I’ve never been able to accept Richard Curbelo’s death, and I didn’t even know him. I can’t imagine how his fiancé manages. By all accounts the former Detroit sportswriter was a great guy, yet another example that really bad things seem to disproportionately happen to really good people.
Curbelo a year ago last January died from intubation complications undergoing a routine colonoscopy at Beaumont Health’s flagship Royal Oak hospital in suburban Detroit. Although he was overweight, Curbelo was an otherwise healthy 51-year-old. Presumably, he underwent a colonoscopy to extend his life, hoping to live happily ever after with Connie, the woman he planned to marry in April. Next month would have been their one-year anniversary.
I don’t blame the nurse anesthetist who tended to Curbelo for his death. I don’t blame the anesthesiologist who oversaw the nurse anesthetist for Curbelo’s death. I blame former Beaumont CEO John Fox, former COO Carolyn Wilson, and former board chair John Lewis for Curbelo’s death. The trio ignored a cacophony of patient safety warnings, and they should have been held responsible.
I immediately thought of Curbelo while reading this hospital trade publication article arguing, “We can’t punish our way to safer medical practices.” The article was in response to criminal charges filed against a former Vanderbilt University Medical Center nurse after she inadvertently injected a 75-year-old patient with a fatal medical dose. The article cites experts saying that prosecuting medical staff for fatal errors will discourage others from pursuing a medical career.
I couldn’t agree more. Medical personnel who accidentally make fatal errors shouldn’t be the ones held criminally liable unless reckless negligence was responsible, such as being drunk or high on drugs. The managers responsible for creating a culture where fatal errors occur are the ones who should face criminal prosecution.
Here’s my argument:
Doctors, nurses, and other medical staff at most hospitals have been reduced to hired help, or “providers” as managements prefer to call them. They are expected to do as they are told and look the other way when they see unsafe practices that concern them. This is true at even the top hospitals.
At Massachusetts General an anesthesiologist resigned from the prestigious hospital and lost her teaching position at Harvard Medical School after she filed a whistleblower lawsuit alleging orthopedic surgeons regularly endangered patients by keeping them under anesthesia longer than medically necessary because they were performing multiple surgeries in different operating rooms. MassGen recently settled the lawsuit for $14.6 million, its third settlement for so-called concurrent, or double-booking surgeries.
In the nearly two years since I developed an interest in healthcare writing about Beaumont Health for Deadline Detroit, I’ve come to appreciate that revenues, profits, collections, and management compensation are what keep most hospital CEOs up at night. Patient care and privacy concerns are secondary. One had to be deaf and blind not to hear the warning cries.
In recent years nurses across the country have moved to organize, invariably citing unsafe working conditions and patient safety issues as their number one concern. Although studies show that when nurses unionize the quality of care improves, hospitals spent tens of millions on union busters to frighten and intimidate their nursing staffs.
It’s a farce that most U.S. hospitals don’t pay taxes because they are “nonprofits.” Johns Hopkins researchers say most “nonprofit” U.S. hospitals aren’t worthy of their tax free status. One study found that “nonprofit” hospitals in North Carolina operate on average with profit margins three times higher than the national average, delivering less charity care than what the organizations saved because of their tax avoidance.
The heightened focus on profits is evident by the dramatic rise in so-called “never events” that aren’t supposed to happen, like a healthy patient dying undergoing a routine colonoscopy. Serious patient safety incidents involving death or injury have reached a record level, and worsening. Multiple studies have revealed that during the pandemic there was a sharp drop in patient safety and infection control. A Kaiser Health News investigation determined that easily more than 10,000 patients died at U.S. hospitals from covid, despite not having been diagnosed with the illness when they were admitted.
Richard Curbelo’s death provides a case study as to how hospital managements and boards can ignore safety warnings with impunity.
The nurse anesthetist who intubated Curbelo and the anesthesiologist overseeing her were employees of a controversial outsourcing firm called NorthStar Anesthesia, which had taken over anesthesiology at Royal Oak and other Beaumont hospitals on January 1. Wilson, Beaumont’s former COO and the executive who awarded NorthStar its outsourcing contract, had banked that most of Beaumont’s fellowship trained anesthesiologists would join NorthStar, but things didn’t turn out that way.
