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Yet another hit piece on the Arizona Republic.
You're so blinded by your hatred of the Republic that you fail to see issues that most conservatives and even this liberal think are important. You also misstate and misinterpret key facts in this story.
"Everything was going great until last December. That's when we learned that the County system had performed poorly in an audit." JCAHO is an accreditation organization that surveys thousands of hospitals and other healthcare facilities. Hospitals and healthcare facilities can be and have been shut down when they fail. The term "audit" describes something more along the lines of an group of accountants going over the books of a financial organization. It's an extremely inaccurate word in this context.
Medicare approval and funding are tied to JCAHO accreditation. Some hospitals, such as the John C. Lincoln system here, choose not to use JCAHO and obtain approval for Medicare funding in other ways. But failing a JCAHO survey, as the Maricopa system nearly did, would almost certainly result in a loss of Medicare reimbursement. Without Medicare funds, the Maricopa system would be bankrupt and shut down.
Your hit piece makes this sound like a petty little issue that's been resolved. We shouldn't worry about it anymore.
Sorry, I do worry. I've worked at the Maricopa Medical Center for years. In spite of years or decades of often poor management, we've always maintained our JCAHO accreditation in the past. The hundreds of doctors, nurses, other medical professionals and ancillary staff who work in the system have every right and reason to scrutinize a near failure that could have shut the hospital down. We're a Level I trauma center, we house the only Burn Unit in the state of Arizona (one of the very best in the country, I must add) and we provide services to thousands of people with little or no ability to pay. We have every right to scrutinize the management of this system.
So do the taxpayers.
Betsey Bayless is paid 383,000 dollars a year. Pretty nice for your first job in the health care field. The Republic could not possibly have made the issue more clear in its editorial. This is our tax money. Mine. Yours. Everyone's. Are we getting what we paid for? We're paying a top level management person a thousand dollars and then some every single day of the year, and then watching silently as the system nearly gets shut down? I thought conservatives valued sound financial management and accountability. Where's the accountability in this? You don't want to know where your tax dollars are going and how they're being spent? You don't want to know what you're getting for your 383,000 a year?
The argument that medical privacy laws would be violated by releasing the JCAHO report doesn't strike me as a strong argument. There are very strict laws in place regulating the release of confidential medical information. JCAHO could not and would not release information that violated an individual patient's right to privacy. Information about a system wide failure to maintain adequate standards does not violate patient privacy laws.
If anything, the Republic's article failed to scrutinize enough. Bayless was appointed to her position by an elected board, the Maricopa Special Health Care District Board. Not one person on this board has any background in the health care field. They acknowledge that candidates with strong health care backgrounds were in fact considered for the position. The Republic should have asked every single board member one simple question: Why did a governing board with no health care experience choose an individual with no health care experience to run a health care system? This decision demands some scrutiny as well. The Republic applauded the decision for all the wrong reasons.
Again, I will answer the question. "Who is scrutinizing Bayless's credentials?" I am. You should be. The taxpayers. The employees of the system. The patients. Everyone.
If this article had appeared in the Capitol Times or even in the Tribune, I think you would have jumped on the bandwagon and demanded to know what's going wrong with your County health care system. But the Republic can do no right.

Commander, you made an interesting and somewhat compelling objection, but you should have quit while you were ahead, because the more I read the more unconvinced I became.

The compelling part is that JCAHO surveys are such a serious business, and that failure could have such severe consequences. This may be a very big story that merits intense media coverage.

But I don't follow your logic that:

a) whatever problems are contained in the report by implication belong at the feet of Betsey Bayless

b) Betsey Bayless makes a good salary, so there should not be any problems at MIHS

c) JCAHO reports don't contain any confidential information, so they should be released without reservation

d) the legal objections to releasing the report to the media (and what appeared to me to be a very reasonable proposed solution from Betsey Bayless) are irrelevant

e) the fact that Betsey Bayless (and the people who hired her) are not health care professionals necessarily implicates them in any negative survey results

Unlike you, I don't work there, and I have absolutely zero health care experience. So I'm not arguing against your expertise, both generally and in this specific case. But I don't think you've answered Greg's point, which had to do with the Republic's methods more than anything specific about MIHS.

What is your objection to her proposal that Superior Court make the decision about what information to release?

