At the Bronx’s Montefiore Medical Center, a woman in her 60s “died on a ventilator with a setting turned too high by residents who didn’t know how to operate the device,” reads the story. In a letter Wednesday to the Journal, Montefiore Chief Legal Officer Christopher Panczner threatened legal action if that charge isn’t retracted. Two investigations, Panczner wrote, had addressed the allegations in the Wall Street Journal article. “Despite an exhaustive review of medical and operational records, as well as interviews of over thirty individuals, no support could be found for the outrageous allegations of malpractice, leading to the death of a patient, contained in that article.”
The Journal hung its account of the ventilator screw-up on input from “residents” — young medical school graduates undergoing intensive, on-the-job training in a specialty. According to the paper, the episode occurred during an overnight shift in March. “[D]octors rushed to the room of a patient in her 60s whose heart had stopped. One noticed a problem: The ventilator keeping her alive had been turned up too high,” reads the story. “A critical-care physician asked two of the family-medicine residents in charge of the 36-bed unit if they knew how to work the settings on a ventilator. The answer was no, according to residents, including one who was present.”
Amid the volume of covid-19 patients, reported the Journal, “residents said they were just learning how to operate the respiratory support devices. Pulmonary doctors have since presented the woman’s death as a cautionary tale in training sessions at the hospital, residents said.”
Catherine C. Skae, vice president for graduate medical education at Montefiore Medical Center, said that when she first saw the allegations in an April 16 email from one of the Journal reporters, “I took it at face value and thought it was true,” she recalled. Then she started probing: Who could this patient have been? The Journal’s inquiry had said that the death occurred in a unit of the hospital known as Northwest 7 in “mid-March,” so Skae and others pulled death records for that area that month. None of the cases matched the circumstances alleged in the Journal.
The Journal didn’t specify whether the woman who died was suffering from covid-19. According to Andrew D. Racine, chief medical officer at Montefiore Medical Center, hospital officials interviewed a range of people with possible awareness of the lapse, including employees in respiratory therapy, nursing, quality management, risk management, patient safety and the residents themselves. “They could not identify an event of the sort that’s being reported in the article,” Racine said.
The hospital’s investigation did indeed find two women in their 60s who’d died in Northwest 7 after having been on ventilators. But their histories didn’t match specifics that the Journal included in its query to Montefiore. Whereas the Journal said that the woman had been admitted the previous day, the only two women matching the Journal’s demographic description had been in the hospital for more than a week. There was also a discrepancy between the time at which the Journal described the woman as dying and the hospital’s records for those two women.
Besides the hospital’s investigation, the Accreditation Council for Graduate Medical Education (ACGME) also reviewed the incident. Its findings, the ACGME wrote in a letter to Montefiore last week, “adequately addressed the concerns raised” to the council. “The Sponsoring Institution and program will not be charged with noncompliance with ACGME’s covid-19 Requirements, and the ACGME will not take any further accreditation action in relation to the information we received. The matter is closed,” reads the May 15 letter.
Hospital spokeswoman Hilary Lefebvre said that both the hospital’s internal investigation and the ACGME investigation interviewed “every single resident” who worked a shift in Northwest 7 in March “and no resident raised an issue or concern about any case that might have fit this description.”
Residents at Montefiore were demoralized by the story and expressed concern that leaders weren’t defending them, Skae said. Montefiore did not comment on the allegations for the Journal’s story, though it had 13 days to do so. Lefebvre said that it would have been premature to comment on a wide-ranging internal investigation, and that the hospital’s interaction with the Journal for a previous story had been disappointing. “All of the engagement with them was unhelpful and made it clear that they didn’t understand hospitals or how hospitals worked,” she said.
Two doctors with Montefiore’s department of family and social medicine sent a letter to the editor of the Journal, updating the newspaper on the results of its internal investigation. “We found no case that matched the description provided by your reporter. ... Residents in our family medicine program universally described disbelief that an intern would be managing a ventilator independently,” read the letter, in part.
No thanks, responded the newspaper. “We won’t publish a letter attacking our journalism and making claims that we don’t believe to be true,” wrote Judi Walsh, a newsroom standards editor at the Journal, in reply to the Montefiore doctors. The paper’s standards unit had reviewed the piece, “and we are confident that it is accurate,” continued Walsh. Furthermore: “The article didn’t say that residents were asked to independently manage a ventilator,” wrote Walsh. No, it “merely” said that residents independently botched that job. From the story: "[A] patient died on a ventilator with a setting turned too high by residents who didn’t know how to operate the device, according to residents there.”
The Erik Wemple Blog asked the Journal about the letter rejection: “Our article was robustly sourced, fair and accurate and we stand by the reporting. We do not publish letters baselessly attacking our journalism and making claims that we don’t believe to be true,” Journal spokesman Steve Severinghaus said in an emailed statement. Many news organizations add responses from interested parties to online articles after they’re published. The Journal hasn’t done so here. “The Journal practices ‘no-surprises journalism’, and as always, we shared with Montefiore what our reporting had indicated and gave them thirteen days to respond before publication. They declined. Updates are meant to add information and/or voices that weren’t available at publication time, or substantively different information for a reader, none of which Montefiore offered in its belated response," Severinghaus said in another statement.
The dispute over the Journal’s resident story illustrates some of the peculiarities of reporting on a hospital gripped by the coronavirus crisis. Thanks to the Health Insurance Portability and Accountability Act (HIPAA), patient confidentiality in U.S. hospitals is ironclad. The Journal’s initial inquiry, accordingly, didn’t name the patient who allegedly died after the ventilator-setting miscue. Lacking a name, hospital officials had to conduct their search via demographics. Seven-hundred clinical hours were sunk into tracking down the claims in the Journal’s article, Lefebvre said.
Sources for the Journal’s claims about the ventilator incident — no surprise — were unnamed. In its first mention of the incident, the Journal attributed the information to “residents.” A more detailed rundown deeper in the story indicated that one of the sources was “present” at the reckoning over the ventilator’s settings. That source apparently spoke to the Journal but did not share the same information with the hospital through its anonymous internal reporting mechanism, Skae said.
The Erik Wemple Blog cannot resolve this spat from our Dining Room Table Coronavirus HQ. The Journal has a long and distinguished record of investigative reporting. The reporter who inquired about the ventilator incident is Joe Palazzolo, who was on the team that won a Pulitzer Prize for reporting in 2018 on the secret payoffs to two women who allegedly had affairs with President Trump. The paper distinguished itself with its scoops on Trump’s corrupt dealings with Ukraine, among many other topics.
At the same time, at least four Montefiore officials have gone on record to challenge the Journal’s reporting. They deserve a voice in the newspaper, whether it’s in the letters space, the article or both.
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