NEWS- Site visit: Scolded Med Center awaits a verdict

Judgment Day has come and gone for the UVA Medical Center, which has been on probation since April, its accreditation by the Council of Graduate Medical Education in limbo. But its fate still remains uncertain a week after the August 1 site visit by representatives of the group's accrediting committee. The site visit– completed at UVA's request– will determine whether the problems with UVA's residency program have improved enough to have its probationary status removed.

Among issues the Council cited in its probationary finding: violations of resident work hours and a lack of support staff, which put pressure on residents to complete non-medical tasks such as lining up transportation or scheduling follow-up appointments. 

"I have worked many 100-plus hour weeks," said one UVA resident, who spoke anonymously with the Hook for the July 20 cover story, "PR Emergency: UVA Med Center struggles with probation." 

In 2003, the Council enacted rules limiting the average number of hours a resident could work to 80 hours a week as well as establishing guidelines for the maximum number of hours residents can be "on call." Other problems the Council cited at the Med Center included inadequate security on "call room" doors (rooms where residents can sleep) and the Medical Center's failure to schedule an interim site visit with the Council between its official five-year inspections.

While many hospitals have had departments placed on probation– Johns Hopkins' acclaimed Internal Medicine program was on probation two years ago– institutional accreditation is a new designation, implemented by the Council just one year ago, and UVA is the first to be placed on this type of probation. In the Hook's previous story, longtime Med Center staffers voiced concerns about the probation affecting staff retention and the Med Center's ability to attract top residents. 

"If we don't get off probation, we've gone to Armageddon for the hospital," said one senior physician, who like others the Hook spoke with, requested anonymity citing fear of retribution from the administration. (Med Center CEO Ed Howell denies any such threat exists, and says there are no examples of retribution during his tenure.)

Would so-called Armageddon really cause the best potential residents to steer clear of UVA? Despite such doomsday predications, hospital administrators profess optimism.

"We have a great training program here at UVA, and we expect to retain our accreditation," says Susan Kirk, associate dean of the Med Center and Designated Institutional Official for Graduate Medical Education.

But the senior physician says he's not at all certain the improvements made will be enough to put the Medical Center back on track. "I'm hearing people give it a 50/50 chance," he says. "It's anything but a done deal."

Whatever the odds, the decision won't be made until sometime in October, according to ACGME spokesperson John Nylen, who reports that the inspectors are preparing a report that will then be considered by the Council's review committee, composed of volunteer physicians from teaching hospitals around the country. The committee next meets in late September or October, Nylen says, meaning no answer is possible before then.

Meanwhile, says the senior physician, it's business as usual at the Med Center, where few people are even discussing the issue.

"There's nothing more we can do about it at this point," he says. "We just wait."

UVA Vice President and Medical Center CEO Ed Howell should hear the verdict in October