Nothing like a little Sicilian slander...

I was a House of Representative Health Committee meetings a few weeks ago. There was a discussion about the validity or usefulness of peer-review accrediating agencies like JCAHO, often called the Joint Commission.

A number of committee members, as well DHS staff, noted that a number of hospitals and other medical providers no longer are part of the Joint Commission accreditating system. I discovered through my own research that John C. Lincoln is one of those hospitals. JCL is a level one trauma hospital just as is the Maricopa County hospital. The committee members and DHS staff noted that the real issue for any medical facility in the state is their state licensure not Joint Commission accreditation. This makes sense as having Joint Commission accreditation and being out of compliance with state laws is upside down.

Having worked in various healthcare environments and mental health agencies who participate in peer-reviewed accreditation processes, I am quite frankly not impressed. Peer-review accreditation is costly, time-consuming, often setting standards which conflict with state licensure. I completely understand why many hospitals and agencies are walking away from peer-review accreditation programs.

As more hospitals and agencies are casting off their peer-review accreditation, the question all of us should be asking is the question which came up at the health committee hearing I attended: what is the state of the current DHS licensure enforcement? How often are facilities visited by the state reviewers? How many reviewers does the state have to make sure state laws are being upheld?

To answers Dewey's questions: First, I have no objection whatsoever to the solution of allowing a court to decide the issue. Greg raised the issue of privacy (Congress is VERY concerned about medical privacy) so I felt I should point out that this is absolutely not an issue of an individual's right to keep their medical information private. A JCAHO report is not going to reveal what medicines the little old lady down the street takes for her blood pressure and her diabetes. A taxpayer funded government organization claiming such a right to "privacy" does disturb me somewhat. I can certainly understand that a private organization would want to keep this information private, but even that troubles me. Private hospitals collect enormous sums of money from Medicare and from state and county governments in reimbursement. Don't the taxpayers have a right to see where their money goes and how it's being spent? Again, it's an accountability issue, not a privacy issue. It will be interesting to see what the court decides. I'd bet a beer on the AZ Republic.
As to Betsey Bayless and her salary, let's switch to baseball. Team loses. Manager gets fired. Basketball: team loses, head coach gets fired. Business: company loses money, major product fails a critical inspection. CEO gets fired. Sorry, but the Commander in Chief believes the buck ultimately stops at the top. Especially when the CEO makes a huge salary.
Dewey is absolutely correct though that the problems don't all belong at the feet of Betsey Bayless. Failing a JCAHO survey is a team effort. A lot of the blame would thus belong to the team of healthcare professionals under her command. Which brings us to Dewey's last question. How does the fact that neither the elected board nor Ms. Bayless are healthcare professionals implicate them?
Let's switch modes and go totally nuclear on this one. An elected board oversees a government operated nuclear power facility. The board appoints someone with no background in science or nuclear technology as the CEO. The nuclear plant goes kaboom and melts down. Radioactive slime oozes everywhere, even into the beer I won. I drink it anyway, start glowing in the dark, and then go kaboom when I burp. How does this implicate the board and the CEO? The meltdown happened because the scientists running the place weren't doing their jobs right. But how would a board and a CEO with no science background have known that the scientists were bad? So I guess in your logic both the board and the CEO are held blameless due to lack of knowledge or just basic incompetence. I'd suggest you pay attention this fall when electing the Special Health Care District Board. A little knowledge there might go a long way.
Ron makes a good point that JCAHO accreditation is of questionable value and that many hospitals such a John C. Lincoln are giving it up. I could write a whole college level paper on this topic. Actually, I already have, several of them in fact. It's beside the point here though. The Maricopa system chose to stick with JCAHO. Flunking their survey is therefore a disaster, or a near disaster.
What's a Sicilian slander, other than an ethnic slur?
For the beer, I'll take a Stone IPA. One of those nice tall bottles, please. Good stuff.

Commander: Thanks for your response. I appreciate your clarification about the privacy issues.

I suppose there's no way to make an informed judgment about the other stuff without seeing any details. But I'll still withhold mine until then. You're right that the buck ought to stop at the top, but I'm curious about what the actual issues are. You certainly may know things the rest of us don't.

But go ahead and enjoy one of those beers while we wait...

I'd like to clarify a couple of points in your post.

