The Joint Commission on Accreditation of Healthcare Organizations caused an industrywide stir last year when it announced tough new guidelines requiring all hospitals to inform patients when the outcome of their care does not measure up to accepted standards.
But even those new rules apparently do not apply to the bizarre, highly publicized case of Mount Auburn Hospital, Cambridge, Mass., where top administrators waited nearly four weeks to tell a patient that his Harvard-educated surgeon had left him unconscious on the operating table for 35 minutes while cashing a paycheck at a local bank.
The reason: the JCAHO's rules, which took effect July 1, 2001, require hospitals inform patients about the "outcomes" of their care, and not necessarily the "process" of that care, said Richard Croteau, M.D., executive director of strategic initiatives at the Oakbrook Terrace, Ill.-based accrediting agency.
In this case, according to officials at Mount Auburn, the patient, Charles Algeri, did not suffer any untoward medical outcomes directly related to the untimely departure of his physician, David Arndt, M.D.
"We do encourage organizations and their physicians to be as forthcoming with their patients as is consistent with good practice," Croteau said. "But I have to make a distinction as to what we encourage and as to what the standards explicitly require. (The standards) address only the outcomes."
Still, Algeri's attorney, Marc Breakstone, alleges that Arndt's behavior did affect the outcome of the complicated procedure for his patient, who lost a significant amount of blood after the July 10 operation and now suffers from pain in one leg. What's more, Breakstone said, his client was treated primarily by physician assistants during his five-day recuperation.
"For the hospital to make a statement that he was unharmed and is progressing normally is a groundless misrepresentation of the facts," Breakstone said. "This is an attempt by them to justify not telling the patient about this doctor."
The hospital's chief spokesman, Michael McConnell, did not return repeated calls requesting comment on the case. Mount Auburn was most recently accredited by the JCAHO in January.
Algeri's case has prompted lawmakers in Massachusetts to consider legislation that would require hospitals to tell patients when doctors lose their privileges, and to inform them about all unexpected errors and events in their care, a measure that would go one step further than the JCAHO's rules.
In contrast to their slow reaction in informing Algeri, officials at 183-bed Mount Auburn wasted little time disciplining Arndt, 41, an orthopedic surgeon who graduated from Harvard University Medical School in 1992. He was suspended one day after the incident.
But those same administrators waited 27 days to tell Algeri about the actions of the inattentive doctor and then did so by telephone, only hours before the state medical board was scheduled to publicly announce the suspension of Arndt's license at an Aug. 7 news conference.
Algeri said his disappearing doctor visited him twice in the hospital after the surgery, even though his privileges had been suspended-a violation of hospital policy.
"Why did they wait until the night before the headline news stories to tell me that my doctor abandoned me and that he had lost his privileges to treat me?" asked Algeri, 45, a taxicab driver who lives in nearby Waltham. "For the five days I was in the hospital and the two weeks in rehab, I thought Dr. Arndt was my doctor."
The case triggered an inquiry from the JCAHO, which contacted Mount Auburn shortly after the state medical board's press conference to request a response to "certain questions" about the case, agency officials said. The 30-day response period has not yet ended. Depending on that response, officials could follow up by sending inspectors to Cambridge for an on-site survey.
In a statement, the hospital said, "Mount Auburn Hospital is dedicated to excellent patient care and maintains high standards of care. Those standards were breached in this incident."
Many key elements of the case are in dispute, but Croteau acknowledged the absence of a surgeon for 35 minutes during a delicate spinal-fusion operation might have contributed to an adverse outcome of some kind. If that is found to be true, he said, the hospital could be cited for failing to comply with the JCAHO's new standard of care.
Yet he also said the guidelines, strictly interpreted, call for hospital officials to describe to patients only the outcome of the procedure, good or bad. They do not, he said, require officials to cite any reasons why those outcomes may have occurred, meaning administrators at Mount Auburn might still have been in compliance with the new regulations if they spoke to Algeri about problems with blood loss yet failed to reveal that his surgeon left him for 35 minutes in the middle of the procedure.