Missouri data disclosure details infection fight
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public health, Public records, Studies, Tools
Missouri law requires hospitals to disclose infection rates for intensive care and certain surgeries. It doesn’t keep that data around for long, but St. Louis Post-Dispatch reporter Jim Doyle still managed to review data from 2005 to 2009.
Robots sanitize an ICU room by spraying hydrogen peroxide vapor into the air at St. John’s Mercy Medical Center.
He found that while numerous local hospitals lagged behind national infection rates, most were improving. A story that could have been a dire assessment of health care-associated infections instead became (mostly) a profile of local hospitals’ drive to cut down on the transmission of such infections. He doesn’t draw a clean line between the state’s monitoring and increased anti-infection efforts, but it’s tempting to read between the lines.
Doyle’s second installment continues the theme, discussing the aggressive, nonstop effort that is required to contain drug-resistant bacteria. Measures range from checklists to room-enveloping antibacterial vapors.
Missouri’s disclosure laws are an important step toward infection fighting, Doyle found, but their narrow definition allows hospitals some wiggle room and may miss serious systemic issues. Speaking of systemic issues, I highly recommend Doyle’s sidebar on why Missouri infection data is so hard to keep around.
UK hospitals fail to comply with safety alerts
Filed under: Europe, Hospitals, Hot Health Headline
Following medical errors and patient safety issues, the United Kingdom’s National Patient Safety Agency issues national safety alerts so that hospitals can change their practices and avoid repeat occurrences. As The Daily Telegraph’s Rebecca Smith reports, a patient advocacy group has found (28-page PDF) that two-thirds of UK hospitals have failed to meet the implementation deadline on at least one alert.
The group blames haphazard enforcement and monitoring for the lapses.
Action against Medical Accidents warned that despite repeated warnings that the alerts were not being complied with, there was no central policy or guidance on which organisation should be monitoring compliance and what action should be taken.
Smith focused on two particularly serious issues, the inappropriate administration of oxygen and injectable medicines. The report groups instances of noncompliance by hospital and by alert.
Globe photographer finds medical records in landfill
Filed under: Health journalism, Hospitals, Hot Health Headline
The Boston Globe’s Liz Kowalczyk tells the story of how one of the paper’s staff photographers stumbled upon a massive medical privacy breach while dumping his trash.
Photo by D’Arcy Norman via Flickr
As Tinker Ready points out on Boston Health News, it’s a reminder that stories are everywhere … and shredders are not. Kowalcyzyk traced the documents to a billing intermediary.
Kowalcyzk uses the landfill scene to demonstrate just how difficult it is for hospital officials to keep confidential information from slipping through the cracks.
The photographer said he saw health and insurance records from at least four hospitals and their pathology groups — Milford, Holyoke, Carney, and Milton — mostly dated 2009. The Globe notified the hospitals. It is unclear how many other hospitals’ records might have been discarded in the dump.
Hospital infections on rise in Nev., reporters find
Filed under: Health journalism, Hospitals, Hot Health Headline
Part two of Marshall Allen and Alex Richards’ Las Vegas Sun hospital investigation series “Do No Harm” takes on hospital-acquired infections. Even though no agency in the state tracks such things, the duo managed to find 2,010 instances of drug-resistant bugs in local hospitals between 2008 and 2009. That number included 647 instances of hospital-acquired MRSA.
In the story, the explain how they overcame industry resistance to dig up the data themselves:
No health agency tracks these cases. In fact, hospitals derailed proposed legislation in 2009 that would have required them to publicly report cases of MRSA in their facilities.
However, hospitals are required by law to submit to the state billing records based on each patient visit. The Sun obtained that information from 1999 to 2009 and analyzed the 2.9 million hospital billing records as part of its two-year investigation, “Do No Harm: Hospital Care in Las Vegas.”
Because of how the records are coded, the Sun was able to identify the number of infections by the two bacteria, and for the years 2008-09 further identify the cases in which the records say the patients acquired the bacteria while hospitalized.
