On October 1, 2018, Houston-based Memorial Hermann Health System and Dallas-based Baylor Scott & White Health announced plans to merge into a new entity. Currently, the two systems combined have 68 hospitals, over 14,000 physicians on their medical staffs, and around 10 million patient visits annually.
If the merger goes through, the new hospital system would dominate a huge swath of Texas, including Houston, Dallas, and Austin. Officials from both hospitals contend that combining ownership and operations would create efficiencies and reduce costs.
Some consumers already express concern that bigger is not always better and that patients will not see any of the cost savings.
As a Houston, Texas medical malpractice lawyer, I have handled many cases involving Memorial Hermann hospitals, as well as other cases in the Dallas area where care provided at a hospital in the Baylor system was at issue.
In my experience, both as an attorney and former hospital administrator, large hospital systems look good on paper, but the quality of care is often lacking.
When I say, “look good on paper,” I am speaking literally.
During any medical malpractice case in which a hospital is a named defendant, we obtain relevant policies and procedures during the written discovery process. Policies and procedures are documents written and adopted by hospitals to guide the professional and clinical conduct of their nurses and other employees.
In many instances, these policies and procedures were written out at system-level, rather than by local hospital leadership. I have often found that local hospital employees have their own way of doing things that do not match the system-mandated policies and procedures.
For instance, I recently deposed some registered nurses who were employees of a suburban hospital that is a part of one of the large nonprofit systems in the Houston area. One of the issues in the case is why the nursing staff did not notify a surgeon when a post-operative patient was not able to urinate a day or two after surgery. This is a condition called urinary retention.
The medical records reflect that an order from the surgeon was in place allowing the nursing staff to use a straight catheter once if the patient had urinary retention, and to notify the surgeon when this occurred.
In this medical negligence case, the nurse noted that the patient had urinary retention. She inserted a straight catheter to drain the patient’s bladder but waited almost eight hours before notifying the surgeon. Our medical expert contends that the nurse’s delay in notifying the doctor caused irreversible nerve injury because he was not returned to surgery in a timely fashion to alleviate spinal cord compression.
Needless to say, these facts put the nurse in a bad light. At deposition, though, the nurse gave her very best effort to make it look like she had done nothing wrong. She explained that the hospital has its own “protocol” for handling urinary retention. Under this so-called protocol, nurses do not even need a doctor’s order to insert a straight catheter and can wait until the end of their shift—which can be up to 12 hours—before notifying a physician.
Interestingly, the hospital has a formal policy and procedure on urinary catheters. This document was passed and imposed on the hospital from the system level and requires a physician order before a nurse can catheterize a patient.
Based on these facts, I concluded that this is a case where the hospital system implemented a policy and procedure to satisfy accreditation purposes, but the local hospitals—or at least this one facility—did not enforce the policy or train the nursing staff to follow it.
Regarding the Memorial Hermann and Baylor Scott & White potential merger, many questions remain. Will it be finalized? If so, will costs go down? Will the quality of care suffer? Our medical malpractice attorneys will be watching closely to answer that last question over the coming years.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
