Agency Upgrades D-H Accreditation
Lebanon — An accreditation agency that monitors the quality of hospital residency programs for training doctors just out of medical school has upgraded the status of Mary Hitchcock Memorial Hospital, which sponsors 47 such programs, and of the hospital’s training program in surgery.
The actions by the Accreditation Council for Graduate Medical Education upgraded the ratings of the hospital and its third largest residency program just as graduating medical students around the country began expressing preferences about where they would like to pursue the next phase of their training.
Hospital officials welcomed the moves. “We weren’t surprised by (the accreditation council’s actions) but were nonetheless very pleased,” said John Birkmeyer, executive vice president and chief academic officer of Dartmouth-Hitchcock, the hospital’s parent organization.
On Jan. 7, the accreditation council raised the status of the surgery residency program at the hospital to “continuing accreditation.” Seven months earlier, it had lowered the program’s rating to “continued accreditation with warning.”
Then, on Jan. 28, the accreditation council removed the same qualifier from the status of Mary Hitchcock Memorial Hospital, which in June had also had a warning added to its accreditation as a residency program sponsor.
Emily Vasiliou, an accreditation council spokeswoman, said the council posts its accreditation actions online but does not comment on how those decisions are arrived at.
A warning limits a program’s ability to add slots or to obtain waivers of limits on residents’ working hours, according to the council’s website. It might also affect potential residents’ opinions of the desirability of pursuing their training in an affected program or sponsoring institution.
Residency comes after medical students graduate and get licensed as physicians. Residents sign contracts that make them paid hospital employees, treat patients and work what are typically long hours under the supervision of experienced doctors responsible for training and educating them in their specialties.
Birkmeyer said that the accreditation warnings at D-H resulted from employment issues and not problems with the quality of the education or health care in the program.
In particular, the accreditation downgrade resulted from a complaint filed by Thersia Knapik, according to hospital officials.
In June 2012, Knapik was sent packing just before her scheduled graduation from Mary Hitchcock’s surgical residency program after officials discovered that she had sent an anonymous letter to another hospital that raised questions about the status of another resident who had been awarded a fellowship, according to pleadings in a lawsuit filed by Knapik.
Knapik’s lawsuit failed after a judge ruled that even though the hospital had not followed its own procedures in handling her case, it had not acted illegally.
But Knapik also filed a complaint with the accreditation council, which last June added the “warning” to the accreditation status of the hospital and its surgical residency program. A warning is issued when a residency program or sponsor fails to comply with council standards in a way “that may jeopardize its accreditation status,” according to the council’s website.
Birkmeyer said that hospital officials first became aware of Knapik’s complaint to the council in February 2014. He said that he and Marc Bertrand, a physician who leads the hospital’s graduate medical education programs, traveled to Chicago last April and met for half a day with the council’s executive director and others.
Then, after the American Board of Surgeons determined that Knapik had fulfilled the requirements of her residency prior to her dismissal from the D-H program, the hospital issued her a “certificate of completion,” Birkmeyer said. That enabled Knapik, who is now a fellow in surgical critical care at the University of North Carolina, to progress in her medical training and career.
Meanwhile, the last step necessary to erase the “warning” from the accreditation status was a site visit by representatives of the accreditation council, who, according to Birkmeyer, determined that D-H had “adequate due process procedures in place with regard to employment decisions.”
The council’s actions stemmed from Knapik’s complaints and “had nothing to do with quality” or broader education issues in the program, Birkmeyer said.
Hospitals fill the ranks of their residency programs in a process that begins when graduating medical students submit applications to a nationwide clearinghouse. Each applicant ranks specialties and sponsoring institutions in orders of preference.
The current application period began Jan. 15 and closes Feb. 24. Computer programs then cross-reference applicant preferences with their standings with sponsoring institutions, and each student is assigned a slot in a program. The prospective residents are informed of their destinations for the coming fall in a medical school rite of passage known as Match Day. This year Match Day is scheduled for March 18.
The only other New Hampshire medical facility accredited by the accreditation council is Concord Hospital, which has 25 residencies in a family medicine program.
The University of Vermont Medical Center in Burlington has 304 residency slots and 38 programs.
Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.
