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.
Medicaid programs slow to act against system exploiters
Filed under: Conflicts of interest, Health data, Hot Health Headline, Public records
At ProPublica, senior reporters Charles Ornstein and Tracy Weber have published the latest turn in their ongoing analysis of conflicts of interest, problem physicians and the disciplinary systems meant to reign them in. This time, they look at Medicaid in Florida and find at least three instances when the state “allowed physicians to keep treating and prescribing drugs to the poor amid clear signs of possible misconduct.”
Their piece revolves around those key examples – two of which were, in all seriousness, brought to their attention by a Scientologist-run watchdog website – and I strongly recommend you read the whole thing for the details. Below, I’ve just highlighted the bigger picture.
In general, Ornstein and Weber found, state Medicaid programs, as well as the federal Centers for Medicare and Medicaid Services, which doesn’t track relevant state data, have failed to act on information which seems to strongly indicate that certain physicians are abusing or exploiting state programs.
Medicaid programs across the country have long had evidence that physicians have been prescribing risky drugs in excess and perhaps to the wrong patients. These prescriptions also racked up huge bills for the programs.
But like Florida, many states did not act on that evidence. Last year, (Sen. Charles) Grassley demanded data from each state about its highest prescribers of pain pills and antipsychotics, and he asked state and federal officials to determine whether the prescriptions written by these doctors were legitimate.
Thieves target pharma cargo, cause shortages
Reporting for WBBH-Fort Myers, Fla., Andy Pierotti reports that highly specialized thieves have made an art form of snatching shipping containers in the state, slipping in like ninjas and getting away with the massive haul in fewer than 90 seconds. They’ll take anything they can get, Pierotti writes, but the big prize is a shipment full of pharmaceuticals.
An intercepted shipment, especially one loaded with rare drugs with tight supply chains, can cause nationwide shortages and price hikes, experts say. And, no matter how esoteric the product, the criminals seem to be able to find buyers.
An NBC2 investigation discovered over the last four years in Florida, thieves stole at least 24 cargo containers full of pharmaceuticals. From dialysis products to eye medicine, they were valued at $5.6 million.
Erik Hoffer, an expert in pharmaceutical cargo crime, says the evidence disappears fast.
“Those pills can be blended into real and fake, there’s no way to trace it anymore and you’ve eaten the evidence,” said Hoffer.
Local hospital administrators say they can feel the pinch when a shipment goes missing, and that the problem has worsened in recent years. There are possible solutions, but their implementation would likely spell more price increases.
Possible remedies to the problem include putting tracking devices on individual pill bottles or cartons, and a consumer interactive tool on the pill box that allows them find out [if] it was reported stolen.
The problem is, that’s expensive and the cost would likely be passed down on the customer.
The stolen drugs pose a health risk, as well. One expert says the stolen drugs can be blended with other drugs and resold, with consumers none the wiser.
Fla. hospitals make little progress on error reduction
Filed under: Government, Health care reform, Health policy, Hospitals, Hot Health Headline, Studies
South Florida Sun Sentinel reporters Sally Kestin and Bob LaMendola report that, despite the myriad initiatives and protocols launched in the dozen years since a landmark report thrust medical errors into the headlines, little progress has been made in actually reducing the toll taken by medical errors.
“I don’t really see any improvement in patient safety,” said Dr. Arthur Palamara, a Hollywood vascular surgeon and advocate for safer practices. “Unfortunately, despite all the protocols that were put in place, the adverse incidents, the wrong-site surgeries still keep happening at the same rate.”
A long list of technological advances and a national emphasis on preventing mistakes “hasn’t made a difference,” said Douglas Dotan, chief executive of CRG Medical, a Houston firm that sets up error-prevention systems…
They found that, while some progress has been made, even the most aggressive hospitals have found it difficult to crack the exceeding complex web of human and mechanical interactions that make errors possible.
These findings, which have become a depressingly predictable event, are built in part on research published in the April, 2011 issue of Health Affairs, a publication to which AHCJ members are granted free access.
AHCJ resources on patient safety
- Health Journalism 2008: Dennis Quaid acts on medical errors
- Health Journalism 2010: Patient safety expert Peter Pronovost, M.D., Ph.D., of Johns Hopkins University was the keynote speaker.Watch an excerpt of his address and see his PowerPoint presentation.
- Deciphering hospital quality data
- Public handicapped by lack of information on medical errors
- Medical errors and the movement toward transparency
- Sunshine Week: Some hospital quality measures online but more could be done
- Hospital patient safety initiatives borrow from transportation industry
- Outsourcing of pharmacies: Prescription for problems?
- Medical misconnections: Patient-safety problems
- Reporter documents surgical errors through public records
Regulations failed to slow cosmetic surgery deaths
Bob LaMendola and Sally Kestin, of the South Florida Sun-Sentinel, report that regulations put in place a decade ago have not reduced the number of deaths related to cosmetic surgery in Florida.
They report that at least 32 people have died in the past 10 years soon after having cosmetic surgery – including ”four South Florida mothers in their 30s who went under the knife in the past two years,” according to state incident reports and police records. The causes of death among the 32 people included poor medical care, reactions to anesthesia and heart and breathing problems.
A Sun-Sentinel series in 1998 by Fred Schulte and Jenni Bergal revealed 34 deaths in the preceding 12 years, some of which were “blamed on lengthy surgeries involving multiple procedures at doctors’ offices that were not then being regulated.” (Full disclosure: I was responsible for the online presentation of that series.)
Following the series, the Florida medical board put in place rules that limited lengthy operations, liposuction procedures and overnight stays and included regular inspections.
LaMendola and Kestin point out that the atmosphere around cosmetic surgery has changed in the intervening years:
One reason for the continued deaths may be a huge growth in cosmetic surgeries, but some surgeons, malpractice attorneys and industry experts say problems persist, and the state needs to do more.
