Boston Globe Media
One Exchange Place, Suite 201
Boston, MA 02109-2132
June 9, 2022
Dear Ms. Wen:
As you may recall, I am the Executive Medical Director of the New England Heart & Vascular Institute at Catholic Medical Center (CMC). I write together with my colleagues Benjamin Westbrook, MD and David Caparrelli, MD. We appreciated the opportunity to meet with you and your team from the Boston Globe onsite at CMC last month. We also appreciated your team's professionalism and dedication to finding facts, not relying on unsubstantiated allegations and innuendo.
CMC has been as transparent and forthright with the information it can share within the bounds of privacy law. As we conveyed at the end of our meeting, we remain ready, willing, and able to address any issues uncovered during your reporting process. To that end, we are aware that your team continues to ask people about unsubstantiated allegations set forth by a whistleblower in the now dismissed qui tam complaint against CMC. The most inflammatory one is that CMC somehow allowed, or even encouraged, Dr. Baribeau and other surgeons to manipulate mortality data by admitting patients to General Inpatient Hospice (GIP) or, as the Globe team has characterized it, “keeping patients alive for more than 30 days.” As you know, together with CMC, we vehemently deny these outrageous claims. They are not based on facts.
As doctors, we abide by the Hippocratic Oath to do no harm and to prescribe only beneficial treatments to patients in our care. This is our mission, our duty, and our obligation. It guides and informs us on all that we do individually and as an institution. The suggestion that we jettisoned these core values and instead provided treatments or required hospital stays that were not in the best interest of any patient is infuriating, because it is simply not true. There is no factual support that any actions were taken to impact surgical mortality rates. Anyone propagating this myth is uninformed and is defaming CMC and its caregivers.
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 purposes; never for the benefit of any surgeon's mortality statistics. In order to understand this fact, certain additional information may be helpful to you. CMC has not had a consistent GIP program for many reasons, but mainly because we have been trying to grow our own palliative care program for several years. In fact, our GIP program was only active for approximately two years, from early 2017 through 2018. During that timeframe, which seems to be the focus of your fact-finding, CMC had a total of 17 patients who were admitted to GIP care. Of those 17 patients, only 6 were surgical patients, and of those 6 surgical patients, only 3 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 by us and the patients’ other providers, in collaboration with their families and representatives, that it was in the best interest of the patients, whether it be at day 8, 28 or 36 post surgery, as examples. Three patients belies the innuendo of a wide-spread 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. The numbers of these patients are proportionately distributed among the three CMC providers, so Dr. Baribeau was not an outlier at CMC in giving his patients a chance at survival and recovery after their major surgeries. Of the patients who were in a hospital bed for more than 30 days, only 2 patients died in the hospital and only 3 were transferred to hospice care. This total number of 5 patients constitutes less than 0.5% of the cardiothoracic patients operated on over this two-year period. This statistic is consistent with prior years and does not support a widespread conspiracy, or even any type of concerted practice.
In fact, the numbers are so low that any impact on surgical mortality rates, whether it be through the formulas from the Center for Medicare and Medicaid Services (CMS), the Northern New England Cardiovascular Disease Study Group (NNECDSG), and Society of Thoracic Surgeons (STS), would be negligible. Importantly, it supports that approximately 88% of patients who were given this long period for a chance at survival were able to be discharged home or to other facilities for further care and continued recovery. It is inconceivable to suggest that Dr. Baribeau, or any of us, should have denied these patients the chance at recovery and/or their hospice benefit. We are astounded by the notion that instead of focusing on what is best for our patients, the Globe seems to be suggesting that we should have been focusing solely on the impact of our clinical decisions on CMS, NNECDSG, and STS mortality reporting, all of which include different formulas and could not be affected in any meaningful way by the data at issue.
The false and defamatory allegations made against CMC have been fully vetted through the government's investigation, and CMC’s own multi-level investigation (which included independent, external resources who CMC engaged). We believe that our facts disprove these allegations and welcome the opportunity to discuss further if there is any doubt.
Regards,
Louis Fink, MD, FACC
Executive Medical Director
New England Heart & Vascular Institute
Benjamin Westbrook, MD, FACS
New England Heart & Vascular Institute
David Caparrelli, MD, FACS
New England Heart & Vascular Institute