NY hospital is fined for unnecessary surgeries

The New York State Health Department has fined Parkway Hospital $32,000 for its failure to prevent and address unnecessary urologic surgeries performed on 12 patients from a home for the mentally ill.

State Health Commissioner Antonia C. Novello, MD, MPH, DrPH, recently announced that the department cited Parkway Hospital for deficiencies related to systemic problems concerning the lack of proper patient consent, diagnostic testing, and assessments of the health risks associated with such invasive procedures, thereby violating the rights of patients and compromising their health and safety.

"This is the final chapter in this case," Novello said. "New York State will not tolerate such cavalier actions as the ones taken by the two doctors in this case. Both doctors’ knowing efforts to deceive the very patients entrusted in their care is unconscionable, and the hospital’s failure to respond swiftly and appropriately after receiving staff complaints about the unnecessary surgeries is gross negligence of the worst kind."

Novello said the patients were admitted to the Parkway Hospital from the Leben Home for Adults with invalid consent forms on a Thursday afternoon, were operated on, stayed in the hospital over the weekend, and were transferred back to Leben Home the following week. None of the patients had any prior history of illness to dictate the type of surgeries performed.

"Beyond the two doctors’ calculated manipulation of these patients, perhaps the most disturbing part of this case is the fact that the hospital failed to take necessary actions in the face of staff complaints," Novello said.

The New York State Board for Professional Medical Conduct disciplined the two doctors involved in this case earlier this year. The board revoked the license of one doctor and suspended the license of the other doctor for practicing fraudulently and willfully filing a false report.

In May 2001, Novello ordered that the Leben Home for Adults’ operating license be suspended and that MediSys Health Network Inc. (a not-for-profit organization that operates other hospitals) be installed as the temporary operator of the Leben Home to ensure that the residents are protected from any further endangerment to their physical and mental health.

As a result of the State Health Department’s investigation, Parkway Hospital was cited for 16 violations of the State Hospital Code, resulting in a maximum fine of $32,000. Deficiencies were cited in the areas of: Governing Body, Medical Staff, Quality Assurance Program, Patients’ Rights, Surgical Services, and Laboratory Services. The proposed fines amount to $2,000 per violation, the maximum monetary penalty allowable under the law.

The hospital is required to submit a Plan of Correction describing how each of the identified deficiencies will be addressed, what corrective actions will be taken, and the protocols to be implemented to insure that similar violations do not recur in the future. Parkway Hospital will also be required to submit quarterly reports to the department for a period of one year, commencing with the effective date of the stipulation and order. These reports shall detail activities undertaken to implement corrective actions and include an assessment of the effectiveness of those corrective measures.

Specifically, the department’s investigation found these problems:

  • The hospital failed to prevent or address unnecessary urologic surgery on patients transferred from the Leben Home despite complaints from staff about the propriety of these admissions.
  • Patients arrived with signed consent forms executed at the Leben Home, even prior to being evaluated by the physician in his office. Some of the patients did not know why they were being hospitalized, and it did not appear as though they were able to provide informed consent.
  • Patients received inadequate pre-surgical evaluations. There was no documented evidence that risks and benefits of the proposed procedures, and alternatives for care or treatment, if any, were disclosed to mentally incompetent patients who arrived at the hospital with signed consent forms.
  • Not all records documented a review of the patients’ overall conditions and health status prior to surgeries, including the identification of a patient’s potential surgical and cardiac problems. There was lack of valid evidence to suggest that any of the patients were in need of the surgeries performed.
  • The pathologist did not re-weigh specimens resulting from the surgeries during gross examination. In order to verify the necessity of the procedure in the first place, a certain amount of tissue needs to have been removed during the procedure for analysis. The pathologist inappropriately accepted the weight of specimens, as obtained by the operating surgeon in the operating room.