Massachusetts General Hospital is rightly celebrated for many great things. Admitting mistakes is not one of them.
That’s a key takeaway from the fall-out over double-booked surgeries at the hospital. The practice, which allows surgeons to oversee two operations at the same time, was revealed in 2015 by the Boston Globe Spotlight team. At the time, Dr. Peter Slavin, president of Massachusetts General Hospital, told the Globe, “We haven’t found a single case where the concurrency has caused a harm, so I don’t think patients should be alarmed by it.”
Fast forward to November 2019, when MGH settled for $13 million with a doctor who challenged the safety of such surgeries, and was fired, allegedly for breaching patient confidentiality policies. As the Globe’s Jonathan Saltzman recently reported, hospital records disclosed through the lawsuit filed by Dr. Dennis Burke also show that double-booking was mentioned as a factor in the bleeding death of a patient whose surgeon was juggling two operations, back in 2010. Meanwhile, a Canadian study, released in 2017, also concluded overlapping surgery can pose health risks.
That sounds like cause for serious introspection. Yet the day the Burke settlement was announced, Slavin and Dr. Timothy Ferris, who heads the hospital’s physicians’ organization, e-mailed a statement to the hospital community that said: “Mass. General strongly defends and stands by the decisions it made along the way.” And to the Globe, the hospital said it “stands by the information it gave to the Globe Spotlight Team in 2015 as well as decisions made throughout the course of this matter.”
MGH is a great medical institution that attracts the finest clinicians and research scientists in the country. I am grateful for treatment received there by my own loved ones. The academic brand is so strong that after 25 years, Partners HealthCare — the parent organization of MGH and Brigham and Women’s Hospital — just announced a name change to Mass General Brigham. But amid all that greatness lurks a weakness — leadership that dislikes being questioned, and is less than honest about institutional blunders. That’s the clear message from the double-booking saga.
Burke first flagged concerns about double-booking within his department in 2008. In 2010, he told superiors. In 2012, he brought his concerns to the attention of the state medical board. He was fired in 2015, supposedly for improperly releasing hundreds of his own patient records, with names redacted, to the Globe Spotlight team. But he always believed it was because of his whistle-blower role.
While debunking Burke’s worries, MGH, meanwhile, commissioned an investigation in 2011, conducted by lawyer Donald K. Stern. Its findings have never been made public, even though the judge overseeing the Burke case ruled there was no justification for keeping them secret.
Other MGH documents disclosed in court pleadings document internal efforts to address double-booking — after Burke raised concerns and after Stern’s report. Minutes from a December 2011 meeting of the surgical coordinating committee note that John Belknap, the chief compliance officer “presented on the frequent occurrence of surgeons running two rooms simultaneously” and discussed the need “for an updated policy." The minutes also say, “Patients have asked who will do their procedure and receive an ambiguous answer.” Three years after a policy was supposedly put in place, minutes from a December 2014 meeting refer to “violations.”
Anticipating the 2015 Spotlight story, Dr. Keith Lillemoe — the chief of surgery — wrote to colleagues, “One question that is anticipated is do we monitor this practice for quality and patient safety. The truth is, we probably have not.” After the Spotlight report, when state investigators were inquiring about the Stern report, Belknap told Dr. David Torchiana, then head of the MGH physicians’ group: “I have been giving them as little as possible while telling the story of the hard work we’ve done on this over the years. . . . As you know, there are some details in that policy that we are not yet compliant with, so if at all possible, I’d like to keep it from them.”
MGH contends it has reformed its double-booking practices. But how does the patient really know — especially when MGH is not really acknowledging any mistakes?