Beth Israel fined $14,000 by NY health department

Hospital is warned to clean up its act

Pointing to repeat deficiencies related to quality assurance, provider credentialing, and incident reporting, the New York State Department of Health has cited Beth Israel Medical Center in New York City for seven violations, resulting in penalties of $14,000 against the hospital. The proposed fines amount to $2,000 per violation, the highest monetary penalty allowable under state law.

In announcing the action, state health commissioner Antonia Novello, MD, MPH, said the state investigation revealed that, no matter what motivated Allan Zarkin, MD, to mutilate his patient, the hospital bore responsibility. "I cannot and will not tolerate a situation in which an individual seeking health care is put in harm’s way because of a facility’s failure to monitor its medical staff and the failure to take prompt corrective action once it became aware of the incident," Novello said. "The violations cited against Beth Israel Medical Center are in reference to the lack of oversight of the hospital’s department of obstetrics and gynecology and a failure on the part of administrators to appropriately report the seriousness of the incident once they became aware of it."

In addition to the fines, the state health department imposed these sanctions:

• The hospital will be required to submit a "Plan of Corrections" describing how each of the identified deficiencies will be addressed and what corrective action will be taken. For a period of one year, the hospital must submit quarterly reports to the state health department detailing the corrective actions that have been implemented and assessing their effectiveness.

• The hospital must retain an independent consultant organization, acceptable to the state health department, to conduct an in-depth analysis of the management and oversight of Beth Israel’s department of obstetrics and gynecology and provide a detailed report and recommendations for improvement within 60 days, with a particular focus on the department’s quality assurance and provider credentialing.

• Beth Israel Medical Center must hire an independent consultant to analyze and suggest hospitalwide improvements to quality assurance and credentialing within 120 days. Once the hospital receives either consultant’s report, recommendations must be implemented within 30 days, providing they are acceptable to the health department.

Doctor will not practice medicine again

Also, the health department made final a disciplinary order under which Zarkin surrendered his license to practice medicine. "Dr. Zarkin’s case is an example of what can go wrong in the medical field if reporting procedures are not adhered to and if prompt and decisive actions by health care facilities are not implemented to protect patients," Novello says. "As health commissioner, my top priority is to ensure that patients receive the best health care, and of the highest quality. Because Dr. Zarkin presents an imminent danger to patients under his care, I have done, and will do, everything within my power to ensure that he never again practices medicine in the state of New York."

The health department cited seven violations of Article 28 of the Public Health Law and the New York State Health facilities code. Deficien cies were cited in the areas of governing body, medical staff, quality assurance program, patient rights, incident reporting, and medical records. The department’s investigation focused not only on whether the hospital properly investigated and took appropriate action after the carving of initials incident, but also on the possible warning signs before the incident that Beth Israel failed to act on.

Specifically, the investigation determined that although the hospital conducted a prompt investigation and suspended Zarkin two days after the carving incident, Beth Israel officials did not file a required incident report through the New York Patient Occurrence Report Tracking System.

In a Sept. 28 report to the health department’s Office of Professional Medical Conduct (OPMC), the hospital indicated only that Zarkin had been suspended because his actions toward an obstetrical patient were grossly inappropriate. No details of the carving incident were provided. The health department now reports that "such lack of specificity in reporting was at variance with previous reports submitted to OPMC by Beth Israel which provided explicit reasons for the suspension actions taken against other physicians."

"Despite clear indications a year before the carving incident that Dr. Zarkin’s behavior was inappropriate, Beth Israel officials did not take necessary action," the report says. "There was no documentation of follow-up by the hospital when nurses and physicians first complained to their superiors of strange behavior by Dr. Zarkin."

In December 1998, Zarkin was sent to the hospital’s occupational health service for evaluation, but counselors were not provided with full information about Zarkin, and the hospital subsequently disregarded its own plan to monitor the doctor’s behavior, the health department reports.

The health department also noted the repeat nature of some of the deficiencies, since violations relating to the operation and oversight of Beth Israel’s department of obstetrics and gynecology, as well as the hospital’s quality assurance program, were cited following an investigation into an incident of patient harm in October 1998.

The hospital still faces likely sanctions from federal investigators and the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.