Recovery in works at Md. General

Scandal-scarred hospital makes changes that aid in regaining its patients and its credibility

Special Report

July 17, 2005|By Julie Bell | Julie Bell,SUN STAFF

Peggy Dowdy wasn't sure whether to trust the place. Maryland General Hospital workers had sent out hundreds of HIV and hepatitis test results that they knew might be wrong. As she met in April with her new doctor in a hospital office building, last year's laboratory scandal weighed on her mind.

The West Baltimore resident wondered whether the doctor would act responsibly as he diagnosed her nosebleeds, the ringing in her ears, the numbness in her arms.

But Dr. Agha Khan was kind, and Dowdy was reassured.

"I heard in the news about the blood thing, the HIV thing," Dowdy said as she left her appointment with Khan. "I was thinking, `Oh, my God. They're going to cut me open and make a mistake on me.

"But he put me right at ease."

Sixteen months after the lab breakdown scared away patients, they are coming back to Maryland General. One at a time, the hospital that has served West Baltimore's ailing poor for more than a century seeks to persuade them that it is still worthy.

As it deals with the distrust generated by the lab, Maryland General also confronts deeper problems. From at least the mid-1990s until spring 2004, the hospital's board and a changing cast of top executives failed to act quickly as oversight systems designed to protect patients failed, according to The Sun's review of regulatory documents, accreditation reports, lawsuits and internal hospital letters, as well as interviews. The oversight breakdowns, The Sun found, sometimes had deadly consequences.

But now, since the lab scandal, the University of Maryland Medical System, which oversees the hospital, has pushed ahead with an ambitious plan. It wants to turn the urban hospital that serves about 12,000 inpatients a year, most of them uninsured, into a national model.

"Our objective," said system Chief Executive Officer Edmond F. Notebaert, "is to restore it to what it ought to be, make it an urban success story."

Overhauling, oursourcing

The University of Maryland Medical System has taken a comprehensive approach, overhauling hospital management, outsourcing entire departments and instituting ways to monitor quality and hold its executives, physicians and nurses accountable.

It is too soon to tell whether the moves are working. But a barometer of their early progress can be found in physicians such as Khan.

Though he is Maryland General's chief of neurosurgery, Khan said he had cut back his practice at the hospital over the past several years amid concern that management lapses, like those that finally surfaced in the lab, made it dangerous to perform complex operations there. But with the recent changes, including a promised unit for special care of stroke victims and neurosurgery patients, Khan is handling more cases at Maryland General.

Something about its possibilities, and its sometimes desperately needy patients, made him stay, even as the hospital descended into a nightmare of its own making.

"This is an area that needs help," Khan said of Maryland General's neighborhood, "and this is where resurrection is going to occur."

Notebaert and other system officials say some of the improvements under way began before the lab scandal, and they dispute that Maryland General had systemic problems. It has been, Notebaert said, a "fundamentally good hospital."

Even elite institutions experience harmful medical errors. But at Maryland General, oversight systems every hospital must have to ensure proper care broke down repeatedly. Interviews, public records and internal hospital documents show that the hospital was particularly lax in dealing with issues of physician competency.

Among the doctors who received and retained practicing privileges were an anesthesiologist who was asked to resign from his previous hospital after the death of a patient, and physicians who had been sued more than a dozen times, including a neurosurgeon who had been sued at least 19 times.

Residents in the hospital's obstetrics department did not have proper around-the-clock supervision, Maryland General's former insurer said in 2002, while half its anesthesiology department was made up of doctors who were not board certified, meaning they had not passed a major test of expertise in their specialty.

Maryland General's insurer tried to cancel the hospital's policy effective January 2002. A key reason, the company said later, was an "overall increase in professional liability suits/claims arising out of direct negligence" by staff and doctors.

The OHIC Insurance Co. identified a managerial breakdown: Hospital officials repeatedly failed to screen out problem physicians and didn't seem to know that Maryland General's attorney had missed court deadlines, failed to file important documents or simply didn't show up in court.

Lab trouble arose last year

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