More details have emerged about why Summa Health System recently lost its accreditation to teach future emergency medicine doctors, including concerns about patient care.
A report obtained by the Beacon Journal shows surveyors with the accreditation group found patients were being sent home from the emergency room after being seen only by residents, not the supervising emergency room physicians, including after residents said they asked for help. The on-site visit last month also found delays in getting specialized care for patients with trauma and possible strokes.
The new teaching staff also lacks the expertise needed to train the new doctors, and has told the residents that the faculty “will be gone in a month,” according to the report.
In one section of the report, Dr. Thomas J. Nasca, the chief executive officer of the Accreditation Council on Graduate Medical Education (ACGME) states: “The physicians in place are faculty in name only but do not fulfill even the most basic of duties and expectations of faculty. Moreover, since they will be gone within a short period, they are not truly the permanent faculty of a program but merely have the title in an attempt to meet the letter of the requirement.”
The 18 pages provided to the Beacon Journal summarize findings and recommendations from the ACGME signed by the organization’s CEO. They include allegations made in the original complaint, the site visit findings from the ACGME surveyors after a visit on Jan. 24, and Nasca’s recommendations. The full report is approximately 150 pages and includes letters and other evidence submitted to and by ACGME.
The loss of accreditation, effective July 1, came after Summa abruptly switched ER staffing groups on New Year’s Day from Summa Emergency Associates (SEA) to Canton-based US Acute Care Solutions (USACS) after failed negotiations. Both Summa and USACS have said they will appeal the decision.
Report disputed
On Friday, spokesmen for Summa and USACS commented briefly. Summa spokesman Mike Bernstein reiterated that out of respect for ACGME, Summa would not be commenting on the report and reissued the same statement he released earlier this week, including that the hospital would be appealing the decision and stands with USACS, which will continue to staff the emergency rooms.
USACS spokesman Marty Richmond said, “We dispute many of the specific findings of the ACGME and will include all in our appeal.” Richmond said the finding that patients were seen and sent home without being seen by an attending physician were not true and “every patient has been seen by a board-certified physician. An attending has seen every patient.”
The findings are the same ones reported earlier this week by the Beacon Journal, but the report goes into more detail and, in many cases, the ACGME takes the hospital and the new teaching staff to task for not meeting requirements.
One part of the report read: “First year residents and rotating residents have been seeing patients without attending supervision. Patients have been sent home without being seen or examined by an attending. Since the attendings do not know hospital protocols there have been delays activating consulting services such as the Stroke or Trauma Teams. While residents have observed care that they feel is unsafe, they have not reported the issues due to fear of retaliation.”
Details concern expert
When told of that incident and others in the report, Dr. Robert McNamara, a Temple University emergency medicine chairman who has served on ACGME accreditation teams, said that while he can’t say for certain that there were patient care issues, the findings are concerning.
“That’s a resident who, it sounds to me, is asking for help and not getting it. That’s not a position you want someone in training to be,” said McNamara, former president of the American Academy of Emergency Medicine.
Other parts of the report include several references to the lack of experience of the new core teaching faculty, including the program director. There are also observations that while some of the new teaching faculty have some prior teaching experience, it had been more than five years since others have taught in an emergency room and “most have had administrative positions at USACS prior to appointment as faculty.” There are references to other doctor staff, not teachers, who spend four to seven days at Summa, supplied by USACS.
The report also notes that the new teaching staff does not have the required academic publications and research qualifications.
Different program
Nasca, the ACGME CEO, also said: “The program, at the time of the site visit, bears little resemblance to the program previously accredited by the ACGME’s Residency Review Committee for Emergency Medicine. The program appears to be an educational program in name only. The implementation of the curriculum has been suspended, residents are providing service to patients which is inconsistently supervised, faculty are transients in the clinical care environment and not knowledgeable of institutional systems, policies and procedures. There is no plan for faculty and resident research. Residents have been intimidated by institutional officials.”
Richmond, the USACS spokesman, said that “the program does not resemble the previous program because the prior physicians walked off the job. We are capable of rebuilding and running this program, just as we do at nine other institutions in the country.”
Summa officials also have said SEA doctors walked off the job. SEA leaders have disagreed, saying they stayed until all patients were seen and transferred to the new USACS doctors after midnight on Jan. 1.
McNamara said he believes that when Nasca talks about the program bearing little resemblance to the former program, it is recognition that the SEA physicians’ program was accredited. If there’s any truth to tips that the Summa board might be considering bringing SEA back, McNamara said, it could maybe have a bearing on changing ACGME’s decision. But it’s no guarantee, he said.
The report, “if anything, it’s strengthened my belief that [USACS] is not going to win an appeal” on its own because its staff does not meet requirements, he said.
But even if SEA comes back, McNamara thinks Summa would still get probationary status and have to work on getting full accreditation.
The report also said the change was made without weighing its impact on education or the working environment for residents.
Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty