Detroit — Detroit Medical Center resident neurosurgeons were bullied, forced to work excessive hours and discouraged from reporting safety concerns, according to complaints referred to in a July letter of allegations from the agency that this month revoked the program's accreditation.

The Accreditation Council of Graduate Medical Education on July 2 outlined the allegations in a letter to Dr. Murali Guthikonda, then the neurological surgery program director for the DMC, and Dr. Mark Juzych, DMC's designated institutional official for Graduate Medical Education and a professor of medicine at Wayne State University. 

It requested the surgery training program's response to four allegations it said had been made about the program. 

The Detroit Medical Center and Wayne State University both declined to comment on the allegations described in the July 2 letter, which was obtained by The Detroit News. Neither institution would release findings of the accreditation council's investigation that led to the council's revocation of accreditation.

It's unclear whether any of the raised allegations led to the decision to end the accreditation.

The accreditation council's move put the seven-year training of 12 residents at risk and further exposed how the fractious relationship between Wayne State University School of Medicine and the DMC is impacting health care in Detroit.

Although the accreditation council's findings aren't yet public, the complaints referred to in the letter claim an atmosphere of intimidation, overwork and coercion to hide clinical concerns that might have put patient safety at risk.

DMC spokesman Brian Taylor told The News in an email that "we aren’t going to respond to the allegations in the letter."

Specifically, the complaints accused the neurosurgery residency program of violating rules on the number of hours residents are allowed to work, asserting two residents who worked past the maximum number of hours were involved in car accidents after leaving work.

"Allegedly, the program director does not support residents when duty hour limits are exceeded and becomes angry when violations are reported," according to the letter. 

The accreditation council limits the residents' hours to 80 per week, averaged over a four-week period, and requires that transportation be provided to residents too tired to drive home.

"It is alleged that residents in the neurological surgery program who report duty hour violations are told by the program director that nothing can be done to address the actions of a faculty member that caused the violations to occur," the letter stated. 

The accreditation council withdrew accreditation from the Neurological Surgery Residency Program earlier this month following a site visit on Sept. 18. Accreditation is set to end on June 30.

On Tuesday, the DMC's Graduate Medical Education Committee announced its decision to appeal the withdrawal of accreditation, a reversal from an internal announcement Friday that it would not appeal. No explanation was given by DMC on what changed its course of action.

"While we understand the seriousness of the issues the program has faced, we believe given the opportunity, we can rebuild the program," health system CEO Anthony Tedeschi announced in an internal message Tuesday.

It's unclear to what extent Wayne State University Medical School was aware of problems with the troubled program, including the allegations raised in the letter. WSU Medical School Dean Jack Sobel said he was "unable to comment on these allegations."

Sobel said the university would work with DMC on the appeal and "recreating a new department of neurosurgery."

The DMC's 65 residency programs are solely sponsored by the DMC, but Wayne State holds contracts with the health system to provide academic training for the residents.

WSU and DMC jointly sponsored residency programs until the early 2000s, when the DMC moved to be the programs' solitary sponsor. The move reflected and furthered tensions between the two institutions.

Before this week, Wayne State promoted the residency program, and how to apply, and continues to feature the biographies of its neurosurgery residents on its website.

Juzych, chairman of the Department of Ophthalmology, Visual and Anatomical Sciences at the medical school, is the designated institutional official for Graduate Medical Education at DMC. Juzych referred requests for comment to the DMC, which did not respond. 

Attempts to reach Guthikonda through the DMC were unsuccessful. Guthikonda was replaced as neurosurgery program director on Sept. 5 by Dr. Steven Ham, a DMC neurosurgeon who is listed on the university's website as an assistant professor of neurosurgery at the WSU School of Medicine.

Sobel said Guthikonda resigned from the university faculty and joined DMC in September 2018. Guthikonda stayed on in his role as program director for the neurosurgery residency program and convinced several other faculty with the program to resign their faculty positions and become DMC employees, according to Sobel. 

The July 2 letter was sent to Guthikonda and still listed him as "Program Director, Neurological Surgery, Wayne State University School of Medicine."

The July letter also alleged the DMC did not ensure that neurosurgery residents work in a safe and professional environment. According to the letter, a complainant alleged the program's director authorized the return to the program of a resident who had been dismissed over concerns about patient safety, professionalism and communication skills.  

"Allegedly, the dismissed resident has made verbal and written threats, prompting residents to have concerns about their personal safety," according to the letter.

A complaint referred to in the letter also alleged the designated institutional official was marginalized within the DMC.

"It is further alleged that the (designated institutional official) has not played any active role in overseeing the possible return of a dismissed neurological surgery resident who is viewed by residents and faculty members as a danger to patient and resident safety," according to the accreditation council's letter to program officials. 

Instead, the program director's decision to return the troubled resident was authorized by the DMC's vice president for academic and community affairs, the complainant alleged, according to the letter. 

Another allegation involved the accreditation council's requirement that sponsoring institutions have systems in place for the reporting of adverse events and unsafe conditions "in a protected manner that is free from reprisal." 

According to the July 2 letter, a complaint alleged that neurological surgery residents "are subjected to intimidation by the program director, who has instructed residents and faculty to not document or report clinical issues, including future issues that may arise with the possible return of a resident who was previously dismissed from the program."

"Allegedly, the neurological surgery program director bullies, intimidates, criticizes, and coerces residents and other members of the care team," the letter stated.

Neurosurgeons must graduate from a residency program accredited by the Accreditation Council of Graduate Medical Education in order to become board certified by the American Board of Neurological Surgery, a critical credential for entering the field. Neurosurgery requires more residency training than any other medical specialty at seven years.

Loss of accreditation for one of DMC's most elite residency programs could damage the DMC's reputation, and underscores concerns by critics the institution's historic commitments to education, research and indigent care have eroded since the health system's purchase by for-profit hospital chains. 

The DMC was purchased amid bitter controversy in 2011 by for-profit Vanguard Health Systems, a Tennessee-based hospital chain. Its current owner is Dallas-based for-profit Tenet Healthcare, which acquired Vanguard in 2013.

The relationship between WSU and DMC has deteriorated sharply over the past several years, putting at risk the medical attention provided to high numbers of indigent and under-served residents in the nation's poorest metropolitan city.

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