St Joseph Hospital: First Do No Harm

My brother Alan was shot in the chest while inside his hospital room at St. Joseph Medical Center in August of last year. The off-duty police officers who nearly took his life did not seek treatment for him after shooting him, but instead, handcuffed him and laid a drape over him as he lay on the ground bleeding. When a physician rushed to the floor to tend to Alan’s life-threatening injuries, officers on the scene would only disclose that Alan was just “Tased”. While the doctor fought to save Alan’s life, someone in the room eventually divulged the critical information that Alan was shot. Miraculously, Alan survived, but our nightmare was only just beginning. In the aftermath of that horrible incident, my family and I were intimidated, threatened, and repeatedly fed fabricated versions of events from authorities and administrators. Complaints from our family and similarly frustrated citizens prompted an investigation from the Centers for Medicare and Medicaid Services (CMS) that uncovered alarming deficiencies in patient care and safety at the hospital. When numerous deadlines to correct the deficiencies lapsed, the CMS moved to effectively terminate St. Joseph’s Medicare and Medicaid funding, threatening its ability to stay open. Many saw the decision as vindication for our family; yet, when I found out St. Joseph’s funding would not be pulled, and that they would be able to take on a corrective plan to keep their doors open, I breathed a sigh of relief.

I have no interest in seeing a major Downtown Houston hospital close it’s doors to the public. When we as a family drafted the complaint submitted to the CMS, our rationale was simple: If they could treat us with such malicious inhumanity in the wake of this family tragedy, we shuddered to think what happened routinely to the more vulnerable patients they served from the surrounding community.

Downtown Houstonians and Americans everywhere deserve better than this. Healthcare standards that squeak by the minimal requirements dictated by the CMS are not enough. St. Joseph needs to look within and seek to heal its open wounds with gumption and humility. St. Joseph must endeavor to achieve excellence and aspire to lead by example for other institutions that cater to the underserved. They need to unify with the rallying voices of healthcare providers from organizations like the Latino Medical Student Association and Physicians for Criminal Justice Reformcalling for improved patient safety regulations, a more egalitarian justice system and culturally competent care. The diverse population that St. Joseph Hospital serves demands it. It is time for them to take heed of the cries from physicians and nurses who expressed horror and concern over the awful incident that happened to my brother in August of last year. Riding the wave of renewed support of the Houston community, and with the help of influential politicians like U.S. Rep. Sheila Jackson Lee, St. Joseph could double its efforts to become an academic medical center where evidence-based literature informs every tenet of patient care from the psychiatric ward to the operating rooms.

However, genuine progress is impossible without reform and accountability for past transgressions. To this day, neither the hospital nor their managing chain IASIS Healthcare has issued an apology to our family for their negligent treatment of my brother, let alone to the Downtown Houston community for the deficient care they were providing. They have never redacted the reckless public statements they made afterward attempting to shirk any responsibility for what happened.

They embraced false narratives and faulty details released after Alan’s shooting and never tried to set the record straight. Reports and witnesses indicated Alan didn’t throw any furniture in the hallway or threaten nurses while in the hospital, but St. Joseph stayed silent as local media outlets continuously spun these absurd and erroneous tales. Alan walked out of his room 4–5 times, calmly, but confused and delusional. A nurse called security for help redirecting him not knowing HPD armed to the teeth would show up. Instead of following standard hospital protocol, they went into his room unannounced without healthcare staff, proceeded to escalate the situation, and nearly killed him. Alan’s medical condition and behavior were ordinary hospital circumstances managed extraordinarily poorly.

It wasn’t benevolence or a commitment to their patients that prompted St. Joseph to engage in efforts to deliver better healthcare. Rather, it was the threat of lost profits after a damning CMS report was released exposing serious deficiencies. It was the brave hospital staff members speaking out honestly, objective investigative findings, and video surveillance that forced them to change their course of action for the better. Alas, real change must start with leadership, which is why I found this recent statement from Dr. Garland Gossett, chairman of medical quality at St. Joseph, so disconcerting:

“I think that the concerns that CMS had were a little bit overzealous, but at the same to we do expect them to do what they need to do,” he said. “But we’ve already made corrections of the minor deficiencies that were identified.”

