised to discover in this article that Dr. Victor Freeman, a Public Benefit Corp. board member, in collaboration with Dr. Ronald David, then chief medical officer for the hospital, externalized Dr. Smalls’ patient management to the D.C. Medical Society and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in lieu of reviewing this matter through the appropriate internal peer-review channels, as expected by the JCAHO. If this is true, it is most disconcerting, particularly because Dr. Freeman is the medical director for quality assurance at Inova Fairfax Hospital and should know that this is a considerable breech. It is noteworthy that Dr. Smalls has not been advised that any external reviewers found any pattern of incompetence or mismanagement in her cases. Dr. Smalls was dismissed without prejudice from the lawsuit of Darryl Kelley. Dr. Smalls was elected president-elect of the medical/dental staff, not president. Other issues in this article relating to her are equally misrepresented.
The article also implied that Dr. Chinwe Agugua discharged a man home who had vertebral fractures. The facts are that Dr. Agugua was involved only in the care of this patient in the trauma bay. Once patients are admitted, their hospital management and subsequent discharge are the responsibilities of the in-house surgical team.
The article also sought to misrepresent issues concerning Dr. Paul O. Oriaifo. Dr. Oriaifo spoke at length with your reporter, providing her with documentation. Nevertheless, she still came away apparently misinformed. She states that, among other things under his leadership, the hospital’s trauma unit lost its Level 1 designation. The facts are that the immediate responsibility for organizing re-verification of the trauma center rests with the director of trauma/critical care, who was, and is still, Dr. Richard Holt. The American College of Surgeons withheld designation determination and is to return for focused review of the service. Additionally, although Dr. Oriaifo is not board-certified in surgery, he completed a full residency from an accredited training program and has had no adverse patient outcomes in his 16-year career. In fact, the last clinical emergency-center evaluation, given to him in June 1999 by Dr. Howard Freed, rated him as excellent. All the trauma surgeons have completed surgical residencies of five years or more from accredited institutions and are board-certified or board-eligible. Dr. Freed, although board-certified in emergency medicine in a grandfather process, has never completed a formal residency in anything. We recognize that, although board certification is desirable, it is only one measure of the quality of care delivered to patients and hence can never be the dividing line on the credentialing and privileging of a physician or dental provider. Both the American Medical Association (AMA) and the National Medical Association (NMA) oppose the growing practice of requiring board certification as a condition in participating in patient care in any arena.
Mencimer was also provided with an extensive rebuttal by Dr. Easton Manderson, which I have subsequently reviewed. Nevertheless, she again chose to publish misinformation. This misinformation concerning Dr. Manderson is so grossly inaccurate and extensive that it is difficult to rebut succinctly, especially because it contains matters related to patient confidentiality. (I have reason to believe that Dr. Manderson will contact you through his lawyer independently and shall subsequently prevail.)
A professional investigative reporter not only follows leads and verifies information, but must also consider the credibility of her sources. Mencimer was advised that Dr. David was vengeful because the medical/dental staff had sought his removal. Dr. David was uncredentialed at our institution and should not have remained in that capacity as long as he did. In fairness to your reporter, perhaps she did not understand the importance of that statement. Credentialing is the process that a provider must adhere to in which he or she submits the evidence that allows him or her to practice to be verified. This means that a provider must submit evidence that he or she possesses the training, experience, licensure, character, ethical behavior, current competence, and mental and physical capacity to perform the privileges requested to provide or direct patient care. Also, the physician must submit any malpractice judgments and/or pending cases standing against him or her. The organization must then substantiate that evidence; additionally, the provider’s AMA profile and National Provider Data Bank status is reviewed. A JCAHO-accredited hospital organization, furthermore, cannot offer or deny privileges without having done this review. Having held or lost membership in the past in other hospitals or health-care organizations can have no independent bearing on being granted privileges in the current application. An organization can choose to give emergency privileges, temporary privileges, privileges with supervision, provisional privileges, or full privileges to its medical staff. The organization may also choose to deny privileges; such denial must be done without personal prejudice and is best substantiated in accordance with the jurisdictional law, the institution’s bylaws, and JCAHO standards.