First, while you are correct that Congress (and the American public as well) are concerned about patient privacy, there is no law on a federal level that I am aware of that prohibits an accrediting organization from releasing its reports to the public.

Secondly, The Arizona Republic has never asked for any patient names in connection with the Joint Commission audit -- or even doctor names for that matter. If this were soley about patient privacy, MIHS officials have known -- or should have known -- since day 1 that they have they opportunity and indeed the duty under the Arizona Public Records Law to redact such information.

The public paid for this accreditation report, and we believe the public is entitled to see it because it may cast valuable light on the way the public's health facilities are being operated.

Thank you for the opportunity to respond.

-- John D'Anna
Valley and State editor
The Arizona Republic


The basic issues you raised with the Republic 'hit piece' are very valid.

After reading the article on Sunday, my reaction was, 'where's the beef?'. That is, there was no real 'meat' in the article, only negative innuendo.

As you said, the article in the Republic does not list any person or organization that is really questioning the credentials or qualifications of Betsey Bayless, despite the headline screaming out otherwise.

The article implies that Ms. Bayless has hired a management staff that does have healthcare background, but does not identify any of these people or their areas of experience or expertise. A good reporter would have been able to find this out.

Why did the article start out with the lead about Ms. Bayless being 'political royalty?' That is a very bizarre statement. Ms. Bayless has been a tireless public servant and elected official for many, many years, but royalty? Give me a break.

Bringing up her salary was an attempt to embarass, however I am sure that Ms. Bayless, with her expertise, would make a lot more in the private sector.

Greg, your explanation that the Republic wants to get it's hands on the audit fully explains why they ran this article. It is clear that when she stood her ground, with a reasonable, legally defensible compromise, the Republic decided to try and publically embarass and humiliate her.

Hint to the Republic: It won't work.

Just a hint about how Maricopa County works. Remember Katrina? I was concerned about our county's preparedness in the event of a disaster like Katrina. Since I have some familiarity with the Local Emergency Planning Committe (LEPC), I decided to do some research. I learned the following:

1. The emergency planning department of the county had been in business since 1902.

2. I learned that the county had no emergency plan in the event of a disaster like Katrina.

I don't know about where most of you work, but where I work if you don't do your job you are escorted to the door.

A county emergency department in business for 102 years (Katrina happened in 2004) - and it doesn't have an emergency plan?

Well, I let a few folks know what I found out. The head of the the county's emergency department went back to Florida where he was hired from. I understand there are now some new 3 ring binders with plans down at the county.

The proposed solution from Bayless seems reasonable ... because of the way Bayless portrayed it and Greg reported it. I'm wondering if what actually happened is the new tactic in stonewalling. That is: You want to see something that's public record, we don't want to show it to you because it's embarrassing, so WE sue YOU for asking, arguing that we're going to let Superior Court decide if the record is public. That will keep a lot of people and organizations of modest means from even asking because they can't afford a court fight. The Republic probably can afford a court fight, but at the least it will tie the issue up in the courts for a while, buy us some time.

I don't know if that's what happened here, but Bayless' language sure sounds like that's the planned tactic.

We make records public because government is doing the people's business, and the people (by gosh, that includes the Arizona Republic!) are entitled to know what government is up to. The Republicans like to say they are the party of open government, but that is the concept at stake here. As pointed out, it would be easy enough to redact information to protect any patient privacy. But I don't think Bayless wants to protect privacy. I think she wants to save fact, and hiding behind patient privacy is the best way.

I think Commander's assertion that Greg is blinded by his hatred for the Republic is spot on here. For all the reasons the Republic has listed and Commander has listed, it would be good for sunshine to fall upon that review.

Interesting that the Republic reporter addressed only those issues that are obvious and not the pertinent point to Greg's post: The "hit" on Bayless because she is not doing what the Republic wants.
If they had stuck to the issue at hand -public access to a report - Greg would not have posted his objection.

Greg hopes Bayless doesn't have a horse - I hope she has a lot of money for lawyers.

Well, Travis, from what I read on these boards, Bayless has no reason to worry. No one is scrutinizing except for the Republic, and everyone here knows no one reads the Republic anymore and even if they do, it's a complete joke anyway. So from that we can conclude that she won't be sleeping with the fishes anytime soon.

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