Programming errors led to overdoses with pain-medicine pumps
Building off a state health department report showing that, as The Morning Call’s Tim Darragh wrote, “Nurses at St. Luke’s Hospital three times in 2010 and 2011 improperly programmed patient-controlled pumps to deliver pain medication, causing patients to overdose themselves,” Darragh dug deep into each incident, uncovering patient details and adding perspective to the errors, which were severe enough that the feds decided the hospital’s patients were in “immediate jeopardy” until steps were taken.
Photo by Felix42 via Flickr.In each of those cases and in three others, the nursing staff failed to document the errors properly, state investigators found.
Employees told the investigators that St. Luke’s did not require annual competency training on the pumps. Unnamed employees offered conflicting statements about when and whether all the staff had received retraining in 2010.
For their part, hospital officials say they have bought new patient-controlled pumps, developed a restricted dosage plan and retrained staff.
“When St. Luke’s nursing staff members identified the dosing pump programming issues, the events were promptly reported to all the appropriate individuals and regulatory agencies as outlined in our Network Patient Safety Plan,” said Carol Kuplen, chief nursing officer for St. Luke’s Hospital & Health Network.
“There was complete transparency in these events,” she said in an interview Thursday.
Related
Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, appeared at a newsmaker briefing at Health Journalism 2010 to announce an FDA initiative to reduce risks associated with infusion pumps. Log in to the AHCJ website to see his presentation and listen to his announcement.
- Press release: FDA Launches Initiative to Reduce Infusion Pump Risks
- FDA page on infusion pumps and FDA’s new safety initiative
- White Paper: Infusion Pump Improvement Initiative
- Guidance for Industry and FDA Staff - Total Product Life Cycle: Infusion Pump - Premarket Notification [510(k)] Submissions
- Letter to Infusion Pump Manufacturers
- Public Meeting: Infusion Pump Workshop, May 25-26, 2010
- Generic Infusion Pump Project
Lopez columns on ailing dad spark discussions about end-of-life decisions
Filed under: Aging, Health policy, Hospitals, Hot Health Headline
From his friendship with a cellist to his adventures with medical marijuana, Los Angeles Times columnist Steve Lopez often draws on highly personal material in his work. His latest series, surrounding the end of his father’s life, mines that vein even more deeply. Lopez has initiated a community-wide conversation about death and dying through his columns, his profiles of several people confronting life’s end, and reader contributions, which have snowballed since the series began this summer.
New journalists’ resource on aging debuts
AHCJ has rolled out another Core Curriculum topic on its website. “Aging” is the second in a series of core topic subject areas the organization believes today’s health journalists will need to master to cover the beat well.
Colorado-based writer Judith Graham is AHCJ’s topic leader on aging. She produces reporting guides, seeks out reliable resources, assigns stories and blogs regularly. She works with Pia Christensen, AHCJ’s managing editor/online services, to find the latest material, edit contributions and make the site as easy to navigate as possible.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
Dec. 28: Open the discussion on dying
What I’ve learned along the way is that we have to get past the fears and cultural taboos that prevent us from discussing death with loved ones. We need to make our wishes known in advance healthcare directives, sparing friends and family the psychological trauma of impossibly difficult decisions. We need more information on end-of-life choices and broad reforms of Medicare, which gladly pays for the tools of slow suffering in terminal patients — feeding tubes, hip replacements, etc.— but is stingier about paying for palliative care despite lower costs and higher patient satisfaction.
Dec. 18: Wishing for the right to make that final exit
Since I began writing about these issues in July, when my father took ill, I’ve had readers argue that how and when we die is not for us to decide, but is in the hands of a higher authority. I respect that view, but I’ve heard from far more readers who make a humane argument for options to avoid lingering and painful deaths. Many say that once they reach the point where they are simply being kept alive - as opposed to living - they want to have the choice of ending their suffering.
Dec. 14: Having to think about the unthinkable
Most people don’t like to plan for dying, but in our state of denial, we leave ourselves vulnerable to conditions we would never want. Arrangements for the end of life are essential.
Dec. 11: A terrible choice to ponder
Medical advances now keep people like my father alive in severely debilitated states, at ever-soaring costs to the public. Is that a humane, compassionate approach?
One doctor told me that our fragmented healthcare system has a built-in incentive to give my dad a feeding tube. The surgeon and hospital would get paid, the nursing home would benefit because Medicare would cover 100 more days and my family would be spared that cost. The only losers would be taxpayers, and maybe even my father, who has already been cut open, probed and filled with buckets of medication, only to become sicker, angrier and more depressed.
Dec. 4: Not ready to die, but prepared
The cancer that started 11 years ago has now ravaged the body of Freddie Ramos. It attacked a kidney first, then a lung, and the 57-year-old family man knows that death waits in the near distance.
He’s not ready to go, he says, but he’s prepared.
Nov. 27: Geriatric doctor doesn’t shy from tough talk
Gene Dorio, an old-school practitioner in Santa Clarita, insists families - and physicians - have honest discussions about end-of-life issues with those in failing health. Too often the difficult conversations are put off for too long.
