Leadership at New Hampshire’s Catholic Medical Center missed numerous “early warning signal[s]” in handling a series of challenges involving a troubled former top heart surgeon, concluded a sobering new report from an outside law firm commissioned by the hospital.
The report cited a breakdown in trust between leadership and doctors, serious problems with quality management and peer review systems, and failures by both senior leadership and trustees in handling concerns about Dr. Yvon Baribeau, a once-celebrated cardiothoracic surgeon who has amassed one of the nation’s worst surgical malpractice records.
Baribeau’s care for eight patients that later resulted in malpractice settlements was never subjected to standard peer-review practices by fellow doctors, according to the report released Wednesday by Horty, Springer & Mattern.
“In retrospect, an argument could be made that more should have been done to discipline Dr. Baribeau over the years,” the lawyers wrote.
“It is imperative that CMC develop an action plan” to address these problems, the report stated.
“As an important next step,” the report continued, “it will be necessary for Board members, Senior Leadership and [medical executive committee] members to recognize, accept, and acknowledge their responsibility for the events of the past. Then, and only then, can the healing begin in earnest.” The medical executive committee is charged with upholding physician standards.
The hospital’s board of trustees hired the Pittsburgh law firm last October to review how the 330-bed Manchester facility oversees patient care, after a Globe Spotlight Team series in September revealed that executives knew for years how dangerous Baribeau had become, yet let him continue to practice.
The heart surgeon, who abruptly retired in 2019, has 21 malpractice settlements linked to his work at the hospital, including 14 cases in which he was accused of contributing to patients’ deaths.
During his tenure, alarmed doctors tried to get Baribeau barred from surgery, but hospital leaders resisted, the Globe reported. The HortySpringer report found that hospital leadership sometimes had a dismissive attitude toward doctors.
Catholic Medical Center chief executive Alex Walker said in a statement that “I accept the findings of this independent review and I take responsibility for them, especially those areas where we have fallen short and could have done better.”
And Walker promised improvement: “I am committed to building on the strengths identified in the report and working to implement the recommendations necessary for us to improve and move forward.”
Hospital board chair Timothy Riley added, “[W]e must hold ourselves accountable and learn what could have been done better.”
But some doctors who previously raised concerns about Baribeau expressed disappointment with the report.
“I think the report is a failure. I don’t think it painted a complete picture, and I don’t think it went far enough to rectify the situation,” Dr. William Kelley, an anesthesiologist at the hospital, told the Globe. “It didn’t go far enough in assigning accountability.”
HortySpringer attorneys Susan Lapenta and Henry Casale reviewed more than 300,000 pages of documents and interviewed more than 90 people for the report, which also faulted Baribeau himself.
“Despite being highly skilled and technically proficient, Dr. Baribeau had occasional cases that raised serious concerns about his judgment and decision-making,” they wrote. “When confronted with concerns about these cases, Dr. Baribeau rarely accepted responsibility and instead seemed to deflect attention away from himself by questioning the process and/or the care provided by others.”
Baribeau declined to speak with the HortySpringer team, on the advice of his attorney, they wrote. Through his attorney, Baribeau also declined to comment for this story.
There were “significant shortcomings” in the hospital’s peer-review practices through which doctors evaluate the quality of care, noted the HortySpringer attorneys. They found that “some of Dr. Baribeau’s cases were not reviewed through the peer-review process, including some cases that resulted in a death or serious complication.”
The peer-review process was compromised in part by a breakdown in relationships between administrators and physician leaders, which “led to a significant lack of trust, respect, and communication,” Lapenta and Casale reported.
Other than assessing the peer-review process, HortySpringer “was not charged with reviewing medical procedures performed by Dr. Baribeau,” they noted.
The report cited several “extremely difficult challenges” the hospital faced over the last several years. “Instead of adopting a proactive, evaluative approach, CMC leadership adopted a more defensive strategy. Valuable time and credibility were lost,” Lapenta and Casale stated.
They cited actions by hospital leaders ”that were viewed, by many, as retaliatory” against certain physician leaders. “These events fostered distrust of Senior Leadership and fed into the perception of a culture of retaliation,” the report stated.
