Express-News investigates Texas nursing homes
Filed under: Hospitals, Hot Health Headline, Public records
San Antonio Express-News reporters Karisa King, John Tedesco and Melissa Fletcher Stoeltje took advantage of a number of tools to assemble a broad investigation into the city’s nursing homes.
Slow action on nursing home problems
In the package’s centerpiece, the reporters plowed through 2,200 claims filed against the town’s 55 licensed nursing homes from 2006 to 2009 and found that investigators arrived long after the incidents in question and marked so many claims “unsubstantiated” that the state attorney general posted a notice advising residents that they should take even unsubstantiated claims into account when evaluating nursing homes. They also consulted ratings and visited 10 local nursing homes.
With the ratings as a guide, the newspaper examined more than 3,000 pages of abuse and neglect investigations and annual inspections of 10 nursing homes with the lowest scores. It also reviewed dozens of wrongful-death lawsuits filed against local nursing homes to examine how Texas watches over its elderly.
In addition to a few dangerous homes and some disquieting anecdotes, the reporters found an unenforced reporting law:
(Department of Aging and Disability Services) also is failing to enforce a state law that requires nursing homes to report details about every resident who dies. State officials are supposed to analyze the fatality reports to publicize problems and trends, but that research isn’t being done.
To top off this tale of dysfunction, they also unearthed at least five cases in which would-be nursing home whistle blowers were fired.
Stoeltje added a sidebar on nursing home rating systems, their utility and their shortcomings. She addresses both the local Texas system and the federal Nursing Home Compare database. She talks to both nursing home operators and patient advocates; the operators tend to dwell on ratings’ weaknesses while advocates spoke on their strengths.
LIST: Examples of problems found at nursing homes
Six more examples culled from complaints and often backed with interviews.
MAP: Quality of nursing homesA Yahoo! map linking nursing home location, size and rating.
Texas Public Radio
Terry Gildea, host of a news discussion program called “The Source,” interviewed all three Express-News reporters about their investigation.
Slim guide:
Covering the Health of Local Nursing Homes
This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
• More investigations of nursing homes
• Aging Nation: Troublesome Health Care Issues
• Headlines an advocate for seniors would like to see
• The impact of aging upon health care
• Covering nursing homes and other issues of aging
• How will retiring boomers affect the national health agenda?
• You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
• Biology of Aging: Sources and Resources
Google charts health data from CDC, World Bank
Google has removed another step between people and information with the release of its new Public Data Explorer. It’s a service through which Google links neat, tidy and reputable sets of data with a beefed-up version of its chart programs.
Right now it’s limited to 13 data sets, though Google implies that it will continue to expand those offerings based on demand. Those data sets include three that are powered by the CDC’s WONDER data delivery platform.
Data from the World Bank includes international numbers on things such as fertility rates, births attended by skilled health staff, rates of immunization against measles, prevalence of HIV, life expectancy and more. You also can find statistics on the U.S. population from the Census Bureau.
At present, the limited selection mean that it probably won’t be useful for more than a handful of stories, but it’s something to keep an eye on as Google continues to add data and customization options.
Here’s a quick example mapping U.S. cancer rates (circle color) and number of cases (circle size) by state.
NOTE: If you can’t see the visualization, you’ll probably need to upgrade your browser.
Schneider: FDA lacks resources to keep food safe
Writing for AOL News (and his blog, Cold Truth) Andrew Schneider writes that the hydrolyzed vegetable protein recall reminds us that, no matter what was said in the wake of last year’s peanut butter recall, the FDA still doesn’t have the ability to pay close attention to source foods that are destined to end up in hundreds of different products.
In this most recent case, it was a test by a supplier, not an FDA representative, that caught the contaminated additive.
The FDA conducted an investigation at the company’s Las Vegas facility after a food producer that bought the flavoring from Basic Food Flavors notified federal agents that it had found Salmonella Tennessee in the vegetable protein.
