BMC loses surgery residency accreditation, but hopeful on appeal
PITTSFIELD -- Berkshire Medical Center's surgery residency program has lost its accreditation, but the hospital is appealing the ruling and hopes the program will be restored.
The Chicago-based Accreditation Council for Graduate Medical Education informed BMC in November that it was withdrawing the accreditation, but didn't state its reasons until Jan. 27, according to hospital officials. The ACGME is a private professional organization responsible for the accreditation of 9,200 residency education programs.
The hospital said the action was brought on by inadequately prepared documentation to the agency during a site visit last year.
ACGME's Resident Review Committee will hold a hearing on BMC's appeal on March 24. The agency's board of directors will issue its final decision in June, said Dr. John R. Potts III, ACGME's senior vice president of surgical accreditation.
If ACGME rejects BMC's appeal, the hospital will have to close the program, which has been in operation since 1962, said the program's interim director, Dr. Pervis Sadighi. But Sadighi said BMC could immediately re-apply for accreditation, and the program would be able to stay open while that process takes place.
BMC's Chief Operating Officer Diane Kelly said losing the program would affect the amount of assistance that staff surgeons receive from residents because "they rely on them to be their eyes and ears," Kelly said.
To maintain that level of communication, Kelly said BMC would hire additional physician assistants.
"It does not affect surgery and people getting care at all," she said.
Dr. Timothy Counihan, who directed BMC's surgery residency program for the past seven years, voluntarily resigned from that position on Feb. 1. Counihan was replaced by Sadighi, who directed the program for 25 years before Counihan took over. Sadighi graduated from BMC's surgery residency program in 1969.
BMC spokesman Michael Leary said Counihan's remains on BMC's staff as an colorectal surgeon.
BMC's surgery residency program provides five years of clinical training for college graduates seeking a career in general surgery, and those interested in further sub-specialty training, according to BMC's website. Fourteen students are enrolled in the program, and two graduate each year, Sadighi said.
The ACGME normally reviews surgery residency programs every five years, according to Potts, although it is considering holding the process on an annual basis.
Hospital officials said they were stunned by the ACGME's decision to withdraw the program's accreditation. But they also acknowledge that they didn't provide documentation in the format ACGME wanted when it visited BMC last April.
The documentation "was not organized, and a number of documents were given to the reviewer in separate files," Sadighi said. "I was told by our consultant that really doesn't go well, because we're increasing their workload two or three times."
Following last April's site visit, BMC officials said the ACGME found fault with three "programmatic procedures" in the surgery residency program that had nothing to do with that clinical quality of care being provided by the residents.
"This has nothing to do with the quality of the residents or their performance," said Dr. Mark Pettus, BMC's director of medical deduction.
Those issues included BMC having conducted only one appraisal or review of a resident's performance instead of two; two residents who had observed one less case than the minimum number that they were required to review; and a work-hour policy that was not documented in the proper format, accordig to Sadighi and Kelly.
Sadighi said the program had received citations, or recommendations for improvement, from the ACGME in the past, and had always been given the chance to correct them. But he said that procedure did not take place this time.
"The first step is a warning, they call the program director, that didn't happen," said Sadighi.
"The second step is a citation, that didn't happen," he said. "The third step is probation, we weren't given that. The last step they take is withdrawal of accreditation."
Sadighi and Pettus will represent BMC at next month's appeals hearing. The hearing will be in Chicago.
"My first line of defense is that all these documentations were there and that we have them," he said. "The second line of defense is very respectfully asking that we be given due process."
The ACGME declined to comment on the specifics of BMC's case because the matter is under appeal. But Potts said the ACGME seldom withdraws the accreditation of surgery residency programs.
"It's a rare occurrence," he said, "because those programs do substantially comply with the standards on an ongoing basis. For a program to lose accreditation, it has to be out of compliance with several of those standards."
He also declined comment on why the ACGME didn't list the reasons why it was withdrawing its accreditation of BMC's surgery residency program two months after it first informed the hospital of its decision.
The Eagle recently received an email with the names of eight members of the surgery residency program who claimed their careers were being held "hostage" because BMC has refused to release them from their commitments so that they can pursue opportunities in other programs. Those residents did not respond to an email from The Eagle seeking further comment.
Kelly said BMC has taken the opposite approach.
"What we've done with the surgery residents is we've encouraged them to do whatever they need to do," she said. "If they want to look for another position, we are releasing them or supporting them with that process."
Because surgery residency programs are funded by the federal government, Pettus said it may be difficult for some BMC residents to enroll in similar programs if there are no openings and the funding is not available.
"That is not within our control," Kelly said.
Kelly characterized BMC's current situation with the ACGME as a learning experience.
"I think that when you're having an on-site review you do know that the regulators want everything very prescriptive," she said. "Health care is used to that, to be very honest with you.
"When they say they want it in one format, they want it in one format," she said. "And I think when they got here and didn't see it all together and documented in the way they had prescribed, I think they took a stand.
"And, we are going to learn from that."
BMC recently received back to back awards by an agency that collects data on hospitals and physicians. Health Grades placed BMC in the top 5 percent of hospitals in the nation for clinical excellence.
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