Five Lessons from the St. Louis Post Dispatch's "Who protects the patients?"

Blythe Bernhard and Jeremy Kohler at the St. Louis Post-Dispatch have launched a series of stories called "Who protects the patients?"

The first in the series, Doctor lost hospital privileges but kept clean record, tells a story that should have Missouri patients calling their state legislators. Here are five lessons from the story for reporters writing about similar cases:

1. Get the court transcripts. One of best pieces of evidence of how a doctor can show a pattern of problems and survive with an unblemished record was a comment Bernhard and Kohler picked up from a court hearing. The doctor in question, Dr. Surendra Chaganti, had been found by a hospital peer review panel to have made the wrong calls in a number of cases. Threatened with losing his hospital privileges, Chaganti sued the chairman of the review panel and the hospital's medical staff president.

Court records show those doctors and St. Anthony's later agreed to a settlement in which the hospital would accept Chaganti's resignation and not report it to a national databank set up to flag problem doctors. 

"He would still look good on paper to everybody," U.S. District Judge Henry E. Autrey noted in a hearing in the case in 2004, according to a transcript. "... Everybody would be happy."

2. Give the doctor his due. The newspaper, within five paragraphs, says, "Chaganti disputed that there was any legitimate basis for taking away his privileges." And the reporters take pains to point out along the way where Chaganti and his brother, who is also his lawyer, have disputed the allegations. This takes nothing away from the story and, in fact, adds quite a bit of good context. After all, the reason to write about a doctor under fire is less about what they have done wrong and more about the title of the series: "Who protects the patients?" Too many reporters are so frightened of talking to the actual subject of their investigation until the very end that they end up with "no comment" or a slammed door. Bernhard and Kohler clearly worked hard to give Chaganti opportunities to respond.

3. Test for echoes. Doctors who sue each other are rarities. Doctors who sue hospitals are rarer still. The story says:

That lawsuit was just one that Chaganti would file when questions were raised about his work. After a psychiatrist at St. Alexius Hospital complained to the healing arts board about Chaganti's patient care in 2003, Chaganti sued the psychiatrist. After CenterPointe Hospital in 2007 denied Chaganti's request for privileges, he filed suit against the hospital seeking an injunction. Naren Chaganti represented him in the lawsuits. 

When you find a doctor who has sued multiple hospitals because administrators have questioned their behavior, you are on to something. Conversely, if you find a hospital that has been sued over and over by doctors who have been shoved out, you may have a great story on your hands. You have either stumbled upon a supremely effective peer review system or a true old boys' network aimed at protecting a dangerous status quo.

4. Crunch the numbers. The Post-Dispatch points out that the Missouri Board of Registration for the Healing Arts licenses and monitors 22,000 doctors. Of those doctors, how many do you think are reported by hospitals to the National Practitioner Data Bank in a given year? The answer is eight. That is a rate of one doctor reported for every 2,705 in the state. I like to think that Missouri's doctors are just that excellent, but it's doubtful.

5. Keep the conversation going. You have a hostile attorney who has sued other people on behalf of his client and now is accusing your newspaper of drawing the attention of state regulators to your client. What do you do? The story says:

Naren Chaganti said the Post-Dispatch was to blame for the new scrutiny of his family because reporters started asking about his brother's record after the Whispering Oaks closure earlier this year.

Bernhard and Kohler – and their editors – could have decided that the heat wasn't worth it. Or they could keep talking with the attorney until the attorney handed them a smoking gun. In this case, the gun was not damning evidence for Chaganti, but damning for the Missouri medical board. They write:

He said he would defend his brother aggressively in the healing arts board case. He showed a reporter a copy of an e-mail from board lawyer Glenn Bradford saying the board was concerned about Chaganti's problems at St. Anthony's and other hospitals but didn't necessarily want to discipline him, just make sure he was "good to continue." If Chaganti agreed to an assessment, the e-mail said, "then we could back burner the case until we see how that shakes out and perhaps save everybody a lot of time, money and distress."

Set up a Google Alert for "Who protects the patients?" This is definitely a series worth paying attention to.