Ray Mariano: At St. Vincent, the fault lies with Tenet Healthcare

During the St. Vincent Hospital nurses strike, I wrote several columns criticizing the hospital administration and its CEO, Carolyn Jackson. As I saw it, the nurses were fighting for their patients. It was a noble cause.

I thought that when they settled the contract, the issue of patient safety had been resolved. It appears that I was wrong.

More recently, I wrote a column about the nurses' allegations that patients at the hospital were receiving substandard care. Nurses made some startling allegations and at least one investigative agency found that the hospital was “noncompliant with applicable Centers for Medicaid and Medicare Services (CMS) Conditions.” This could put the hospital’s accreditation in jeopardy. Again, I criticized Jackson.

As a result of that column, I received a number of emails from readers who told me about their own experience at the hospital, verifying the nurses' allegations. One reader claimed that their loved one “waited for hours” for medication” and that they “couldn’t find a nurse or PCA,” saying “it was a nightmare.” I was disheartened when a reader wrote that his 64-year-old sister was forced to sit “in a wet bed” crying because there was no nurse to attend to her and she was humiliated. Readers made other far more serious accusations.

I have been highly critical of Jackson and her administration for what many nurses and some patients say are serious patient deficiencies and substandard care. And I have criticized Jackson for trying to strong-arm and intimidate nurses by firing some of the nurses who filed complaints against the hospital.

However, as I reflect on it, I’m not so sure that I’ve placed the blame where it belongs. Sure, Jackson is the face of the hospital and is absolutely responsible for any instances of substandard care that might be found. And her tactics of firing those who complained was found, in at least one instance so far, to be “an act of punishment and thinly veiled retaliation.”

But I’m guessing that her bosses at Tenet Healthcare, who own the hospital, know exactly what she’s doing and that they approve. If they didn’t, Jackson wouldn’t still be there.

Tenet’s record

Based in Dallas, Tenet Healthcare is a behemoth with 58 acute care hospitals and 648 health care facilities in its portfolio. Its total revenue in 2023 was $19.5 billion. These guys are huge.

Unfortunately, a simple internet search shows that Tenet has a sordid business record. According to multiple media sources, over the past 20 years Tenet has been forced to pay more than $2 billion in fines and penalties. That’s a great deal of money. But more eye-popping are the charges that accompany these fines.

Here are just a few of the reports of wrongdoing that I found online.

In one case, according to a Department of Justice press release, Tenet and two of its subsidiaries paid nearly $30 million to resolve allegations of kickbacks to doctors for referrals.

In another case, according to ProPublica, Tenet and a subsidiary paid $25 million after Hurricane Katrina to resolve allegations that they were ill-prepared for the storm, including that “some doctors subsequently acknowledged that they had hastened the deaths of patients by injecting them with drugs.” No criminal charges were filed.

Also, again according to the Department of Justice, there was the $1.4 million they were forced to pay “to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for implanting unnecessary cardiac monitors.”

In another Department of Justice case, Tenet and two of its subsidiaries were forced to pay $513 million “to resolve criminal charges and civil claims related to a scheme to defraud the United States and (for paying) kickbacks in exchange for patient referrals,” including pregnant undocumented Hispanic women.

More recently, according to Market Insider and other publications, Tenet paid $160 million to settle a class action suit for unpaid overtime to nurses and physician assistants.

In 2005, Consumer Watchdog published a story titled “Profile of a Repeat Offender: Tenet Healthcare Corporation.” According to the story, Tenet pleaded guilty “to federal conspiracy charges for paying kickbacks and bribes to doctors.” It paid $375 million to settle the charges.

In 2016, the Dallas Morning News wrote a piece with the headline: “Why can’t Tenet Healthcare, a repeat offender, stop the fraud scandals?”

I don’t know what it’s like to run a major hospital. But allegations of kickbacks, implanting unnecessary cardiac monitors and an assortment of other dubious practices don’t paint a picture of a health care system that puts patients first.

Tenet’s response

These are serious charges. So I called and emailed Tenet’s headquarters to give them a chance to respond. I never heard back. I guess the charges and the penalties speak for themselves.

So what’s the answer?

One reader wrote that “it’s time for Jackson to go.” Perhaps. But I don’t think that solves the problem. Tenet will just bring in another CEO who will likely do more of the same.

Another reader got closer to a solution: “Tenet need(s) to be held accountable and prosecuted to the full extent of the law.” I agree. While it appears that being prosecuted and paying hundreds of millions of dollars in fines is all calculated into Tenet’s cost of doing business, the fines and negative publicity may have had an impact. In 2002, Tenet’s stock price rose to a high of $208. Today that price is just over $100.

If federal and state investigative agencies find that the business practices at St. Vincent jeopardize patient safety, the Massachusetts Attorney General should protect the patients and hold the hospital accountable.

Email Raymond V. Mariano at rmariano.telegram@gmail.com. He served four terms as mayor of Worcester and previously served on the City Council and School Committee. He grew up in Great Brook Valley and holds degrees from Worcester State College and Clark University. He was most recently executive director of the Worcester Housing Authority. His column appears weekly in the Sunday Telegram. His endorsements do not necessarily reflect the position of the Telegram & Gazette.

This article originally appeared on Telegram & Gazette: Ray Mariano on St. vincent Hospital and Tenet Healthcare