September 3, 2008 > Local quality health care under fire
Local quality health care under fire
By William Marshak
In 1986, mounting unease about the quality of health care in the United States resulted in the Health Care Quality Improvement Act (HCQIA). The impetus for this national legislation was increasing concern about medical malpractice and an effort to restrict the movement of incompetent physicians from state to state with limited or no disclosure of previous activities.
As a result of this legislation, rules and regulations were created for "effective peer review." The challenge to the medical community was to find a method to assess technical information and evaluate fellow practitioner medical decisions that can be open to interpretation and professional judgment. Over the years since passage of HCQIA, peer review techniques have been questioned by those who allege abuse of the system.
Competition and financial conflicts have led to charges of "sham" reviews by some who have been censured for malpractice. However, the medical community, especially a local hospital, is charged with the responsibility for human life and cannot allow poor and dangerous medical care at its facilities. To ignore or condone incidents of incompetence or negligence would be dangerous for the general public and an abrogation of the institution's responsibilities. The difficulty for professional practitioners of any technical art, especially when it directly affects health, is to allow trained members to use their skills without excessive restriction while protecting the wellbeing of those who rely on such training.
Recently, a documentary entitled "Life for Sale" alleged serious charges in regards to peer review and the actions of hospital administrators and staff, especially at Washington Hospital. A local daily newspaper gave significant coverage to this film listing local cardiologist, Dr. Evelyn Li, as the film's "medical consultant." The film was produced by Orb Film Productions. A search of corporate filings with the California Secretary of State reveals a company called "The Orb" which lists Evelyn Li as President. A local theater was engaged to show the film and advertisement purchased.
Records obtained from the Medical Board of California state that several complaints - commonly called an "805" (Health Facility/Peer Review Reporting Form required by Section 805 of the California Business & Professions Code) - against Dr. Li have been reported by St. Rose Hospital dating to May 2005 citing "lack of clinical judgment." As of June 15, 2002, St. Rose Hospital "summarily suspended all clinical privileges." Dr. Li subsequently resigned her medical staff membership and clinical privileges effective February 29, 2008. Washington Hospital has also filed complaints with the Medical Board stating "grave concern regarding Dr. Li's competence" and the fear that "failure to take immediate action could result in imminent harm to patients." Restrictions of Dr. Li at this facility include "proctoring of all admissions and requiring proctor agreement for plan of care prior to admission or treatment of patients because failure to take immediate action could result in imminent harm to patients..."
Anecdotal experiences related by patients and family members in the film point to predetermined conclusions. Interspersed with many minutes of stock footage of street scenes and exterior views of Washington Hospital, a few local physicians are interviewed. Although the majority of questions are asked in general terms, the moderator concludes with dire warnings and specific disparaging comments directed at Washington Hospital. Dr. Li is painted as an outstanding physician who has been subjected wrongly to "sham peer review." Ramineo Rao, M.D., a local vascular and general surgeon, previously head of Washington Hospital Intensive Care Unit, also notes that he was a victim of such practices.
Local physicians Ajit Sandhu, M.D. and Bhupinder Bhandari, M.D. are interviewed in the production. They expressed shock, disbelief and dismay at the use of their comments and inference of complicity with what they consider the primary objective of the film - retaliation and smear tactics against Washington Hospital. The intention of the film was misrepresented and use of it as a commercial or political venture is unacceptable.
Editing was biased and any positive references about Washington Hospital were omitted. Answers that did not support the film's arguments about the quality of health care at Washington Hospital or pressure to release patients early were cut from the production. Both physicians say that their responses were used out of context and reflect a completely different and misleading view of their feelings about Washington Hospital. They agreed that Washington Hospital is "a center of excellence."
Dr. Sandhu has been practicing Internal and Pulmonary Medicine in Fremont since 1982. He has also been a member of the staff of Washington Hospital during that time and has served as Chief of Medical Staff and Chair of the Department of Medicine. Dr. Li approached Dr. Sandhu saying her daughter was "doing a project" regarding health care issues for school.
Dr. Bhandari has been working with Washington Hospital since 1995 when he relocated from University of California at San Francisco where he completed a fellowship in Gastroenterology and liver disorders. He has been elected to serve as Washington Hospital Chief of Medical Staff and also served as the chair of the Department of Medicine at Washington Hospital and on the Board of Directors for Washington Outpatient Center. According to Dr. Bhandari, Dr. Li asked for assistance to make a movie to "share insights" with her patients about medical staff issues, services available and facilities at Washington Hospital.
Dr. Evelyn Li is currently a candidate for the Board of Directors of Washington Hospital.