Accrediting Agency Warns Hitchcock
Lebanon — An independent accreditation organization for medical education has issued warnings to Mary Hitchcock Memorial Hospital and its surgery-training program for new doctors after receiving a complaint from a resident who was dismissed from that program.
That development punctuated a five-year-old controversy that put a temporary roadblock in the career path of an aspiring doctor and raised questions about the policies and practices at Dartmouth-Hitchcock, which trains hundreds of physicians in dozens of specialties.
On June 13, the Accreditation Council for Graduate Medical Education, a nonprofit group based in Chicago, changed the status of Mary Hitchcock, the teaching hospital that comprises a key element in Dartmouth-Hitchcock’s medical network, to “continued accreditation with warning,” according to Paige Amidon, ACGME’s senior vice president for communications. Then, on June 25, ACGME put the hospital’s surgical residency program in the same category.
ACGME’s “mission is to improve healthcare and population health by assessing and advancing the quality of resident physicians’ education through accreditation,” according to its policies and procedures manual. Warnings are issued when a review committee “determines that a program or sponsoring institution has areas of non-compliance that may jeopardize its accreditation status,” according to the ACGME website.
However, ACGME does not make public the areas of non-compliance that prompt warnings, or any “data, correspondence, conversation, or event leading to any accreditation decision,” Amidon said.
During the 2013-2014 academic year, 20 of the 698 institutions with graduate medical education programs were in a “continued accreditation with warning” status, Amidon said. That year, 155 of the 9,790 residency programs operated by those institutions were in that status, she said.
Programs operating with warnings in place are prohibited from seeking permanent increases in the number of resident positions in their programs or waivers of duty hour limits, according to ACGME. During the just-completed academic year, D-H filled 28 of its 32 residency slots for surgeons.
The surgery program is the only one of the 47 residency programs at Mary Hitchcock that has received a warning, Amidon said.
ACGME’s accreditation decisions in June were “specifically related to the dismissal of a resident, Dr. Thersia Knapik, from Dartmouth-Hitchcock’s surgery residency program in June 2012,” D-H spokesman Mike Barwell said in a statement sent by email last week.
Knapik sued the hospital for wrongful termination, breach of contract and unfair dealings in U.S. District Court in Rutland after she was expelled from the residency program.
D-H doctors discovered she had anonymously contacted officials of a Kentucky fellowship program to raise ethical concerns about another D-H resident who had been awarded a fellowship, according to court filings. A D-H doctor came to Knapik’s house where friends and family had gathered to celebrate her graduation and told her she had been fired, according to her court filings.
Knapik lost her lawsuit. “A federal court determined that she was lawfully dismissed from the program,” Barwell pointed out.
In that case, a federal judge granted a summary judgment in which he concluded that D-H “failed to follow” its own grievance process but hadn’t had to because Knapik’s dismissal was an academic decision and “academic decisions are entitled to substantial deference.”
D-H officials did confirm to other institutions that Knapik had completed her residency and she was able to take the so-called surgery boards, an examination that verifies competency in that specialty, and continue her post-graduate medical education.
“Dartmouth-Hitchcock has provided Dr. Knapik with documentation of her completion of the surgery residency program,” Barwell said in his Wednesday email. “It is our understanding that she is currently enrolled in a surgical critical care fellowship in the Southeast and we hope that she will be successful in her pursuit of additional training and in her surgical career.”
Norman Watts, a Woodstock lawyer who represents Knapik, said that she is enrolled in a fellowship at a hospital affiliated with the University of North Carolina.
Watts last week said Knapik was not available for comment.
Online records at the North Carolina Medical Board show that Knapik was issued a license to practice medicine in that state on May 16, 2014, and that she received board certification as a surgeon this year. Knapik is listed as one of two critical care fellows on the website of the surgery department of the University of North Carolina School of Medicine. Knapik received her medical degree from UNC in 2007.
The action by ACGME prompted change at D-H, according to Barwell.
“We reviewed our graduate medical education due-process policies and procedures, identifying some areas for improvement and implementing changes,” he said. “We have taken steps to address ACGME’s concerns and continue to recruit excellent candidates for our 47 residency training programs.”
Amidon said the warning could be removed from the hospital’s accreditation during an upcoming annual review by ACGME’s Institutional Review Committee, while the surgery residency program’s slate could be cleaned during a similar review by ACGME’s Surgery Review Committee.
ACGME last made a site visit to review D-H’s accreditation as a sponsoring institution in October 2011, and the approximate date of the next visit is Nov. 1, according to the ACGME website.
ACGME made a site visit to D-H’s surgery residency program in February, and no date has been set for a future visit.
Rick Jurgens can be reached at firstname.lastname@example.org or 603-727-3229.