Boston Globe Media
One Exchange Place, Suite 201
Boston, MA 02109-2132
Dear Ms. Wen:
Over the last several months, we at Catholic Medical Center (CMC) have done all we can to answer your questions and provide information to your reporting team regarding our cardiac program and Dr. Yvon Baribeau, a former member of the CMC medical staff. Over the past seven months we have provided detailed information about our internal quality review processes, our culture, and our values as an organization. We have answered dozens of your questions and made members of our senior leadership team and medical staff available for on-the-record interviews. What we haven’t done, and will not do, is breach our legal and ethical duties of confidentiality with respect to patient care and personnel matters, quality protected information, and confidential legal settlements. The Globe knows that this puts us at a severe disadvantage— we cannot correct false information about our hospital and our programs if the only way to do so would be to violate the law.
As you know, the federal government took action on only one issue raised in the qui tam. Much of what you have asked about has been focused on other allegations about which the federal government took no action. Similarly, you have asked many questions about a complaint made to the New Hampshire Board of Medicine, allegations that you know were dismissed. As we have told you repeatedly, both the U.S. Attorney and the New Hampshire Board of Medicine were given full access to patient records and spent many months exhaustively combing through the facts. In essence, the Globe seems to be writing a story based on allegations without validation or balance and without any perspective. We fear this will result in an inherently one-sided narrative, one which we strongly deny and have done our best to refute.
We ask that you pause and reflect on the totality of the information and, at the very least, work to ensure that your story presents a balanced account before causing unwarranted damage to Catholic Medical Center’s reputation.
As your team heads toward completion of your story and final review, we wanted to take this last opportunity to re-emphasize our position on key elements. We are not going to rehash every answer we have provided over the last seven months, but we do want to highlight some of the main the issues that seem to form the core of your story and ask again that you consider our perspective, which we maintain is the accurate one.
CMC’s Culture of Quality and Excellence
CMC is an organization that lives by the values of respect, integrity, commitment and compassion. That means we are dedicated to the highest-quality care for our patents and their families, and we grieve with families over the loss of a loved one. We are also dedicated to continuous improvement, which is why we have an open and rigorous process for self-evaluation and compliance. Our internal review processes are consistent with industry and national best practices. While we believe they are among the most progressive and sophisticated in the country, we work continually on improvements because we know that perfection is a goal that can never be achieved.
The high quality and transparency of our cardiac program is confirmed by outside organizations, such as the Northern New England Cardiovascular Disease Study Group (NNECDSG) and the Society of Thoracic Surgeons (STS), who monitor and collect data on physician performance and patient outcomes. CMC has voluntarily participated in the STS database continuously since 1994 and has signed releases to allow the results to be viewed in the public domain. CMC has voluntarily participated in the NNECSG continuously since 1987. These independent organizations audit our procedures and give strong ratings to the New England Heart and Vascular Institute (NEHVI) and its physicians. Our hospital and NEHVI consistently earn high ratings predicated on good patient outcomes and quality care. But even that high level of performance cannot guarantee perfect outcomes for all patients, all the time. No high-acuity health care institution can guarantee outcomes when working with some of the sickest patients, many of whom have complex cardiac issues. By focusing on a relatively few number of cases when viewed among all cases NEHVI handled in the past 30 years, and with multiple significant errors in the narratives presented to us, we believe you are missing the larger picture of an extremely high-quality program that serves tens of thousands of patients, with a long track record of excellence and patient satisfaction.
The narrative the Globe seems to be following is inconsistent with our quality data, paints a picture of a hospital that is unrecognizable from the place we know, and is based on allegations that we have strongly refuted. Many of these allegations, as we have discussed, we believe originated from a small group of individuals intent on causing harm to CMC.
Commitment to Openness and Continuous Improvement
We have provided you with detailed information about CMC’s rigorous processes for selfevaluation, compliance, and improvement, processes that are open to any employee of the organization who may have concerns.
One such process is the morbidity and mortality conference (M&M). An M&M conference allows physicians and their colleagues to review cases that resulted in morbidity or mortality to identify areas of improvement. The forum is voluntary and promotes professionalism, ethical integrity, and transparency in assessing and improving patient care in an effort to support a culture of continuous improvement.
