In June 2002, two doctors told the Texas Medical Association's Advocacy Committee that their hospital valued money over patient safety.
These aren't just any two physicians -- they are the current and former chiefs of staff at Cleveland Regional Medical Center. And their hospital is owned by Community Health Systems, one of the nation's largest health care groups.
Doctors Mark Kreit and Philip Wisiackas alleged that "corporate influence" and reckless administrative policies became Cleveland's norm. They said CHS bypassed peer review in allowing certain doctors to perform procedures the hospital wasn't equipped to handle -- including bariatric surgery, more commonly called stomach stapling.
"Physicians have been pushed to perform in a hostile and unethical environment, under conditions where records falsification, patient safety concerns and basic nursing service deficiencies" are commonplace, the doctors wrote in their 17-page presentation to the TMA.
The TMA thanked them for their time.
A month later, Houston surgeon Ramesh Srungaram stapled the stomachs of four women at Highland Medical Center, a CHS-owned hospital in Lubbock. After problems with the surgeries, the women were rushed to another hospital where doctors worked frantically to save them. One died. One survived only after ingesting $80,000 worth of experimental medicine.
CHS marketed its bariatric services through an online intermediary called COMPASS Weigh Loss Solutions. COMPASS pairs prospective patients with doctors like Srungaram and arranges for their travels to Cleveland and Lubbock.
The three women who nearly died, and the one who did, found Srungaram through the COMPASS Web site. Houston attorney Richard Mithoff filed lawsuits on their behalf against CHS, COMPASS, Srungaram and Highland Medical Center.
A Houston Press feature on the plight of the women (see "A Figure to Die For," January 2) included information on the presentation by Kreit and Wisiackas to the TMA.
Last month, Cleveland Regional successfully slapped Kreit -- and 15 other current and former Cleveland staff members -- with a temporary restraining order prohibiting them from revealing privileged information on peer reviews. The hospital alleges that such information had been leaked to the Press and Mithoff.
A Harris County district court is scheduled to rule later this month on a temporary injunction that would muzzle the 16 defendants.
Kreit says he never violated confidentiality -- and he's not sorry he spoke out.
"They're not going to let me sit quiet when I feel like patients' safety is being endangered," he says. "I can't just not say anything." Kreit says he and Wisiackas approached the TMA only after Cleveland Regional's administration brushed them off.
Kreit's attorney, John Spalding, says his client never disclosed privileged information. He also says the hospital's attorney, Patricia Dube, requested the TRO without notifying him or Kreit -- allowing Dube to slam-dunk a shotgun-approach petition.
Neither Dube nor CHS spokeswoman Rosemary Walsh would comment for this article.
Defendants in the injunction action are members of the hospital's board of trustees and current and former staff physicians and nurses. It also includes a CEO who left four years ago and whose whereabouts are unknown.
The injunction request claims that Mithoff wants to use privileged information as evidence in his case. Included in that material is a document that allegedly shows how CHS ranks its "Top and Bottom 20 Doctors"-- by average length of patient stay versus cost to the hospital.
In an affidavit, Cleveland Regional CEO Ron MacLaren stated, "It appears from The Houston Press article that these physicians made unauthorized disclosure that was only known to those involved in the committee and credentialing process."
According to the TRO action, Kreit's and Wisiackas's assertions were also "false, defamatory and disparaging to Cleveland Regional Medical Center."
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But Spalding says the hospital is over-reaching.
"The TRO asks for these doctors not to talk about anybody who ever asked for privileges, or sought privileges, or had privileges at the Cleveland Hospital," Spalding says. "Does that sound a little overbroad to you?"
He also says some of the 16 people on the TRO are allied with the hospital and would never talk about alleged unethical procedures. He says the hospital listed more names than necessary as a subterfuge to tape the mouths of true objectors like Kreit.
"Some of those people, it's a joke," he says. "They would never have disseminated information because they're in cahoots with the hospital."