In answer to the criticism about its actions during the peanut episode, FDA officials said they have no way knowing to whom suppliers sell their food products, what those products are and where they’re sold. The FDA says it doesn’t have the personnel or the needed regulations to handle the millions of shipments made within the food industry every week.
But what was seen with the dangerous peanuts, and what we’re beginning to see with the flavoring agent, is that producers of end products — those items that actually reach store and warehouse shelves — are declaring their own voluntary recalls.
Patient data errors force VA to close EMR system
Nextgov’s Bob Brewin reports that errors in patient data have forced the Department of Veterans Affairs to close access to the Bidirectional Health Information Exchange, the Defense Department’s vast electronic medical record system. The bug first surfaced in February when a physician noticed that the system claimed one of his female patients had been prescribed an erectile dysfunction drug. The errors have been blamed on old code in the six-year-old system which could not handle peak usage rates.
The glitch did not cause harm to any patient, but “the potential exists for decisions regarding patient care to be made using incorrect or incomplete data,” said Jean Scott, director of the Veterans Health Administration’s Information Technology Patient Safety Office, in the alert issued on Wednesday.
… The VA clinician may see the patient’s data during one session, but another session may not display the data previously seen,” the alert noted. “This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports.”
The system is expected to go back online March 9. Until then, Brewin writes, “VA doctors will have to obtain a patients’ health information from their paper medical files, faxes or PDF attachments that are e-mailed to the physicians.”
According to its tagline, Nextgov focuses on “Technology and the Business of Government.”
Kidney swap connects six in small Mo. town
Filed under: Health journalism, Hospitals, Hot Health Headline
Joy Robertson of KOLR-Springfield, Mo., tells the story of the coincidences and generosity that led to six residents of Licking, Mo., (population 1,471) swapping kidneys in a St. Louis hospital. Here’s a quick timeline, to give you an idea of how it all came together.
- Licking resident Stephanie Hood needed a kidney.
- Friends Randy and Melissa Lewis wanted to donate one for her, but neither was a match.
- Randy decided to donate his kidney anyway.
- Carrie Goforth, a 29-year-old Licking mother on dialysis, was a match for Randy.
- Meanwhile, Melissa Lewis decided to donate her kidney as well.
- Hers went to Gern Beasley, another Licking resident.
- Finally, Stephanie Hood, the patient who started it all, also got the kidney she needed. Her donor? Her cousin Diane. From Licking.
Reporting on kidney donation
Josephine Marcotty of the Minneapolis Star Tribune recently wrote a series addressing the increasing demand for kidneys, a need spurred by an aging population, increases in diabetes, obesity and high-blood pressure. In a recent AHCJ article, she explained how the story came together and how other reporters can follow in her footsteps and expand upon her work.
Nurses face dangers of workplace violence
Marlene A. Prost, writing for Human Resource Executive Online, reports that workplace violence is a growing problem for nurses.
She cites reports from Australia and the United States showing that about half of nurses in two surveys had been punched or otherwise assaulted in the past year. It appears the assaults are coming from patients and their families and friends.
However, Prost reports, nursing and hospital associations are taking notice and action, such as “improving security, encouraging incident reports and fighting to strengthen state laws to prevent violence and punish offenders.”
Hospitals are using guidelines from The Joint Commission, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health to make nurses safer. They also are training nurses to defuse volatile situations and encouraging them to report incidents, according to the article.
Reporters may be able to find more information through the Bureau of Labor Statistics and the American Nurses Association also has information about workplace violence. The Joint Commission issued a Sentinel Event Alert in 2008 about intimidating and disruptive behaviors in the health care environment.
Mental health parity law implementation evolves
Filed under: Government, Health care reform, Hot Health Headline
Writing for Kaiser Health News and The Washington Post, Sandra Boodman considers the effect that the American mental health parity law has had since it went into effect on Jan. 1.
The law applies to about 140 million Americans, Boodman writes, most of whom are insured by employers with more than 50 employees. For qualifying groups, “Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment.” It doesn’t apply to individual policies and doesn’t require employers to offer mental health coverage of any kind.
