Detroit hospital vows quality care but won’t discuss coronavirus issues
With a global pandemic in the backdrop, the Detroit Medical Center submitted its annual report to the Michigan Attorney General's Office this month, detailing the ways in which it says it is adhering to promises made in 2010 as part of its sale to a for-profit health care system.
Among those commitments is a promise to continue to provide high-quality care to patients without selling off any of its hospitals; invest in capital improvements, and support medical education and research for at least 10 years to Nashville-based Vanguard Health Systems.
DMC CEO Audrey Gregory, who took over in January, told Detroit Free Press this week that the health system is upholding those promises as it enters its final year of obligations and oversight by a Legacy Board created to monitor its adherence to the benchmarks as it transitioned from nonprofit to for-profit ownership.
"The DMC has a deep commitment to the community, and it is something that we're extremely proud of," Gregory said. "This is a community that has complex medical needs. ... We have met those needs with skill and compassion. We're committed to doing this into the future. I would think for us that is the most important thing."
Yet in the midst of a worldwide crisis — the coronavirus pandemic — Gregory declined to discuss episodes in recent weeks that caused concerns about quality of care at the DMC tied to the COVID-19 pandemic, most notably at Sinai-Grace Hospital.
There, emergency room nurses walked off the job on a night in early April because they said staffing levels were too low to safely care for a growing roster of patients severely sickened by coronavirus. It's also where photos were leaked to the media apparently showing body bags stacked in empty rooms and resting on empty chairs because the morgue had run out of space to accommodate the dead.
Stories from the front
Bridge Magazine, Detroit Free Press and Michigan Radio are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb rerb@bridgemi.com at Bridge, Kristen Jordan Shamus kshamus@freepress.com at the Free Press and Kate Wells katwells@umich.edu at Michigan Radio.
And unlike other southeast Michigan hospital systems Beaumont Health, Henry Ford Health System, St. Joseph Mercy Health System and Michigan Medicine, DMC has not routinely released information on the number of COVID-19 tests, hospital admissions or discharges. Likewise, DMC does not report on employees who were sickened or tested positive for the virus, as others have.
Meanwhile, at least two members of a legacy board, created to provide oversight of DMC’s performance, pronounced themselves skeptical of the system’s progress, citing among other worries quality of patient care and the uncertain fate of DMC’s neurosurgery residency program.
Gregory, who has a background in nursing, joined the DMC in 2019 from Memphis-based St. Francis Healthcare System, which is owned by Tenet Healthcare Corp. The Dallas-based for-profit company purchased the DMC from Vanguard in 2013. As part of the sale, Tenet also agreed to uphold the promises of high quality of care, research, investment and education through 2020.
However, in recent years, the health system has been plagued by reports about dirty surgical tools that sometimes forced doctors to delay procedures, and failed state and federal health and safety inspections. A neurosurgeon training program at DMC lost its accreditation, jeopardizing the reputation of the health system and its longtime academic partner, Wayne State University.
"I will say, looking at the history of the DMC, ... the reputation is something we will continue to work on," Gregory said. "And I think the reputation is about the trust that we work to earn from our patients that we serve. ... The issues around surgical instruments, I think as an organization, we have done a phenomenal job in resolving and working through those issues. And that continues to be at the forefront of what we do as an organization."
She said the Rehabilitation Institute of Michigan is one of four hospitals that received comprehensive rehabilitation certification, and noted that Detroit Receiving and Huron Valley Sinai hospitals both passed unannounced inspections.
"We remain committed to making sure that we are providing great quality to our community," she said. "And I will tell you as a nurse, that is something that is extremely important to me, and something that we will continue to focus on."
The hospital system’s report highlights $850 million in capital improvements Tenet Healthcare has spent since purchasing the DMC.
Among the projects are renovations and upgrades for Children's Hospital of Michigan, which also added a new six-story, $155 million critical care tower in 2018, and the construction of the DMC Heart Hospital, which opened in 2014.
Gregory also touted the DMC's role in supporting the state's largest medical residency training program in partnership with Wayne State University, its clinical research and its commitment to providing care to the poorest of Michiganders.
In its report last year, the DMC oversight Legacy Board offered a less-rosy assessment, saying it had "serious concerns" about the hospital system’s commitment to fulfilling the covenants laid out in the original sale.
"Recent developments are negative and have received extensive media coverage," according to the Legacy Board's report in June 2019.
"The hospitals have performed poorly on basic patient safety and quality inspections, the long-standing relationship with [Wayne State University] School of Medicine is fracturing, there have been allegations of negative patient outcomes resulting from staff reductions, and, this week, additional layoffs have been announced.
"Less public concerns include inadequate support of research activities, which, over time, will jeopardize DMC's ranking as an academic medical center. Importantly, Legacy has frequently requested DMC to demonstrate its financial support of research and DMC has not presented a credible case that it is in compliance with the commitment to support research. Outcomes for academic medical centers previously owned by Tenet provide no reason for optimism. Nor do the widely circulated reports concerning the debt levels disclosed in Tenet's balance sheet and the high level of executive turnover at Tenet."
Legacy Board Chairman Richard Widgren told the Free Press that the board has yet to complete its analysis of how the DMC has fared in fulfilling the promises it made to the community for this year.
Ordinarily, the DMC and the Legacy Board submit their reports together to the Attorney General's Office for review. This year, the DMC submitted its report without the Legacy Board's perspective.
"There's not much that we raised that is accounted for in any meaningful way since that time," Widgren said. "So we're following up this year with a report that will revisit those issues and the progress that they've made or the progress they have not made. We'll do that in the most balanced ways that we can."
Legacy Board President Joseph Walsh said after concerns were raised last year about the DMC's investment in medical education and collaboration with Wayne State University, the hospital system's leaders promised to add 80 more residents to the program.
"That was really impressive, and really reassured our board members that maybe we had gotten it wrong, and maybe we had communication issues," Walsh said.
“This year, unfortunately, two things have happened: First of all, they have rescinded that statement with only very general comments that errors were made .. .but far more importantly the neurosurgery residency program was de-accredited. This is really a rare, rare occurrence and it was done in a very quick fashion by the ACGME (Accreditation Council for Graduate Medical Education).
Gregory disputed that the DMC is not invested in medical education, citing 1,058 residents who were trained in 2019 and an investment of $76.7 million.
"The numbers speak for themselves," she said. "I see that as a clear commitment and whether or not we increase residents or decrease the number of residents is really dependent on the needs of the organization and what the teaching requirements are and what can be met. ... I think it should be noted that we did not cut any position from a residency perspective that currently exists. This discussion about cutting positions, we did not cut any positions that currently exist."
She added: "To expand just for the sake of expanding without planning and making sure it makes sense is somewhat irresponsible. ... We have not taken away any positions and we will continue to assess what we need to add, if we need to add, and when we need to do that."
But Widgen said that the Legacy Board's examination of the DMC's spending on the residency program in the last decade "has been, in fact, anemic at best."
The loss of the neurosurgery residency program, which will end in June of this year, Gregory said, "is regretful. ... It is our intent to work with Wayne State. We will grow our program and believe you me, we will be getting reassessed and ... have our neurosurgery residency program back."
Widgren and Walsh said the Legacy Board report for this year is still being drafted and will be made public and submitted to the Attorney General's Office as soon as possible.
There will be one more report after this one, filed in 2021 and based on DMC operations in 2020. After that, "there's going to be less oversight and they'll have a little bit more freedom to move as they want to," Walsh said.
Widgren said the hope is that its final reports will give the hospital system "a program that they can work on and improve on. And by the time this is passed over to the city in the state, it'll be up to everybody's expectations."
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