Nov. 11: When death is certain, but dignity is not
For a senior, those two dreaded words - “broken hip” - are often the beginning of the end. Doctors said that without surgery, my father would probably die within three months. But surgery itself could kill him, given his weak heart.
Because of the morphine and dementia, it wasn’t clear that my father understood his options.
Aug. 13: Waiting calmly to die
The email from a reader in Westwood was short, to the point and disturbing.
“My life has been very full,” wrote Polly Berger. “But now it is getting very bad, and I want to go to that other world.”
Berger also said she wished there were more Dr. Jack Kevorkians around. I responded immediately, worried it was a cry for help.
July 17: Waiting in the dark with Dad
And so it goes, the slow, inexorable march to the place we all must visit. Watching, I find myself wondering why we’re so ill-equipped to accommodate, accept and talk about the fate we all are guaranteed.
We’re not very good at dying, or even aging. We dye our hair unnatural colors, pin back our faces and pretend nobody knows. We’ve got an obsession with youth and a phobia about death.
Ongoing: Matters of life & death
As part of the series, the Times invited readers to share their own experiences. Many have.
Lopez, author of The Soloist, was the keynote speaker at AHCJ’s 2008 Urban Health Journalism Workshop.
Florida hospitals sidestep state constitution, keep records under wraps
Filed under: Health journalism, Hospitals, Hot Health Headline, Public records
Writing for BrowardBulldog.org, an independent investigative news site serving South Florida, Amber Statler-Matthews reports that hospitals are going to what one man called “extraordinary lengths” to prevent patients from accessing records that, according to the Florida constitution’s “Patient’s Right to Know Act,” should be made available.
Seven years ago, Florida voters overwhelmingly approved a Constitutional amendment that gave patients who had been hospitalized the right to see reports dealing with botched medical procedures and poor care. While the amendment could be used to give patients vital information before a medical mistake is made, its practical and more much publicized purpose was to give aggrieved patients more power in court by opening up malpractice complaints and confidential internal reviews of doctors and hospitals.
In the years since the amendment, the state’s courts have been pressed on both sides, with hospitals dedicating considerable resources to throwing up “roadblocks and legal challenges to block access to patient records,” Statler-Matthews writes. “In response, patients across Florida are using the law to ask judges to pry open reports about medical errors.”
For more on how the battle has evolved and details on how Florida hospitals are circumventing the constitution, see Statler-Matthews’ full piece.
Reporters spend 10 weeks immersed in end-of-life care
Filed under: Health journalism, Hospitals, Hot Health Headline, Nursing
Toronto Globe and Mail reporter Lisa Priest and photographer Moe Doiron spent two-and-a-half months embedded in a 20-bed critical care unit at a Toronto
Photo by quinn.anya via Flickr
hospital, following four patients and their families and chronicling life in an environment where, Priest writes, “death is a constant, almost routine event, claiming one in five patients who enter.”
Their assignment was to find out “How does one prepare for the end of life?” and explore the medical, ethical and economic challenges of that stage of life.
The result is a sprawling, intensive report on the state of end-of-life care in Canada, heavy on anecdotes. Priest’s centerpiece is subtitled “Spending 10 weeks with patients facing death“) but remains cognizant of big picture issues like cost and quality of life.
Seattle hospitals love building costly ERs
The Puget Sound emergency room construction boom is in full swing, and Seattle Times reporter Carol Ostrom has taken a pointed look at the cost-related consequences of local hospital expansion.
She examines why hospitals are opting for more and glitzier ERs over lower-cost alternatives such as clinics and urgent care facilities. She also considers why state efforts to guide hospitals toward more efficient spending have failed, and explains how hospitals justify their actions. If you don’t have time for the full story, here’s a relatively tame excerpt:
The ER building boom has prompted a backlash from some lawmakers and advocates of affordable health care, who complain that nearly all Washington hospitals get substantial tax breaks and construction financing through tax-exempt bonds.
Free-standing ERs, these critics charge, are cash cows for hospitals, strategically built in affluent areas to lure busy, well-insured patients and collect fat reimbursements.
KevinMD: Media is key to curbing MRI overuse
Filed under: Conflicts of interest, Health journalism, Health policy, Hospitals
On the MedPage Today outlet KevinMD.com, Dr. Kevin Pho himself writes that media coverage of the overuse of certain screening procedures is “long overdue,” and praises The New York Times‘ recent coverage of a study showing that in some cases MRIs can lead to more harm than good.
In the Times, reporter Gina Kolata explained, when unleashed upon the throwing shoulders of 31 healthy professional baseball pitchers, “M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.” It’s a result, Kolata wrote, that shows that MRIs are “easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.”
Back at his web portal, Pho writes that there are two steps that need to be taken to curb the overuse of the MRI. The first is cracking down on physicians who own their own MRI machines or otherwise profit from the tests, and the second is what he calls “adjusting patient expectations.” That’s where, he says, the media comes in.
there are some, but not all, patients who expect a scan and equate an MRI with “being thorough.” In fact, when orthopedic fellows cited in the Times story suggest that patients may not need a scan, patients “look at them like, ‘You don’t know what you’re doing.’”
