Errors test openness at Beth Israel Deaconess

Disclosures will benefit hospital, president insists

Paul Levy heads Beth Israel Deaconness, where Karen Vasques (above) died in childbirth.

For the past year, Paul Levy, president of Beth Israel Deaconess Medical Center, has more than ever before staked his reputation on "transparency," particularly about medical errors inside his Harvard teaching hospital.

In January, he made a splash when he announced the hospital would aim to eliminate all preventable harm to patients within four years and would publish quarterly reports on its progress. Whether speaking from a podium or writing on his blog, Levy maintains that admitting and learning from serious mistakes is far more important than avoiding public-relations blows.

This stance has won him praise in some quarters - and, in recent months, has sorely tested him as well.

In late June, news broke that a cosmetic surgeon was fired after he appeared to be dozing while performing a liposuction procedure. A few days later, a veteran surgeon completed surgery on a woman's ankle - only to discover it was the wrong ankle.

Earlier this month, an anesthesiologist, who had battled drug addiction and been terminated a year earlier, was found dead in a hospital closet, a possible suicide. And just last week, a 37-year-old Medford woman died during an emergency caesarean section at the hospital; her baby has survived.

Other controversies have erupted under Levy's leadership this year as well, including a management shake-up in the surgery department, complaints of overworked surgery residents, and bitter volleys between Levy and a national union trying to organize the hospital's workers. The union chronicles a range of complaints on a website called "Eye on BI" and on bus shelter advertisements, and accuses Levy of promoting "corporate-style medicine."

Yet sitting in his office last week, the 58-year-old chief executive officer displayed an upbeat attitude, saying he refuses to let the publicity about these issues rattle his mission to make his 621-bed hospital, which performs about 9,000 surgeries a year, one of the most aggressive in confronting problems.

"We trust that, over time, we will be judged fairly," said Levy, who has been at the hospital's helm for nearly seven years.

Levy said he is confident the "short-term adverse publicity" will soon be outweighed by improved patient care and greater trust within the institution.

"The same things happen elsewhere, but you don't hear about it elsewhere," said Levy, who often keeps the staff and public posted through his "Running a Hospital" blog.

Reliable data do not exist to compare patient safety at Boston-area hospitals, said James Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge, a nonprofit research group. He said serious mistakes are required to be reported to state agencies overseeing doctors or hospitals; however, many mistakes, such as medication errors, are not reported because the staff never detect them.

He said some hospitals with the most aggressive attitude about identifying errors will appear more mistake-prone, but only because they catch and report more problems. Conway said his review of available data shows that Beth Israel Deaconess has a safety record that is typical of most major Boston-area hospitals.

According to a state public health department official, Beth Israel Deaconess, so far this year, had nine "serious reportable events," which are defined as problems that should never occur at a hospital. In addition to this month's maternal death, there were two accidental falls; two medication errors; two wrong-site surgeries; an object left inside a patient; and a bed sore.

Conway praised Levy's courage for withstanding the public scrutiny that comes when a hospital is "at the leading edge of transparency in the nation."

The distressing recent news out of the hospital - particularly the mother's death - has not been lost on some patients and visitors who were at the hospital last week.

"I don't overreact, but there's lots of people who do," said Andrea Gayle-Bennett, 51, of Lynn, who was visiting a cancer patient there. "I figure this couldn't be the only place where these problems happen."

Local hospitals differ on how they proceed when an error is uncovered, though all say they immediately notify the patient and family, launch an internal investigation where the mistake occurred, as well as notify, as required by law, the proper state authorities.

In the case of the wrong-ankle surgery this summer, for example, Levy notified the entire Beth Israel Deaconess staff within a few days of the mistake, as well as initiated contact with the media.

At Brigham and Women's Hospital, however, Dr. Andy Whittemore, chief medical officer, said executives notified about a wrong-side surgery may not have felt the need to inform all staff at the hospital. He also said they do not generally initiate contact with the media, in part out of concern that even general details may reveal the patient's identity.

At Massachusetts General Hospital, Dr. Gregg Meyer, senior vice president for quality and safety, said his hospital believes in transparency, but has a "graded response" to the staff and public depending on the circumstances.

At Beth Israel Deaconess, the hospital is not as transparent as Levy says it is, according to Max Borten, a malpractice lawyer representing the Quincy patient whose cosmetic surgeon was fired. Borten said his client, Michael Hicks, never even received an explanation or an apology after Dr. Loren Borud, who had a history of substance abuse, was "impaired" during the surgery. The operation lasted more than six hours, five hours more than it was expected to last, and Hicks has suffered numerous complications, Borten said.

When asked about Hicks's case, Levy said he could not respond in detail because of pending litigation. The death of Karen Vasques while delivering her baby on Oct. 17 is one of four maternal deaths during childbirth this year that have been reported to the state Department of Public Health, which investigates all such cases. The other deaths were at Cape Cod Hospital in Hyannis, Newton-Wellesley Hospital in Newton, and South Shore Hospital in Weymouth, according to the state health department.

"We have to find out exactly what happened," said Robyn Briatico, an Everett attorney and relative who is acting as the family's spokeswoman. "All we know is that something very tragic happened to a very young woman." She said the newborn, Elise, remained hospitalized as of Friday.

Some Beth Israel Deaconess staff said they hope the public does not get a skewed view of the hospital, just because some of their problems are out in the open. Dr. Peter Zimetbaum, director of clinical cardiology, who has been at the hospital for nearly 20 years, described as "gutsy" Levy's open approach to admitting mistakes.

"It's safer to be a patient at Beth Israel now than at any other time in my whole career here," Zimetbaum said.

Stephanie Ebbert and Gloria Negri of the Globe staff contributed to this report. Patricia Wen can be reached at wen@globe.com.