The Blue Ribbon Commission, an independent panel of healthcare experts, in response to negative media attention from the three infant deaths last year, recently released its general evaluation of the Stony Brook University Medical Center (SBUMC).’ While the report found that ‘there were no systemic quality failures at the Stony Brook University Medical Center,’ much of the report was devoted to describing shortcomings at SBUMC.’ Areas of improvement, according to the report, include lines of communication, reorganization of administrative duties, and ways to move forward regarding the pediatric cardiac surgery program.
The findings, according to the BRC report itself, were in accordance with evaluations from the Joint Commission on Healthcare on Accreditation of Healthcare Organizations (JCAHO) and Centers for Medicare and Medicaid Services.
Regarding the quality of care at the hospital, the report noted, ‘Most SUNY-SB faculty state they have no hesitancy in having their family or themselves cared for at Stony Brook.” However, ‘Most feel that the full potential of the institution is greater than its present performance.’
The BRC was initially created in response to the deaths of three pediatric patients at SBUMC and an order from the New York State Department of Health (NYSDOH) to shut down pediatric cardiac surgery and catheterization services. The BRC report acknowledges the concern of the NYSDOH of having an itinerant physician, Jan Quaegebeur, M.D., primarily situated in Columbia Presbyterian Hospital in Manhattan coming to SBUMC once a week, along with a low volume of cases (50 per year).
These deaths, after review by the BRC, were not attributed to the level of care provided by the pediatric cardiac surgery and catheterization services at SBUMC, but rather to the severe nature of the cases themselves.
The BRC report provides three options for the pediatric cardiac surgery and catheterization services. First, reopening the pediatric cardiac surgery program, pending the hiring of a full-time pediatric cardiac surgeon, while still seeking out a solution for round-the-clock coverage in the event of an emergency.’ Second, maintaining the status-quo, vouching for the high success rate of surgeon Quaegebeur, while making minor changes to the program for safety purposes, including the training of cardiac surgeons for pediatric cases. ‘
The third option, endorsed by the BRC, calls for the hospital to ‘abandon the independent pediatric cardiac surgery option at this time.’
When asked about which of the three options would be a course of action the university is willing to take, university officials simply quoted the high level of care provided by the program and offered no further insight.
Other comments were made in the BRC report concerning the lack of a collegial atmosphere at SBUMC. The press release from the university on Jan. 11 stated, ‘Efforts must be made to strengthen openness and communication in both directions between leadership and faculty, to foster greater collegiality among the various specialties and disciplines, to ensure proper cooperation among the School of Medicine, the hospital, and Faculty Practice Plan.’
However, the BRC report went much further in recounting the problem.’ The report states, ‘Faculty commonly describe the atmosphere of the Medical Center as ‘lacking transparency’ and ‘opaque.” Many faulty report that there is no effort to engage them in understanding where the institution is heading and in enlisting them as a whole in marching under one flag.” It goes on to say, ‘The result is that ‘silos’ predominate, with each department or unit looking narrowly into its own issues, with a resultant further decrease in the culture of collegiality.’
Many faculty members feel, according to the report, ‘Some issues appear to be swept under the rug.’ Whether the reasons are justified or not, when kept from awareness of the staff the handling of such issues can be interpreted as biased and inappropriate decision-making on the part of the leadership. In the absence of candor and effective two-way communication, perceptions, right or wrong, become the reality for individuals in whom those perceptions arise.’
In response, the University cites the implementation of Town Hall meetings as a means of increasing collegiality and openness of the campus.
Steven L. Strongwater, M.D., the newly instated CEO of the medical center, commented, ‘To maintain an appropriate level of communication, Dean Richard Fine and I will continue to hold Town Hall meetings updating the medical center, campus, and community physicians on developments at the hospital. Several of these meetings have already been held.’
Town Hall meetings, however, were not mentioned anywhere in the BRC report, even though the interviews performed for the evaluation were conducted after initial meetings were held.’ It remains to be seen if the University’s plan to create an open, less ‘opaque’ atmosphere from these meetings is effective.
Several other concerns were stated in the BRC report with regard to the relationship of the medical center to the SUNY system. There has been a rising movement from the State to find ways to reduce the rising costs in the state health system, as seen with the formation of the Berger Commission, also known as the New York State Commission on Health Care Facilities in the 21st Century. Recently, legislation was proposed by State Senator Kenneth LaValle for splitting the Hospital and University as well as the creation of a 15-member governing body to oversee hospital operations. As seen from reports in local news, this movement has been quelled temporarily in an agreement between President Kenny and LaValle to hold off on the legislation, pending the implementation of such a governing body.
The BRC report describes the outlook for a split in terms of the university’s research endeavors, ‘To separate the medical school with easy interaction with diverse colleagues throughout the university is, in our opinion, a move to hamper medical school scholarship, research innovation and clinical advance.’
Strongwater stated, ‘There is no movement to separate the hospital from the university. The Berger Commission did not recommend privatization of SUNY hospitals; it has merely recommended a review of the feasibility and advisability of privatization. The Blue Ribbon Commission strongly supported the idea of keeping the university and hospital together.’
Questions of leadership at SBUMC were also addressed in the BRC report. When asked about the prospect of moving forward with the tentative Kenny/LaValle agreement, as described above, CEO Strongwater said, ‘The SUNY Board of Trustees has delegated by resolution to the university president the role of governing body of the hospital. According to regulation, the governing body is ‘legally responsible for directing the operation of the hospital in accordance with its mission.”
The BRC explicitly states, ‘We cannot emphasize too strongly that operating decisions should not be made by the governing body, that is, the President. The responsibilities of the President are too vast, overseeing all of the University, to have day-to-day understanding of the complexities of each school in the Health Science Center (HSC). And where President Kenny’s background is in the liberal arts, we feel she needs a highly respected and well-organized Vice President of Medical Affairs with a background in academic medicine to serve as an intermediary between her policy making and the operations of each health sciences school.’
The BRC report also mentioned, regarding the proposed Vice President of Medical Affairs position, ‘Such an integration of complex responsibilities has not happened since Dr. Oaks departed, to the detriment of Stony Brook.” Dr. Howard Oaks was the Vice President of the Health Sciences Center.
Strongwater stated, ‘The Blue
Ribbon Commission was very thorough and we are reviewing the recommendations very carefully. For instance, an advisory board for the hospital is already being developed.’
The Blue Ribbon Commission (BRC) was composed of five individuals: Mitchell T. Rabkin, M.D., Chair; Aram V. Chobanian, M.D., Paul Hickey, M.D., Gilbert S. Omenn, M.D., Ph.D., and Charles Young, Ph.D. These five individuals were assembled by the Washington Advisory Group/LECG, which, according to the group,’ ‘provides strategic counsel and management consulting to companies, universities, governments and non-profit organizations with a focus on research and development and higher education.’
As a parting remark, the BRC offered its thanks and hope for the future. ‘We are grateful to the administration, faculty, and staff of SUNY, the Medical School and Hospital for their candor, trust, and cooperation. We trust that the recommendations of this ‘Blue Ribbon Commission’ will be widely shared within the University and will assist SUNY Stony Brook and SUNY in working towards their status envisioned at its founding; Stony Brook University Medical Center has the potential to do so.
James Bouklas, Tejas Gawade, and Will James contributed reporting.