Doctors can help educate patients away from the mythical benefits of overtesting. But the most effective teacher is the media, which wields significantly more influence. That’s why a story like this in the Times should be applauded, and promoted.
A fun aside? The study was conducted by none other than Dr. James Andrews, whose name will be familiar to anyone with even a passing familiarity with the sports pages.
Ohio’s hospital transparency law under fire
Filed under: Aging, Conflicts of interest, Europe, Government, Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Public records, Studies, Tools
Thanks are due to blogger and one-time hospital executive Paul Levy for drawing our attention to the Ohio hospital industry’s recent push to overturn much of the state’s recently passed transparency legislation.
The law required hospitals to post performance data, such as infection rates and patient satisfaction, on the Ohio Hospital Compare site.
According to Brandon Glenn’s report in the MedCity News, the hospital industry opposes the site, online since Jan. 1, 2010, because it serves the same purpose as the federal Hospital Compare site.
The OHA supports the new legislation… because it wants to remove “duplicative” reporting requirements on the state’s hospitals. Ohio hospitals already report the same data to a federal Hospital Compare website maintained for the public by the Centers for Medicare & Medicaid Services, said OHA spokeswoman Tiffany Himmelreich.
The new legislation “doesn’t reduce reporting. It just eliminates reporting the same information to two different places,” she said. “We don’t want the public to feel that this is taking a step backwards in terms of data availability.”
For their part, consumer advocates say website maintenance is not an onerous burden, and that the hospital association’s push is part of a larger, statewide antitransparency trend.
As an interesting side note, Glenn found the Ohio Hospital Compare site to be rendered inoperable by apparent bugs on an initial visit but discovered that, after his inquiries to the state health department, the site was put into working order.
Public hospitals, not nonprofits, shoulder burden of charity care
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Member news, Public records
Writing in the Contra Costa Times, Sandy Kleffman reports that while nonprofit hospitals in the East Bay are given millions in tax breaks, “The responsibility of caring for the indigent falls largely on the region’s public hospitals.”
Kleffman’s findings are based on her analysis of publicly available California Office of Statewide Health Planning and Development reports, documents which she learned to access and process at a September webinar led by AHCJ board president and ProPublica senior reporter Charles Ornstein.
Her analysis revealed a substantial imbalance in the numbers, especially between public hospitals and nonprofits. For example, Contra Costa’s county hospital provided more than three quarters of the total amount of charity care given in the country in 2010, while the six nonprofits together accounted for just under 23 percent.
For their part, representatives of nonprofit hospitals protested that the numbers do not take into account the other community benefits they provide, nor are they adjusted to compensate for the differences in demographics across each institution’s patient pool.
For more on what went into Kleffman’s report, see her sidebar on “How we made comparisons.”
Texas psych clinics take Medicare’s millions without oversight
Filed under: Health care reform, Health data, Health policy, Hospitals, Hot Health Headline
The Houston Chronicle’s Terri Langford reports that for-profit outpatient psychiatric clinics in the state, most located around Houston, are collecting millions in Medicare dollars yet “require no license to operate in Texas.”
She writes that, despite access to significant federal funds, the clinics are subject to little oversight from any level of government, especially when it comes to patient care.
…other than a one time inspection conducted by Medicare when clinics start operating - these programs have no detailed standards or “conditions of participation,” that must be met before filing claims and collecting taxpayer money.
…
The U.S. Department of Health and Human Services flagged the problem earlier this year, saying “no regulatory basis exists to ensure basic levels of quality and safety” for CMHC care.
The loopholes, including the lack of an established means to kick poorly performing centers out of the medicare system, apply nationwide, but their exploitation remains localized.
Records show that in 2009, Medicare paid $287 million on these programs nationwide, 74 percent of them located in the three states that have no state licensing requirements: Florida, Louisiana and Texas.
Reporters uncover Calif. chain’s systematic upcoding
Filed under: Government, Health data, Health journalism, Hospitals, Hot Health Headline, Public records
In a follow-up to their lengthy California Watch investigation into sketchy billing practices at the state’s Prime Healthcare chain, Christina Jewett and Stephen Doig looked at newly released data and found that “Prime Healthcare Services bills Medicare for a variety of unusual ailments – among them a brain disease and a condition causing eyes to bleed – that can generate lucrative payments to the chain.”
For this piece, the reporters reviewed hundreds of pages from five related court cases and talked to a number of former Prime employees who protested the hospital’s billing practices — many of which they say were mandated directly by the company’s owner. Doig and Jewett then returned to the data and found that, as the 14-hospital chain’s leadership pushed providers to bill for a certain lucrative condition, instances of that condition just happened to rise in Prime hospitals.
Jewett and Doig even analyzed medical codes to estimate how much the alleged upcoding could have earned Prime hospitals.
It is not possible to pinpoint how much additional revenue Prime earned when documenting the unusual conditions, because each patient may have numerous diagnoses. But it is clear that conditions reported in outsized rates at Prime hospitals can bring in an additional $3,000 to $7,000, compared with similar but less serious conditions.
Taken together, the report stands out for its deft integration data, court records and interviews into a cohesive investigation.
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