Post-Dispatch: Doctor lost hospital privileges but kept clean record

In 2002, St. Anthony’s Medical Center in St. Louis told a psychiatrist he could lose his hospital privileges, following charges that he had delivered substandard care. The doctor sued hospital officials, and the hospital settled–agreeing to accept the doctor’s resignation and not report him to a national databank of problem doctors.

His record, in other words, remained clean, despite the charges.

Jeremy Kohler and Blythe Bernhard of the St. Louis Post-Dispatch did a nice feature using this case to highlight the shortcomings in medicine’s rules for disciplining–and reporting–doctors who are endangering patients.

Under federal law, they write, hospitals are required to report serious disciplinary actions to a national databank. But critics say hospitals are often failing to file reports.

It’s a nice story–a clear and engaging explanation of a baroque system for identifying doctors who might endanger patients.

My main comment would be that Kohler and Bernhard might have made the story even more gripping by featuring some of the details of their reporting much higher in the story. This parallels comments I made in a post Wednesday about a story in Discover magazine.

Here’s the Kohler-Bernhard lede:

When a man died nine years ago at St. Anthony’s Medical Center, a panel of doctors there said he had received substandard care from his psychiatrist, Dr. Surendra Chaganti.

While not blaming Chaganti for the man’s death, the panel said Chaganti prescribed drugs that could have been harmful and failed to send the man to the emergency room after noting he had been given another patient’s medicine.

That’s not bad. It quickly gets to the point. But here’s something I plucked from lower in the story, which might have made an especially gripping lede:

[When a patient with kidney damage was admitted for detox in 2001] Chaganti prescribed five psychiatric drugs, according to the complaint. The board said Chaganti gave Lawrence high doses of two drugs that are recommended only in small doses for kidney patients.

A high dosage of one drug caused him to become delirious, “which was not recognized and properly treated,” the board said. Lawrence was then given a sixth drug, which worsened his delirium.

Medical records indicated that Lawrence was agitated, wandering around the ward and not following directions, said Medical Examiner Dr. Mary E. Case…

Obviously, this would need a little editing to work as a lede. But the details–five drugs, delirium, agitation, wandering around the ward–are all things that could have made a great lede. Instead, they didn’t appear until about halfway through the story, by which time many readers–fickle, uncaring creatures that they are–would have turned the page.

These details are far superior to what’s in the lede: “prescribed drugs that could have been harmful.”

I don’t want my unsolicited editing, however, to take away from what is a very good story. For some reason, I seem to have donned my green eyeshade this week, and I can’t stop editing. It’s an illness; expect me to recover. Besides, I’m almost out of blue pencils.

Thanks to the Covering Health blog of the Association of Health Care Journalists for calling my attention to this piece.

– Paul Raeburn