CMC has numerous other quality, medical staff, and system processes in place to ensure patient safety. These include internal case reviews, peer reviews, root cause analyses, and outside reviews by independent experts. CMC takes concerns about a case or a provider seriously and looks to these processes to address concerns and implement changes that could lead to improvement.
We also promote a just culture where employees should feel safe voicing concerns, and we offer an anonymous reporting channel to support that.
Allegations that CMC would have ignored concerns raised about Dr. Baribeau, or any physician, simply doesn’t square with the facts, our internal review processes, or our culture. As we discussed, there are individuals who tried to go around those processes. Our hospital always will be managed through a proper and formal process of reviewing any and all claims of concern from any employee at CMC.
False Allegation of Data Manipulation
Among the most misleading allegations the Globe asked about is that CMC somehow manipulated data relating to patient deaths in order to enhance mortality statistics. Nothing could be further from the truth. This is another allegation that was dismissed as part of the qui tam complaint.
CMC never engaged in any practice to “manage the numbers” of cardiac deaths.
You have heard directly from the leaders of our cardiac program that the retention of surgical patients in a hospital bed at CMC for more than 30 days is only done, and has only ever been done, for beneficial, case-specific purposes and never for the benefit of any surgeon's mortality statistics.
All Medicare patients have a hospice benefit. There are different levels of hospice care, one called hospice general inpatient care, or GIP. GIP is for pain control or symptom management provided in an inpatient facility, such as CMC, and is intended to be short-term. Notably, GIP hospice care is less expensive for Medicare than respite hospice care. In order to trigger this Medicare benefit, a patient must be administratively “discharged” from the hospital and “admitted” to hospice GIP while still physically in a CMC bed, resulting in a change of ID bands. This practice was solely for the benefit of patients, and it is patently false to suggest it was ever used to manipulate mortality data.
As noted by Drs. Westbook, Caparrelli and Fink, CMC’s GIP program was active for approximately two years, from early 2017 through 2018. During that timeframe, CMC had a total of 17 patients who were admitted to GIP care. Of those 17 patients, only six were surgical patients, and of those six surgical patients, only three were admitted to this level of hospice care greater than 30 days from their date of surgery. All were admitted to this level of care when it was determined to be in the best interest of patients. Three patients undercuts the notion of some widespread conspiracy to manipulate data at the expense of patient care.
During this same two-year period, CMC’s cardiothoracic surgeons (who then included Dr. Baribeau, Dr. Westbrook, and Dr. Caparrelli) operated on approximately 1,700 inpatients. Of those patients, approximately 2.5% were in a hospital bed for more than 30 days after the date of their procedure. Of the patients who were in a hospital bed for more than 30 days, only two patients died in the hospital and only three were transferred to hospice care. This total number of five patients constitutes less than 0.5% of the cardiothoracic patients operated on over this twoyear period. The numbers are so low that any impact on surgical mortality rates would be negligible, further underscoring the ridiculousness of the manipulation claims.
Standard of Care by Dr. Baribeau
Dr. Baribeau was a cardiovascular and thoracic surgeon who practiced at CMC from November 1992 until his retirement in September 2019. He joined CMC’s medical staff as an independent practitioner with a private practice group in Manchester. In 2013, CMC acquired the practice and employed Dr. Baribeau and his colleague, Dr. Westbrook. Dr. Baribeau was Board certified in vascular, thoracic, and general surgery and provided some of the most advanced forms of surgical treatment for cardiac disease in the region. During his time at CMC, he introduced minimally invasive coronary artery bypass (small incision), off-pump coronary artery bypass (beating heart), and robotically-assisted cardiac and thoracic surgery. Dr. Baribeau performed thousands of complex, highly specialized cardiac procedures on some of the sickest patients in northern New England, saving countless lives.
Throughout his tenure at CMC, Dr. Baribeau’s patient safety and quality metrics were not statistically different from those of his peers. Any concerns raised about Dr. Baribeau and his care were reviewed through the hospital’s processes and taken very seriously. Opportunities for improvement that were identified were implemented consistent with CMC’s processes and best practices.
As an added measure of oversight and compliance, our local outside counsel conducted an internal investigation related to Dr. Baribeau in collaboration with CMC’s Compliance and Risk Management Departments. This counsel frequently advised on medical staff affairs and had decades of historical knowledge of CMC’s medical staff members and actions. She also helped CMC cooperate with the Board of Medicine’s investigation of Dr. Baribeau. Given the threatened litigation, CMC also engaged separate counsel for itself and Dr. Baribeau through its insurance company, and they both completed another layer of investigation into numerous patients treated by Dr. Baribeau. None of these investigations revealed the reckless conduct alleged by Dr. Goldberg in his qui tam complaint or the Board of Medicine complaint.
