A prominent federal judge quietly resigned from the board of directors at Baylor St. Luke’s Medical Center this year after the Houston Chronicle and ProPublica detailed a high rate of patient deaths and unusual complications following heart transplants at the hospital.
Carolyn Dineen King, a senior U.S. Circuit Court judge, confirmed that she stepped down from the St. Luke’s board on May 30, two weeks after the investigation was published. King joined the board in January 2014 and chaired the committee that oversees quality and patient safety at the hospital.
In a follow-up email, King said it would be inappropriate to discuss St. Luke’s business since she no longer serves on the board.
On May 16, the Chronicle and ProPublica published the first in a series of stories about the famed heart program. In recent years, the stories revealed, the program performed an outsized number of transplants resulting in deaths or unusual complications while continuing to market itself based on its storied past. Several top physicians left the program after raising concerns, including a couple of cardiologists who started sending some of their patients to other hospitals for transplants.
In a written response, St. Luke’s said King was the only board member who resigned this year. Marilyn Gerry, a hospital spokeswoman, said administrators took steps to “correct and improve” the heart transplant program during the past three years and kept board members informed of their progress.
“We shared periodic updates with the board and various committees over this time, and began providing additional updates and further details over the past year as board members wanted more information about our ongoing progress,” Gerry wrote.
The hospital also noted that a special committee of the board, appointed after the ProPublica and Chronicle investigation was published, is focused on improving the heart transplant program and “committed to ensuring the high level of excellence that everyone envisions at Baylor St. Luke’s.”
Marc Shapiro, chairman of the St. Luke’s board, praised King in a written statement and said he was pleased that she remains on the board of Baylor College of Medicine, which co-manages St. Luke’s as part of a joint venture with the hospital.
“Judge King has made significant contributions to our hospital over many years,” Shapiro wrote. “Our entire organization benefited enormously from her wisdom and insight.”
Hospital leaders did not address the reasons for King’s resignation in its responses to questions.
In the past, boards that govern nonprofit hospitals were primarily concerned with the financial health of their institutions. But increasingly, according to health policy experts, boards are taking a more active role in monitoring and improving the quality of care and patient safety.
Dr. Arnold Epstein, a professor of health policy and management at Harvard University, said it’s essential that board members are fully informed about a hospital’s performance. Epstein has conducted research that shows hospitals with boards that aggressively monitor outcomes and set goals to improve them score better in health care quality metrics.
St. Luke’s Heart Transplant Program to Lose Medicare Funding Today
The action is a stunning blow for a historic program that has performed among the most heart transplants in the nation.
“The board should be identifying areas of care in need of improvement and setting annual performance goals,” Epstein said. “And, oh by the way, Mr. CEO, your salary is going to be partially dependent on how you perform on this.”
King’s resignation had not been disclosed publicly, and although many nonprofit hospitals list their board members online, St. Luke’s does not. The hospital provided the list on Thursday after reporters asked for comment on King’s resignation.
King, appointed to the U.S. Court of Appeals for the 5th Circuit in 1979, is a prominent figure in Houston, where she has volunteered for several educational and health care organizations. She was the first female chief judge of the 5th Circuit and was appointed by the late Chief Justice William Rehnquist to the executive committee of the Judicial Conference of the United States, which oversees the federal court system. She chaired that group from 2002 through 2005.
St. Luke’s officials previously have said problems with the heart transplant program were confined to 2015, when seven out of 21 heart recipients died within a year of their transplants. But the program has struggled in other ways since then: Multiple heart transplant recipients have suffered unusual complications, including two who had major veins stitched closed during surgery, according to physicians and other health care professionals who spoke to ProPublica and the Chronicle. Another patient’s heart transplant failed this year after operating-room equipment malfunctioned during a key stage of surgery.
On June 1, two days after King’s resignation, St. Luke’s administrators voluntarily suspended the heart transplant program to study what led to two additional patient deaths in May but then reopened it two weeks later, saying they had made policy and staff changes. Days later, the Centers for Medicare and Medicaid Services announced it would cut off federal funding to the program on Aug. 17 because the hospital failed to demonstrate it had done enough to improve outcomes.
Following the federal termination, St. Luke’s is no longer allowed to bill Medicare and Medicaid for heart transplants, a move that could lead private insurance companies to follow suit. The deadline to appeal Medicare’s decision is Sept. 14, but hospital administrators have not said if they plan to do so.
The program is continuing to treat patients, hospital officials said. As of Friday, 84 people were listed as awaiting heart transplants at St. Luke’s.
(We are indebted to Mike Hixenbaugh, Houston Chronicle and Charles Ornstein, ProPublica for this important story)