There are still questions about the implementation of the law, many of which are addressed in the Obama administration’s implementation plan (PDF), which should take effect on July 1.
Officials of key business and insurance industry groups said they were displeased that the regulations were “more expansive” than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
Fortunately, it looks like that sort of cost increase will be rare, based on research that shows similar rules improved access without increasing cost.
For some background on the mental health parity law, check out MIWatch.org.
High cost of foodborne illness broken down by state
The Make Our Food Safe coalition’s latest study provides a state-by-state breakdown of the cost of foodborne illness, both in absolute and per-capita terms. The report estimates that foodborne illnesses cost about $152 billion each year in America, with the cost being spread fairly evenly across the country.
Hawaii ($553) and Mississippi ($543) suffer the highest cost per capita, while Nevada ($450) and Utah ($448) bear the lightest per-capita load.
The report is the work of former FDA economist Robert L. Scharff, now a professor at Ohio State (bio). You can read the entire 27-page report in PDF form, scan the one-page summary or play with the accompanying interactive map and draw your own conclusions. You can also listen to an MP3 of the related media telebriefing.
Are insurers to blame for rising costs?
The San Francisco Chronicle’s Carolyn Lochhead and Victoria Colliver use the recent furor over insurer Anthem’s rate hikes to explore just how much of the blame for rising health care costs should be shouldered by insurers. The reporters find that, in the end, insurers are just another one of the cartels (others include device makers and providers) and operate inside the opaque world of medical pricing and snag hefty cuts for themselves. Lochead and Colliver put it thus:
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
The reporters write that, despite their best efforts, they weren’t able to get many folks on the record. When they did find someone who was willing to talk, it was often a source we’ve seen before in other cost stories. It’s a tough theme to get quotes on, as nobody wants to burn bridges with their professional suppliers and everybody’s got some sort of skin in the game. They did, however, manage to find a local source who offered an original and illuminating anecdote:
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
(Hat tip to AHCJ Immediate Past President Trudy Lieberman, who wrote a column on CJR.org praising the Chronicle’s story.)
Palliative care piece launches embedded dispatches
Philadelphia Inquirer staff writer Michael Vitez has been embedded with Abington Memorial Hospital in suburban Montgomery County, Pa. Karl Stark, the Inquirer’s health and science editor, writes that “means he went there for an extended period and reported what he saw with almost no restrictions.”
Here’s how Vitez describes the series, which will be published over the next few months:
My goal is to spend a year at Abington, writing stories that show how one hospital deals with the biggest issues in health care today and also the changes that are coming fast and furious - regardless of what Congress and the President do - to hospitals and health care.
This first story looks at how the palliative care movement is medicine’s response to the dismal way people have died. I try to show, up close, how the team works, the agony that families feel, the immense costs involved.
In future stories, I’m going to look at how a hospital struggles to bring down infection rates, how it handles patients who have nowhere to go, the madness of one Medicare rule, the impact of the uninsured, and more. I hope in the end readers will get a bedside view of how things work, how things are changing, and I hope a great appreciation for our common humanity.
Vitez’s first report is a very readable and nuanced account of palliative care, something he looks at from the perspective of a patient’s family as well as that of the medical professionals.
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Don't miss Health Journalism 2010, AHCJ's annual conference. You'll walk away from his world-class program with story ideas, new sources, stronger reporting skills, chances to meet newsmakers and network with other journalists. Fellowships are available.
- Addressing the growing demand for kidneys
- Ethics in hard times: Panel for science and health journalists
- Compromised care: What reporters learned about felons in nursing homes
- Experts say tuberculosis poses a nearly silent threat
- Childhood obesity: Experts discuss strategies, solutions journalists should cover
- Mark your calendar now for Health Journalism 2010!
- Directory of freelance health journalists now available
- New resource: Easier-to-use Nursing Home Compare data
- Resources for covering H1N1 flu, pandemics and preparedness
- Online tools for creating multimedia: easy, accessible, and inexpensive
