Quality Improvement
Review the case Surgical Need or Greed on page 93 of the Cases in Health Care Management textbook and answer the questions below. Please number your responses to align with the instructions. Your research and theory application should focus on quality and process improvement. Your final submission is expected to total 4-5 pages of text. Make sure to support your positions with at least 3 scholarly references focused on quality and process improvement.
1. What do you see as the top three management issues in this case?
2. What obligation do the Chief Medical Officer, the Department of Surgery, and the hospital have to
ensure that procedures are done for the appropriate indications?
3. If the allegations are true, what obligation does the hospital have to protect the patients in the community from Dr. Kutall? What should the hospital do to prevent this type of situation in the future? Provide your reflections and personal opinions as well as your recommendations for addressing these problems.
CASE STUDY: Surgical Need or Greed
You are the Chief Medical Officer (CMO) at Sunnyside Memorial Medical Center (SMMC). It has been brought to your attention that one of your surgeons, Dr. Kutall, is doing an extraordinary amount of carotid artery surgery. Your first impression is that this is good for the institution. He has developed a large referral practice, been a member of the staff for many years, and always supported the hospital.
Drs. Smith and Boyle have requested a meeting with you because they are concerned about this extraordinary number of procedures and have reviewed some of the preoperative indications. Dr. Smith is Chief of Vascular Surgery and chairs the quality assurance committee for the department. It is his job to examine the indications for these procedures.
The surgeon in question, Dr. Kutall, has been operating on the basis of duplex ultrasound testing obtained primarily from his laboratory, which he operates independently of the hospital. A few patients had their workups done elsewhere. Drs. Smith and Boyle reviewed those studies and felt the results did not warrant surgical intervention. The quality assurance committee has asked Dr. Kutall to provide the workup and diagnostic information for his last 50 carotid surgeries.
The committee reviewed the reports from Dr. Kutalls vascular laboratory. According to his reports, all signed by Dr. Kutall, the patients met the criteria for surgery. However, when Drs. Smith and Boyle reviewed the scans, they felt that these were grossly overread. What Dr. Kutall considered a greater than 70% blockage, the other surgeons read as no greater than 50% blockage. The gold standard indication for carotid surgery is an arterial blockage of 70% or greater. Dr. Kutalls procedures on patients with no greater than 50% blockage were definitely not indicated or appropriate. Upon further review, the success rate for Dr. Kutalls surgery seemed to be in the acceptable range, which would be one reason Dr. Kutalls practice variation had not appeared on the hospital quality assurance radar in the past. His results were not bad, but the surgeries were not indicated. Inappropriate surgery puts patients at risk unnecessarily, to say nothing about resulting in excessive expenditures for unnecessary procedures.
As the CMO, it is your job to ensure appropriate medical care and patient safety. The report on Dr. Kutall and his dubious practices was forwarded to the medical executive board for review. It is now up to them to decide if Dr. Kutall should be disciplined.