It’s misleading to suggest, as you have, that “Dr. Baribeau has a long history of medical malpractice claims and settlements dating back to the 1990s.” There were four medical malpractice claims brought against Dr. Baribeau between 1992 and 2018, one of which was dismissed. This number is consistent with someone in his area of practice.
The Globe has focused on a group of potential claims presented to CMC and Dr. Baribeau after Dr. Baribeau’s retirement that were resolved without lawsuits ever being filed.
As we’ve stated previously, there are many reasons for settling potential malpractice claims. Reaching a settlement is neither an admission of fault, nor a reflection of the merits of a specific complaint or the standard of care provided. At the same time, settling claims does not diminish the anguish felt by patients or families who pursue a claim, and we empathize with their loss.
With respect to mortality data, Dr. Baribeau offered open heart and other surgeries to many patients as a last chance at survival. His patients were often at an increased risk for complications, including death, due to age or co-morbidities. And as noted previously, the suggestion that there was an effort to manipulate mortality data is false and unsupported by the facts.
Prior Reviews by Board of Medicine and U.S. Attorney
In 2018 and 2019, CMC fully cooperated with the New Hampshire Board of Medicine during the course of an extensive investigation focused on Dr. Baribeau. This investigation was triggered by a complaint filed on behalf of an anonymous physician and involved the review of at least a dozen complete patient medical records that CMC produced. After a months’ long review, the Board of Medicine dismissed the complaint and did not initiate disciplinary action. Unlike the Globe, the Board of Medicine had complete and lawful access to patient records, and were able to complete a thorough review, not simply accept the information provided by one side as fact.
Regarding the qui tam action, CMC vigorously denied the allegations set forth by the whistleblower, Dr. Goldberg, and cooperated fully with the government’s investigation. We have pointed out to you significant errors in the qui tam, including at least one named witness who says she never spoke the quotes attributed to her in the action. At the conclusion of the investigation, the government dismissed the entire complaint with one exception – specifically, a call arrangement dating back to 2008, which is the basis for the $3.8 million settlement.
False Allegations of Retribution
You’ve said that sources allege CMC engaged in retaliation against physicians who raised concerns about Dr. Baribeau. CMC has strongly rejected any such claim of such retaliation, and you are well aware that, due to confidentiality requirements, we cannot share details regarding any specific personnel matter.
We have also told you that individuals who tried to circumvent the formal review and oversight processes would have been redirected back to the established process in order to ensure matters were handled appropriately, with fairness and transparency. Allegations by those individuals that CMC’s adherence to appropriate process reflects a disregard for their concerns reflects a twisting of reality beyond recognition.
As we also shared with you, many of the individuals who have made these claims served on the Medical Executive Committee and had every opportunity to elevate concerns they may have had through the established processes, ensuring appropriate review and oversight.
That is why we have reiterated to you on multiple occasions that if any employee wishes to discuss the specifics of their employment at CMC, they can authorize us to release a copy of their personnel file to share with you. We have yet to receive any such authorization or request to release personnel files, which leaves us wondering, given the allegations, why not? Your approach to this particular area causes us great concern because it lacks any balance to your storytelling.
We met with you in May in an effort to help you find and report the truth and we discussed then the importance of hearing from all sides in that pursuit. The Globe, and the Spotlight team specifically, know well the legal limitations we face responding to allegations you’ve asked about repeatedly for seven months. We are troubled, and shared these concerns with you previously, that we are aware of employees and former employees with first-hand knowledge of the facts who weren’t comfortable if their names were made public, but you refused to speak with them unless they agreed to be named. Yet we’re also aware that your reporters offered the option of confidentiality to several people whom you hoped would share views critical of our physicians or hospital. We fail to see how that is fair or, more importantly, how that allows the Globe to provide an accurate portrayal for its readers. We hope the Globe doesn’t become an instrument for those with animus toward CMC.
Respectfully,
Alex Walker
President & CEO
Catholic Medical Center
Louis Fink, M.D., FACC
Executive Medical Director
New England Heart & Vascular Institute