TAMPA — A program at the University of South Florida that trains doctors specializing in high-risk pregnancies has had its accreditation yanked after a review board found the students were overworked and poorly supervised.
That will not surprise Dr. Adam Urato, a former USF faculty member. For the past two years, Urato, a maternal fetal medicine specialist now at Tufts University in Boston, has been warning USF's College of Medicine officials that trainees have inadequate oversight, particularly when they're treating poor pregnant women at Genesis, a busy Tampa clinic.
The American Board of Obstetrics and Gynecology agrees. Based on a site visit in late October by two maternal fetal medicine experts, the board told USF this month that the fellowship program has lost accreditation.
"Specifically, there appeared to be very little, if any, supervision of the fellows at the Genesis Clinic," the board's executive director, Dr. Norman Gant, said in a Feb. 6 letter suspending the program's credentials.
It is the only one of 82 advanced medical training programs offered by USF to be blackballed by an accrediting board.
The three fellows who are currently in USF's maternal fetal medicine program will be allowed to complete the three-year course or transfer to another university.
The blow to USF's College of Medicine comes as the fellowship's director, Dr. Ruben Quintero, is headed out the door. Quintero, a world-renowned fetal surgeon, is joining the faculty of the University of Miami's Leonard M. Miller School of Medicine next month. He has been head of USF's program for training high-risk obstetricians since December 2005.
Quintero disputed the board's findings on Thursday. "The arguments being used to suspend the program are not factual," he said.
Dr. David Keefe, chairman of USF's department of obstetrics and gynecology, said he will appeal the board's decision. USF also is changing the status of the fellows from faculty to graduate medical education training slots. Dr. Peter Fabri, USF's associate dean for graduate medical education, said the change should ensure fellows receive adequate supervision, education and research opportunities.
It will be the latest effort to salvage a training program in high-risk pregnancies for physicians who have completed a four-year residency in obstetrics and gynecology. The fellowship had been put on probation by the accrediting body in 2005, but was removed in 2007 after USF promised changes. During the October visit, reviewers found that noncompliance issues had not been corrected.
Keefe and Quintero insist all of the board's earlier concerns were addressed and that the review committee was provided with substantial proof of compliance. The board, however, still found serious shortcomings in the program.
"As a matter of fact, the issue of supervision of the fellows has apparently become even worse," Gant told Keefe in his letter earlier this month.
Urato, the whistle-blower who is now an assistant professor at Tufts, joined USF in mid 2006 to run a clinic for high-risk pregnant women in Manatee County. By November 2006, he was questioning the legality of having USF fellows work unsupervised in the clinic when he was absent. Keefe and Quintero insisted that having an attending physician available by phone was sufficient.
When the accrediting board told USF such "telemedicine" was not allowed, fellows were no longer sent unsupervised to Manatee. USF terminated its contract with the federally funded program at the end of last year.
Meanwhile, Urato said fellows were complaining to him about lack of supervision at Genesis Clinic. The clinic off Hillsborough Avenue is owned by Tampa General Hospital and sees up to 50 high-risk pregnancies a day, with about 70 percent of the patients on Medicaid and 20 percent uninsured. "When I raised it as a patient safety issue with Drs. Keefe and Quintero, I was accused of not being a team player," Urato said. "I was just astounded that they accepted that poor pregnant women should get a different standard of care."
Keefe remains adamant that the fellows are being appropriately supervised at Genesis, with an attending physician on site every day. He also said no one has ever shown there are safety problems with patient care at the clinic.
Urato, who teaches, supervises students and cares for patients at Tufts, said it's impossible for untutored fellows to know what they're missing in complex medical cases.
"You can't rely on someone just starting out to care for 40 to 50 high-risk, pregnant women every day," he said. "It's inappropriate and unsafe. If everybody who knew better raised their voice, it would change."
Kris Hundley can be reached at firstname.lastname@example.org or (727) 892-2996.