In Dr. David’s case, the then-president of the medical/dental staff, Renee McCoy Collins, surreptitiously collaborated with John Fairman, the then-CEO, and brought Dr. David on staff uncredentialed. Attempts were made by the aforementioned to change the bylaws of the medical/dental staff improperly to allow this. On discovery of the improper bylaws change, the medical staff immediately reversed it, because it jeopardized our JCAHO status—JCAHO requires that providers who direct patient care be credentialed and be governed by their bylaws, which must also detail that process. Dr. David continually had outbursts of selective prejudiced attempts at questionable disciplinary actions against members of the medical staff, in a manner inconsistent with our bylaws, that we feared could make us subject to litigation on process unnecessarily. We do not support or tolerate incompetent physicians. However, there is a professional process that must be adhered to when pressing standard-of-care issues regarding physicians, which has nothing to do with being an employee; this process must govern your approach to providers or you will find yourself in a legal quagmire. Dr. David’s repeated harsh unprofessional stands, in which he attempted to generalize to all of the professional staff the unverified actions of a few, prompted Dr. Oriaifo, in or about November 1998, to approach Fairman to move Dr. David to another position because he was not a “people’s person.” Additionally, in our review, Dr. David did not appear to have been credentialed. Several months passed. It was not until April 1999, when I personally confronted Dr. David in the presence of Dr. Freeman, a member of the PBC board, regarding his credentials, that he admitted that he was not credentialed. He assured me that he would present his credentials immediately, but Dr. David never presented his credentials for review in spite of repeated requests. Because all providers must adhere to review of their credentials, this being an expected and accepted standard of practice, his continued refusal to submit to this standard review has left us questioning whether he had something substantial to hide. Dr. David was removed in June 1999 as chief medical officer by the administration after two votes of no confidence from the medical staff and intervention by D.C. Councilmember David Catania. He resigned from the organization in September 1999 unceremoniously.
As regards Dr. Robin Newton, whose vote of no confidence was garnered, your reporter implied, because she would not let Dr. Oriaifo volunteer, let us be clear: Dr. Newton was hand-picked by Fairman to ascend to the office of chief medical officer without competition and over the concerns of the elected medical/dental staff representatives. We nevertheless have tried, and continue to try, to work with her. Although the volunteering issue was one of 14 items listed against her—the pivotal reason for that recent vote of no confidence was her repeated problems with misrepresentation of communications, the most recent being to the elected medical leadership concerning JCAHO issues.
If the Washington City Paper’s approach to reviewing the medical care in Washington, D.C., is to pull up the skirts of hospitals citywide, then it will always find soiled underpants. All hospital organizations have concerns that they wish to handle internally—they are not hiding. Hospitals contain health-care providers who are human beings. Human beings can make errors or be part of systems that make errors. Internal reviews of such issues try to address these errors. I hope that your review of other health-care organizations will be done as extensively, but far more accurately.
The PBC—D.C. General Hospital, more specifically—is in a struggle for survival, solely because of fiscal mismanagement. Your reporter and your paper are being used in an attempt to distract you and the public from significant realities. The internal misinformation you have been fed is clearly an attempt to discredit our trauma service, which serves a great need to our surrounding community, and to discredit our dedicated physician and provider staff. It is a brutal way to attempt to silence the medical professionals who have remained silent too long, while we have attempted to remain inside the usual communication venues to press for congressional action. We will not go silently into the night and let our patients be robbed of needed clinical services because fiscal oversight was essentially nonexistent. We will not allow the powers behind this disgraceful attempt to discredit our professional careers as a means to silence us prevail. The City Paper is being pushed into a fire that it did not set. Please be careful not to be consumed.
Medical and Dental Staff
D.C. Health & Hospitals Public Benefit Corp.