A new, eye-opening report found major problems afoot at the flagship hospital of the National Institutes of Health (NIH). The report found that the NIH Clinical Center (headquartered in Bethesda, Maryland) falls victim to a host of issues: low morale, patient safety problems, poor management, poor communications, lack of accountability, and outdated practices.
The NIH Clinical Center is often hailed as the nation’s premier biomedical research institution. Its scientists don’t just fiddle with test tubes in laboratories — they conduct clinical research trials on experimental treatments. They see 10,000 patients every year from across the United States and around the globe. And for many patients, the NIH Clinical Center is their last hope.
At first glance, I thought the new report must surely refer to the Veterans Administration (VA) instead. President Trump’s new VA Director, Dr. David Shulkin, just fired more than 500 incompetent, obstructionist bureaucrats. Shulkin started by using congressional legislation passed during the Obama administration in 2012. But Obama never acted upon it.
Some department employees who were fired for unsatisfactory performance were able to be rehired after appealing to the Merit Systems Protection Board (MSPB). Shulkin asked for new legislation that limits the role of the MSPB in overturning firings. Congress passed the Department of Veterans Affairs Accountability and Whistleblower Protection Act to alleviate this issue, which Trump signed in June.
Of course, the NIH and the VA are both government health care agencies. But NIH has always been Congress’ favorite “jewel in the crown” of the federal government. Clearly — as the new report shows — government bureaucrats can even ruin a crown jewel.
Living in shadows of NIH
For many years, my family and I lived in the shadow (literally) of the NIH beast in Bethesda. So, we “know a thing or two, because we’ve seen a thing or two.”
For decades, Congress lavished ever more funding to the NIH for wars against giant health enemies including cancer and resistant infections. They built buildings faster than they could fill them on their huge, oversized campus perched atop some of the nation’s most expensive real estate.
The NIH acquired annexes all over Bethesda to accommodate even more bureaucrats pushing papers. At the end of our block, to the west, where we had our little two-bedroom house in Bethesda, sat a towering NIH annex office building. The annex stands higher than anything permitted in adjacent Washington, D.C., where zoning prohibits building taller than the U.S. Capitol dome.
During fall and winter, in the later afternoon, the shadow of this monstrosity would slowly creep down the street, plunging our modest home into premature darkness, as the sun dipped behind its bulk.
Outsized ambition and misplaced priorities
In the late-1980s, Congress was politically pressured to make “emergency” funds available for AIDS/HIV research. Despite all the extra space it had acquired, NIH somehow still didn’t have enough room to accommodate the new research.
To make room, they promptly closed down the clinical research facility where NIH scientists were studying autoimmune diseases such as lupus.
NIH mandated this change, despite the fact that AIDS is a preventable infection using 19th century public health practices. Subsequently, research into autoimmune diseases was abandoned. (To this day, we still don’t have a known prevention, treatment or cure for these kinds of autoimmune diseases.)
I often wonder if the ongoing lack of effective clinical protocols for autoimmune diseases has something to do with that decision in the 1980s. Or does the lack of research for autoimmune diseases stem from the overall poor management and employee performance cited in the new report?
Johns Hopkins moves into town
Perhaps sensing an opportunity (as they’re apt to do), the Johns Hopkins University (JHU) Hospital System in Baltimore acquired Suburban Hospital in Bethesda in 2007.
They now offer experimental treatments in clinical research conducted by a real academic medical research center. When JHU opened its clinical research program a decade ago, I was asked to speak at the opening since I’d given the keynote address at the JHU annual continuing medical education course the year prior.
Quagmire of medical care
NIH’s Clinical Center conducts research for 17 different NIH institutes. That means patients often take part in different research protocols with different teams of doctors. As a result, according to the report, “it can be very difficult to identify the medically responsible physician at any particular time.”
Additionally, when patients at the 200-bed NIH hospital need emergency transfers to hospitals for medical care that NIH cannot provide, it can take up to 45 minutes for an outside ambulance to clear NIH’s lavish security.
It’s important to also note that after 9/11, NIH spent a fortune for new security fences, vehicle inspection checkpoints, restricted access choke points, and other high-security devices and facilities. I think they would have built a mote and drawbridge too, but the zoning commission of the local “Peoples’ Republic” of Montgomery County, Maryland, would not approve it. NIH security now rivals anything in the infamous Green Zone at the U.S. Embassy in Baghdad, Iraq.
I don’t know whether to laugh or cry at the outsized notion that a bunch of poorly managed government health bureaucrats consider themselves so essential to national security as to exceed the needs of legitimate constitutional functions of the federal government in the Department of Defense.
In fact, the Walter Reed National Military Medical Center (where I also once worked) now sits across the street from NIH. It has nothing to rival NIH’s high cost “high security,” although it does have appropriate and adequate security (and always has).
Unlike real hospitals — where professional staff regularly attend conferences to review patient safety, misadventures, and unexpected problems — NIH doctors state they are often have to read about problems in public news reports.
The outside review concluded, “patient safety has become subservient to the demands of research.”
The NIH “Director-for-Life,” Francis Collins, has finally been prompted to overhaul the leadership of the Clinical Center Hospital. But he says NIH is still great…despite fragmented, organizational structure, suboptimal and uneven communications, declining state…and no strategic plan.
In other words, it’s “close enough for government work.”
Meanwhile, the new Trump administration has proposed a 22 percent cut to NIH’s bloated, mismanaged budget. You can hear the howls about how “millions will die” all across Washington. Instead of reassigning incompetent bureaucrats and keeping them on the payroll with full lifetime benefits (as they’ve done for decades, for example, as a way of staffing their lamentable center for research on Complementary/Alternative Medicine), NIH should welcome cuts like the VA is finally doing. That action would do a lot to boost the “morale” of the competent and dedicated doctors still remaining at NIH. (I know it would have done wonders for me when I was still there.)
Perhaps there may again some light on the streets of Bethesda after all.
“New NIH report finds low morale, continued patient safety concerns,” Washington Post (www.washingtonpost.com) 7/14/2017
Rosiak, Luke. “YOU’RE FIRED! Trump’s VA Terminates 500, Suspends 200 for Misconduct,” (2017 July 9). Daily Caller. Retrieved from: http://dailycaller.com/2017/07/09/youre-fired-trumps-va-terminates-500-suspends-200-for-misconduct/