Administrators also “seemed focused on controlling employed practitioners,” Lapenta and Casale wrote. “[I]t was reported that Senior Leadership did not welcome, invite, or value the input of employed practitioners, but rather made comments such as: ‘the best employees are the ones I never hear from.’”
“Well qualified, committed physicians” and other providers “are difficult to find and harder to keep,” the lawyers stated. “Senior Leadership should take steps to develop and maintain meaningful relationships with Medical Staff members . . . by engaging them in problem solving rather than sidelining them.”
HortySpringer also cited problems with the board of trustees, including a failure to ask tough questions about Baribeau.
When the board was informed of 17 malpractice claims against Baribeau in 2020 and approved the settlement of those claims, trustees “should have asked probing questions” of senior leadership, the report stated, and should have “held the responsible members of Senior Leadership accountable” after CMC settled a federal whistle-blower lawsuit in 2022.
The report also found Catholic Medical Center misrepresented documents on its stroke program that were submitted to the Joint Commission, which accredits hospitals, an offense unrelated to Baribeau that is “very serious.”
It recommended the hospital improve its quality management program, which “lacks the necessary leadership” and uses “antiquated information systems.”
As it moves forward, the HortySpringer attorneys stated, the hospital’s leadership “will have to be candid and honest” and “will have to acknowledge and accept accountability for past actions.”
Hospital leaders promised change, but also said they would stand by Walker, a longtime executive who took over as CEO in 2021.
“We trust Alex Walker’s leadership skills, values and commitment to CMC,” said Riley, the board chair. “We have charged him to begin developing a collaborative process . . . to implement the recommendations in the report.”
Last year, Walker defended the hospital’s quality-review process, stated that Baribeau was treated just like every other doctor, and suggested that staff criticism of the surgeon was prompted by personal grudges or competitive jealousies. “Dr. Baribeau was absolutely among those folks that were revered,” Walker told the Globe at the time.
Doctors raised questions about the current administration handling the challenges the hospital faces.
“I don’t see how we can move forward and gain the respect and trust back of the people of Manchester and New Hampshire while the current leadership remains,” said Dr. Weldon Sanford, the hospital’s chief of pathology, and one of many physicians who previously expressed concerns about Baribeau.
For months, the HortySpringer team has explored issues including the way leadership handled such concerns.
“Based on our review, we found that the Boston Globe articles, in general, accurately reported critical patient care events and concerns at CMC,” wrote Lapenta and Casale. “At the same time, we found that in several key areas the articles did not completely report underlying events or fully reflect the complexities of hospital operations.”
In recent months, Catholic Medical Center has faced considerable financial and leadership challenges, including a wave of departures by executives. Since last September, the hospital’s chief financial officer, chief operating officer, and chief medical officer are among top administrators who have left or announced plans to do so. Dr. Louis Fink, executive medical director of the hospital’s New England Heart & Vascular Institute where Baribeau worked, announced his planned retirement in September.
Catholic Medical Center’s bond rating has also dropped in recent years, and last October, Moody’s Investors Service revised the hospital’s outlook from stable to negative, indicating that Moody’s believed the hospital’s current Baa3 rating might sink further into “junk bond” status.
The report also comes amid a broad ongoing investigation by New Hampshire’s professional licensing agency into whether former Catholic Medical Center administrators endangered public safety by failing to report problems with Baribeau, as reported by the Globe in March.
The investigation by the state’s Office of Professional Licensure and Certification, which oversees the running of the New Hampshire Board of Medicine, is focusing on two doctors who were top administrators at the hospital, according to people with knowledge of the matter who asked for anonymity because they are not authorized to discuss the confidential probe. The OPLC is investigating whether those administrators failed to report disciplinary actions or restrictions in privileges involving Baribeau to the medical board, the sources told the Globe.
Throughout Baribeau’s quarter-century tenure at Catholic Medical Center, he appeared to have a perfect record on the medical board’s website, despite a 28-day suspension of privileges by the hospital in 2013, for inappropriate patient care.