While it’s hard to put their numbers in a national context because of widely varying methods of measurement and reporting, the duo can say that such infections jumped 34 percent from 2008 to 2009. Allen and Richards then establish two facts:
- Some institutions have developed ways to keep MRSA and friends under control.
- None of those institutions are in Las Vegas, where inspections show that hospitals could be doing a lot more.
Efforts to force Nevada hospitals to disclose MRSA cases withered under heavy industry opposition, though the legislature is now considering a watered-down version that would not public the MRSA rates of specific facilities.
It’s worth noting that the paper has published responses from readers who have plenty of their own hospital horror stories. The website includes their input both in text and through excerpts of some of the voicemails Allen has received since the first part of the series was published. They are heart wrenching but serve as an excellent example of how reporters can involve readers in a project.
Reporters encounter hospital’s lack of transparency
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline
Blythe Bernhard and Jeremy Kohler of the St. Louis Post-Dispatch investigated a string of serious mistakes at a local hospital and found the story of a 16-year-old girl who suffocated in a bean-bag chair after being sedated. It’s a remarkable and chilling story on its own and, as AHCJ Immediate Past President Trudy Lieberman points out, it’s made even more valuable for health journalists thanks to Kohler’s willingness to explain his investigative process.
Acting on multiple tips referring to a botched 2007 kidney removal, Kohler began the laborious process of triangulating the error. You should really take a minute to read his entire explanation, but if you really don’t have time, just take note that his path was something like this: Tips from sources -> Joint Commission -> Missouri Division of Insurance -> National Practitioner Data Bank -> Missouri Department of Health and Senior Services -> Missouri Board of Professional Registration for the Healing Arts -> The actual hospital.
And even then, he was unable to get clear confirmation that surgeons had removed the wrong kidney from a patient. Instead, the hospital cited privacy regulations.
Last week, officials with SSM Health Care, the St. Louis-based corporation that operates DePaul and several other hospitals, said they could not speak about specific patient cases because of federal privacy laws. “The desire to defend ourselves and paint an accurate and full picture does not outweigh our patients’ right to privacy,” they said in a statement.
Even a subject like this, which clearly involves what Kohler calls “information that patients in need of a surgeon would be interested in knowing,” the obstacles between readers and the truth about a “never event” appear insurmountable.
HIPAA’s role in transplant story, correction
Filed under: Health journalism, Hospitals, Public records
The Village Voice says things are rather tense at the New York Post after it incorrectly reported on Monday that an alleged killer received a liver transplant at New York-Presbyterian Hospital. Frederik Joelving of Reuters Health reported on Tuesday that the hospital denied the transplant had taken place there.
Cover of Monday's New York Post.
That was followed by a correction in the Post on Wednesday morning. The original story is no longer available on the Post’s site but is available through Google’s cache.
According to the Village Voice, which quotes unnamed sources in the Post newsroom, “Rupert Murdoch was so enthralled with the story when it ran, that he called Post editor-in-chief Col Allan to personally congratulate him on it.” It also says the tip for the story came from Allan.
Because of the Post’s story, the hospital eventually had to deny that Johnny Concepcion, accused of killing his wife, received a transplant there after eating rat poison in a suicide attempt. Hospital comments on whether a patient has been treated are fairly unusual as hospitals try not to run afoul of the privacy rules outlines in the Health Insurance Portability and Accountability Act.
In fact, the Post’s correction says the hospital declined to comment before it published the original story, citing HIPAA, but that “Curiously, the hospital now sees itself free to publicly discuss Concepcion’s case.”
Speaking of HIPAA, The Reporters Committee for Freedom of the Press recently released “FERPA, HIPAA & DPPA: How federal privacy laws affect newsgathering,” a guide to federal privacy protection laws.