“Minor deficiencies”? Dr. Gossett, there is nothing “minor” about a patient nearly being killed inside his hospital room while seeking treatment. There is nothing “minor” about a hospital discharging a patient expressing suicidal tendencies or staff violating infection control protocols — all findings from the CMS report. Dr. Gossett, if it were your son, your brother, your father, or your spouse bleeding to death on that hospital floor in shackles after earnestly seeking treatment, would you call it a “minor” deficiency? I would hope not.

I want to believe he misspoke in that moment, but repeated statements like this from St. Joseph personnel reaffirm my belief that, had the initial complaints against St. Joseph not been filed, the abysmal deficiencies in care discovered would most certainly have continued at their institution unchecked.

There is a unique opportunity for law enforcement and healthcare professionals to come together in the wake of this terrible saga and collaborate to accomplish a crucial goal members of both professions have pledged themselves to: Saving more lives. Already the role of commissioned officers has been redefined in St. Joseph’s care guidelines, a step in the right direction that allows for better alignment of goals between hospital security and healthcare providers. Our family is championing an effort “Medicine Not Bullets”, that does not speak out not against firearms in general, but asks that we dedicate more thought to the security policies and protocols in place to protect vulnerable patients and dedicated staff in the hospital. Here’s a preliminary suggestion: Advocate to implement the Project Betaguidelines as part of state protocols for dealing with patients who are agitated, confused, or suffering from mental illness in the emergency room and on inpatient floors.

Now that the hospital is going to remain open isn’t the time to casually dismiss the glaring holes in patient care that almost caused its doors to close in the first place. It’s time for St. Joseph Hospital to own up, demonstratively fix itself, and move forward with dignity, virtue, and a dedication to a higher standard of care for patients. There are outstanding clinicians and compassionate ancillary staff there to make it happen. I met them, and they wept with my family and me in the aftermath of Alan’s shooting when St. Joseph’s administration, the DA’s office, and HPD representatives were putting us through hell. There are people at St. Joseph dedicated to providing outstanding care for patients; they just aren’t the people in charge.

Stated plainly: CEO Mark Bernard must resign in order for any meaningful reform to take place at St. Joseph. As officials implement a systematic plan for improvement, CEO Mark Bernard must allow a more humanistic, competent, and capable executive to fill his shoes. In the wake of my brother’s shooting, Bernard stated, “If it should happen today, they would have not done anything different”. Under his supervision, the hospital released a statement proclaiming, “…we are certain that in this instance, hospital staff and the police officers took all appropriate action…”. Through these callous statements, Bernard showed that St. Joseph openly and publicly condoned the violations of a patient’s rights without regard for the human life that was almost lost or any acknowledgement of its negligence. Alan lived only by the grace of God. The bullet was just millimeters away from hitting Alan’s vital vessels and organs. A twinge in the trajectory of the bullet that pierced my brother’s chest would have killed him instantly. Their sentiments were akin to proclaiming that a violent death of a patient at the hands of their staff is completely acceptable. Such blame-shifting, blustery statements are dangerous, and indicative of the wanton disregard for a patient’s life, remarks that Mark Bernard has consistently maintained. Under his leadership, St. Joseph missed not one, not two, but three deadlines to rectify the problems in patient care at the institution. This man has no business running a hospital. He lacks the integrity, sympathy and common sense needed to oversee a large institution of healing. He certainly has no place running operations at a hospital like St. Joseph, which caters to Houston residents who need our empathy most — the impoverished, the underserved, the homeless, and the mentally ill. That he remains at his post despite repeated disastrous failures to handle this crisis is tremendously worrisome and hinders St. Joseph’s ability to truly reform.

Our family and the passionate student leaders in healthcare who have spoken out against the horrendous treatment of my brother are taking action, and we need St. Joseph to do the same. This could be a galvanizing moment in which we come together in an unprecedented manner to advocate for the health and safety of our patients as well as reform of a criminal justice system that adamantly tries to put a patient seeking treatment in prison even to this day. Thoughtful policy changes can be made to prevent another St. Joseph from happening to another community. When I started medical school, I took an oath to commit myself to the principle of beneficence and protect my patients. It would serve our physicians in the Houston area well to harken back to that noble promise we made — “primum non nocere”. First, do no harm. I know above all else that our patients’ lives matter. St. Joseph Hospital — My brother’s blood stains your hands. You have 16 months to convince me, the CMS, as well as the rest of the country, that you believe your patients’ lives matter too. Please, don’t fail us again.