About half Royal Oak’s anesthesiologists quit rather than join NorthStar; dozens of Beaumont nurse anesthetists also quit. On industry message boards NorthStar is referred to as Death Star, for reasons I’m not entirely certain but I’m confident the designation isn’t meant as a compliment. As Beaumont’s anesthesiology staff departed about a dozen top-tier surgeons also quit, reportedly because of concerns about NorthStar.
In September 2020, the co-heads of Beaumont Royal Oak’s cardiology department, sent a letter to John Lewis, chair of Beaumont Health’s board, warning him “in the strongest possible terms” they had “serious concerns” about NorthStar’s ability to maintain the hospital’s historical cardiac anesthesia standards. Underscoring those standards, the former head of Beaumont Royal Oak’s anesthesiology department was a former president of the American Society of Anesthesiologists. Earlier in September the former vice chair of Beaumont and a prominent donor wrote to Michigan Attorney General Dana Nessel pleading with her to remove Fox and the board members who supported him, citing patient safety concerns.
Nessel took no action.
A Harvard-trained cardiologist sent multiple emails the following month to Beaumont trustees calling on them to fire CEO John Fox and his deputies. This was in addition to a survey revealing most Beaumont doctors had little faith in Fox and his management team. On the first business day of 2021, the Beaumont nurse anesthetists who agreed to join NorthStar sought union certification, citing “unsafe” staffing conditions.
There was a myriad of other safety issues that should have concerned the board. Beaumont’s orthopedic surgeons were being pressured to use Stryker medical devices they considered inferior. The head of orthopedics and one of Beaumont’s top executives received more than $900,000 from Stryker in consulting fees. In December 2019, when two nationally renowned cardiac surgeons at Beaumont Royal Oak resigned, a surgeon at another Beaumont hospital warned of “critical staffing issues” at his facility because of cutbacks.
When Curbelo arrived for his colonoscopy, it’s unlikely he knew of all the safety issues and warnings. Having spent his entire life in the metro Detroit area, he likely believed that Beaumont was still one of the nation’s top regional hospitals, as it was before Fox and his team took over and implemented extensive cost cutting measures that ballooned the hospital system’s cash reserve to $3.5 billion, including a $1 billion haul in 2020, the first year of the pandemic.
It’s not publicly known why Curbelo was intubated to begin with. A prominent anesthesiologist told me that it’s rare for colonoscopy patients to be intubated, even if they are obese. She told me that Beaumont losing dozens of anesthesiologists and nurse anesthetists en masse was a safety risk because such considerable turnover meant there were too many anesthesia professionals unfamiliar with the hospital’s emergency protocols for dealing with issues such as intubations gone awry.
I can’t fathom how anyone can argue that Beaumont maintained a culture of safety when Curbelo arrived at its Royal Oak hospital on that fateful day he underwent his colonoscopy. But neither Fox, Wilson, nor Lewis suffered any repercussions for ignoring all the warnings.
Beaumont was just taken over by Grand Rapids-based Spectrum Health, a deal that likely netted Fox a golden parachute amounting to millions of dollars. Wilson, who was earning about $2 million a year, likely received a generous payout when she stepped down in advance of Spectrum’s takeover.
Lewis, the former board chair, also stepped down, but Julie Fream, his vice chair, is now the chair of the combined Spectrum and Beaumont, the biggest hospital system and the biggest employer in Michigan.
In my mind, hospital CEOs and COOs should be required to sign certificates of safety outlining all the measures they’ve put in place to protect patients. Hospital chairs and directors should be required to sign certificates saying they are monitoring the articulated safety procedures to ensure they are being followed.
When fatal accidents happen because managements and boards failed to ensure the promised safety protocols, that should warrant criminal prosecution.
R.I.P. Richard Curbelo. Sadly, you were but one of tens of thousands of patients who die every year at U.S. hospitals because of the inordinate focus on profits, not patient safety. The managers responsible have no incentive to change their priorities, but the threat of jail time would be an immediate game changer.
Fear of spending a few years in the slammer for failing to ensure a culture of patient safety would quickly become the most pressing issue keeping hospital CEOs awake at night. The threat of jail would provide a modicum of justification for their oversized compensation. Overseeing safe patient care is why they get paid the big bucks.