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Hospital's residencies at risk
Poor review may end accreditation for Stroger program

Thursday, November 01, 2007
Special to
by Judith Graham | Tribune staff reporter

Cook County's flagship public hospital doesn't provide enough clinical experience or medical oversight to young doctors specializing in obstetrics and gynecology, and its OB/GYN residency program should be stripped of accreditation, a major medical group is recommending.

The professional rebuke is a serious blow to Stroger Hospital, which has nurtured generations of top-notch obstetricians and gynecologists and which depends on residents -- young doctors in training -- to deliver babies, and perform abortions and hysterectomies.

Dr. Robert Simon, interim chief of the Cook County Bureau of Health, said Wednesday that Stroger Hospital would file an appeal with the Accreditation Council for Graduate Medical Education and repeatedly expressed confidence the council's recommendation would be overturned.
Medical residents are receiving most of the experience they should be getting, Simon insisted. The problem occurred, he said, when hospital staff gave inaccurate information to the accreditation council this year, when the hospital's OB/GYN residency program was reviewed. That data, from 2003 to 2006, underestimated the number of abortions, hysterectomies and other procedures medical residents are performing, he said.

"We're hopeful we can fix this" by adding more senior doctors to supervise OB/GYN residents and by offering more administrative support to the residency program, Simon said. "We feel we have a strong argument."

Julie Jacob, spokeswoman for the accreditation council, declined to comment, saying information gathered during a hospital review is confidential.

Dr. Brad Langer, interim medical director at Stroger Hospital, acknowledged that a letter received last week cited the medical center for 20 deficiencies, mostly related to insufficient clinical experience for doctors-in-training. Young doctors are expected to perform a certain number of medical procedures each year as part of their residencies.

The hospital has purchased new computer software and medical equipment, fixed administrative problems and urged residents to carefully document online what they do, said Dr. Fidel Abrego, director of Stroger Hospital's OB/GYN department.

Under a year-old affiliation agreement with Mt. Sinai Hospital, OB/GYN residents also are getting the chance to deliver far more babies and participate in more Cesarean sections, Abrego said. The number of births at Stroger Hospital has declined significantly during the last decade, to about 1,000 deliveries a year. Mt. Sinai delivers 4,500 babies annually.

A great deal rides on officials' ability to persuade the accreditation council to reverse its recommendation. The OB/GYN unit at Stroger Hospital is one of the medical center's four key services, along with medicine, surgery and pediatrics. Twenty OB/GYN residents, who earn a fraction of senior physicians' salaries, provide the bulk of medical care delivered at extremely low cost. The residents spend four years training at the hospital.

If the residency program is decertified, those young doctors would leave Stroger Hospital for other training opportunities. The hospital would then have to hire new physicians or scale back the OB/GYN service, experts said. Stroger's reputation with future generations of physicians would suffer, as would its revenue, as obstetrics is one service where nearly all patients have some kind of insurance.

Stroger Hospital has 30 days to file an appeal; the accreditation council will meet to consider the request within three weeks and could take action any time after that.

A coalition of community groups quickly seized on the development to renew its call for a change of governance at Cook County's health system. The Emergency Network to Save Cook County Health Services has asked county commissioners to relinquish control of the public health network to an independent trustee for a three-year period.

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