The section on HIPAA explains the history of the privacy rules, the Standards for Privacy of Individually Identifiable Health Information, and discusses how it has been misunderstood and misused to keep information from reporters. AHCJ President Charles Ornstein, a senior reporter at ProPublica, is quoted extensively and offers examples of its misapplication. The piece also outlines what the law does allow.
Frugal Minnesota splurges on lower backs
Filed under: Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Public health, Studies, Tools
For physicians and patients, treating lower back pain is an exercise in restraint and patience. According to federal guidelines, such pain usually resolves itself within six weeks with minimum intervention, so it’s often a matter of resisting the temptation to order a $500 MRI within that time window. And in Minnesota, a state known for its health-care-related moderation, that temptation seems to be too much.
As the Christopher Snowbeck of the St. Paul Pioneer Press reports, Minnesota doctors are worse than the national average when it comes to giving lower back pain patients MRIs without exploring cheaper alternatives. And in the land of Lake Wobegon, being below average is a big deal. The conclusions come from Hospital Compare’s newly released 2008 outcomes data. To learn more about this data, check out AHCJ’s recent conference call on the subject.
For some help reading between the lines of Snowbeck’s story (and the Hospital Compare data), see Gary Schwizter’s recent blog post on the subject; he doesn’t mince words.
The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.
For more about treatment of back pain, particularly how much money is spent on it, see the just-released “Back Problems: Use and Expenditures for the U.S. Adult Population, 2007” (PDF) from the Agency for Healthcare Research and Quality.
151 hospitals use Tasers to control unruly patients
Filed under: Health data, Hospitals, Hot Health Headline
In the wake of allegations that the nephew of a supreme court justice was Tased in a Louisiana hospital, The Washington Post’s Leslie Tamura has found that
Photo by centralasian via Flickr
151 hospitals in the United States use or are testing Taser electronic control devices, according to the company that makes the devices. Each hospital develops their own guidelines for Taser use. Experts quoted in Tamura’s story seem to agree that Tasers should be used as a last resort.
Jeffrey Ho, identified in the story as an emergency room doctor and the author of a 2009 paper about the use of Tasers in health-care settings, points out that “The hospital environment is not 100 percent calm and peaceful all the time. Acts of violence do occur against staff, physicians, nurses, those types of things, and really the best method of security is to be proactive.”
But the Taser company blog tells us that Ho is “an independent, expert medical consultant to TASER.” That potential conflict of interest has been noted by Dan Bowman at Fierce Healthcare and Bernice Young at Mother Jones, who reported in 2009 that Ho had received $70,000 in 12 months from the company.
Robert Philibert, a professor of psychiatry, genetics and neurosciences at the University of Iowa who has studied Tasers and similar weapons in psychiatric care, calls the practice “extraordinarily troubling.”
Another expert quoted in the story, William P. Bozeman of Wake Forest University, says receiving a Taser shot is painful “but as soon as the Taser stops sending out electricity, the pain is over and you’re fully functional again in a matter of moments.” Bozeman, as the story points out, “published a study in 2009 of 1,201 people who had been stunned and found that 99.7 percent of them have few to no injuries.”
AAMC gives recommendations for clinical COI
After taking on continuing medical education and medical research, the Association of American Medical Colleges is now tackling conflicts of interest related to clinical care with its latest report, “In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making” (46-page PDF). If you’re just looking for the Big Recommendations, the most salient of which are paraphrased below, fast forward to pages 24 and 25. Warning: They’re vague.
- Medical centers should compensate doctors in a way that promotes the patients’ best interests.
- Professional medical societies and medical institutions (such as teaching hospitals) need to take a long, hard look at their own relationships with the industry.
- Institutions should identify their physicians’ industry relationships, set thresholds for their disclosure, and identify situations in which disclosures should be made directly to the patient. These regulations should all have teeth.
- Centers and physicians should work with patients to figure out how best to disclose industry ties.
The AAMC committee that produced the report wrote that, while they focused on academic medicine, their recommendations could (and should) be applied to all of clinical medicine.
Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
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- Health reporting resources for journalists on state and local government beats
