By: Dr. Padmanabhan – May 2013
Readers of the Valley Patriot are aware of the totally avoidable death of Brian Evans’ mother, an incident reported on exclusively by this paper. The issues raised by this incident have far-reaching implications for everyone in Massachusetts and the country. I shall focus on one in this column.
Brian chose Holy Family Hospital as the place to provide his mother’s medical treatment based on a quality ranking of A, certified by a consultancy called the Leapfrog Group in Boston. Leapfrog issues rankings in the form of grades A, B, C etc. We are supposed to believe that Hospitals ranked A by Leapfrog provide excellent care and are a safe place to take our loved ones to.
Let us now examine that assumption.
The Leapfrog Group consultancy was founded by Dr. Lucian Leape at the Harvard School of Public Health. Interestingly his webpage at Harvard says many things but neglects that little detail [http://www.hsph.harvard.edu/lucian-leape/]. Through the auspices of a private nonprofit organization that calls itself the Institute of Medicine, Dr. Leape published a report on the vast danger of medical errors and recommended his consultancy by name in this report to help hospitals reduce errors.
Leapfrog on the other hand, advertises to the hilt the names of Dr. Lucian Leape and his colleague Dr. Ashish Jha, also at Harvard, as a way of legitimizing its rankings. We are supposed to believe that a Leapfrog rank of A actually means that the hospital provides the highest quality care possible, and provides the highest level of patient safety because it is associated with Dr. Leape and Dr. Jha at Harvard. The report in the Boston Globe last year on Leapfrog’s rankings certainly gave us that impression.
Leapfrog’s rankings are sought after by hospitals because of the huge sum of cold cash that accompanies a Leapfrog ranking of A. The cash comes from all of us via Medicare and private insurance companies who set aside a sum every year as a reward for hospitals who get a Leapfrog ranking of A. Typically, this bonus payment is in the hundreds of thousands of dollars every year.
Obamacare helps Leapfrog directly by further docking payment to hospitals who do not get a high rank. US Health Secretary Kathleen Sebelius and Dr. Leape together headlined last year’s annual meeting of the American Medical Students Association. And Sebelius’ Department of Health and Human Services paid for Dr. Leape’s keynote address at that symposium. Our tax dollars at work, directly paying for a generation of new doctors trained to unquestioningly worship at Dr. Leape’s altar.
Leapfrog of course does not issue it’s A for free. You have to pay them. But you pay them happily because you know Medicare and private insurance are going to shower you with bonus payments that will more than make up for the initial purchase of the Leapfrog ranking. It is no different from people throwing their money at Bernie Madoff.
That’s how it works.
What Brian Evans tragically discovered when his mother was left to die at Holy Family Hospital despite a Leapfrog ranking of A is what I personally discovered when I worked at Cambridge Hospital, also a happy recipient of an A from Leapfrog.
In Cambridge’s case, a hospital that commits major medical errors and refuses to do mandatory analyses of them or report them to relevant authorities, the irony is even richer as Dr. Lucian Leape is a Trustee of the hospital himself and has published finger-wagging papers on changing the culture of medicine using Cambridge as an example to be emulated.
The latest press release from Leape’s Institute, from March 10, 2013, includes his statement –
“Because they are powerful role models, all clinical faculty need to be the kinds of physician we want our students to become,” said Dr. Leape.
Of course Cambridge had to get a Leapfrog rank of A. It would take the shine off the rank considerably if Dr. Leape’s own hospital did not. The entire scheme would be at risk.
In the category called Leadership Structures and Systems, it is described as follows –
“Leadership failure is one of the most frequent causes of unexpected events that cause the injury or death of a patient. Studies reveal that failure in reliability and systems performance stems from inconsistent execution. Leadership structures and systems must be established to ensure: organization-wide awareness of patient safety performance gaps, direct accountability of leaders, investment in performance improvement abilities, and that action is taken to ensure safe care of every patient..” Dr. Leape’s Cambridge Hospital has been awarded the full 120 marks out of 120, the same as Massachusetts General Hospital.
After all, that category deals directly with Dr. Leape himself.
It is no wonder thus, that Brian Evan’s mother was neglected to death by a hospital with a Leapfrog ranking of A. Any Hospital has good and bad staff and errors can slip in, but simply going by a Leapfrog ranking of A is sheer folly…and you are unlikely to learn this from the Boston Globe.
Dr. Padmanabhan is board certified Neurologist who specializes in Multiple Sclerosis in the Boston area. You can reach him at firstname.lastname@example.org