Failing Fla. transplant program misled media, employees, patients
Filed under: Health journalism, Hospitals, Public records
Writing in the The Florida Times-Union, reporter Jeremy Cox used public records requests to find that a kidney transplant program at a local safety net hospital had been at risk of closure by federal regulators prior to its abrupt closure in January. It had “failed to meet six of 12 federal standards.”
Image from Wikimedia Commons
Furthermore, Cox writes, the records revealed “that hospital officials intentionally misled local media outlets about the full extent of the program’s breakdown. In a memo to Shands spokesman Dan Leveton about how to address the media, Steven Blumberg, vice president of planning and business development, said, ‘If asked, we will say that a program with low volumes is not economical to operate and that quality can be ensured with higher volumes.’” That statement, of course, makes no mention of looming federal intervention or a failure to meet basic quality standards.
Cox’s writeup should serve local reporters well as a sort of “anatomy of a failed transplant program,” as he delves into the regulatory process and exactly where the hospital went wrong.
For those of you who were, like myself, unfamiliar with the institution, Cox writes that “Shands is run by a private not-for-profit company, but it is widely seen as Northeast Florida’s safety-net hospital. The city of Jacksonville gives the facility about $23 million a year to care for the city’s poor, and it gets millions more from the state.”
Fla. juvenile justice system relies on heavy antipsychotic use
Filed under: Children, Conflicts of interest, Health journalism, Hot Health Headline
In looking into the state Department of Juvenile Justice’s use of powerful prescription antipsychotics, The Palm Beach Post’s Michael LaForgia “analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents.” It shows, as he surfaces with some powerful numbers and equally alarming anecdotes (Part 1, Part 2, Infographic).
…in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids - and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.
A key concern is that the prescriptions may be driven by their improper use as chemical restraints, or by the hefty speaker (and related) fees being paid from pharmaceutical companies to the most prolific prescription writers. Unfortunately, specifics are hard to come by as most homes are run by private contractors and the state doesn’t have the resources for close monitoring. For this story, the reporters were only able to obtain two years worth of data for 25 jails and three programs – a fraction of the statewide total. Those data still paint what LaForgia calls a “startling story.”
A look at the sheer numbers of drugs purchased … suggests a startling story is unfolding in state homes for wayward kids.
In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.
That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.
DEA disciplines Fla. physicians; state allows them to continue practicing
Filed under: Health data, Pharmaceuticals, Public records
Writing for Health News Florida, Brittany Davis shows the importance of following up on a disciplined caregivers story. In February, the DEA released the names of 32 Florida doctors whose prescriptions, they say, were fueling the state’s notorious pill mills. The DEA suspended the narcotics licenses of those doctors at the time.
In her follow-up, Davis finds that at least four of the physicians are still practicing, five have been arrested, at least 12 have shuttered or moved their practices, and a full two dozen still have clear Florida medical licenses despite the federal action. The disconnect between state and federal agencies, she found, may come down to simple communication problems.
[DEA spokesman David Melenkevitz] said the DEA focuses on enforcement, not outreach, and may not necessarily pass on its findings to the [state Department of Health].
“We’re a federal agency and they’re a state agency,” he said. “We work together but operate separately.”
Pat Castillo, of the United Way Broward County Commission on Drug Abuse, said she is “concerned about the disconnect” between the DEA and the DOH.
She’d like to find a way to fill in the gap and help patients get the most updated information on whether their doctors have been in trouble, she said.
“If their DEA licenses are taken away, certainly that’s a red flag,” Castillo said. “Having that kind of information is critical.”
A spokesperson for the state’s Department of Health said that the agency may not “know about the DEA suspensions, or the agency may be conducting its own investigation.”
Herald reports on failures of assisted living system
Filed under: Government, Health data, Health journalism, Hot Health Headline
The Miami Herald’s yearlong “Neglected to Death” series on abuse and violations in assisted living facilities is expansive, but I recommend starting with this explanation of how the story came together. In short, the crux of project, reported by Rob Barry, Carol Marbin Miller and Michael Sallah, is a huge database, which never had been made public, the paper obtained from state regulators. An accompanying editorial from Aminda Marques Gonzalez details its somewhat unique provenance.
At the heart of the reporting is a rich database of hundreds of thousands of records that includes all inspections and complaint investigations by the Florida Agency for Health Care Administration, the sole regulatory agency for ALFs [assisted living facilities]. Layered in: a decade of complaints filed with the State Department of Elder Affairs and public records including police reports, death certificates and autopsy reports.
The paper has made the database searchable and open to the public.
The Herald reports on a facility where violence is so commonplace that incidents have prompted more than 1,200 calls to 911 in the past five years. It’s important to note that, while we usually think of assisted living for the elderly, there are such facilities for those who have mental illness and other disabilities.
Other stories tell of residents suffering from sores that went untreated, homes and caretakers that failed to keep medical records, facilities that did not protect vulnerable residents from those with a criminal background, a failure to track patients with dementia and more.
A timeline helps explain how and why the assisted-living facilities became a part of the Florida system and their growth.
Health reform battle entering a new phase
As I try to figure out what AHCJ members most need as they cover health reform in year two of the Affordable Care Act, I tried to see if I could detect themes at the AHCJ conference in Philadelphia. That unified theory of health reporting plan went out the door as I heard questions ranging from very basic queries about pre-existing conditions to far more technical inquiries about accountable care organizations.
My next plan was to blog about the “reporting on health reform” session. A conference fellow beat me to that - (also see the tip sheets Covering health reform issues, Health care reform: Litigation update, Three health reform issues to watch in the states).
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
The repeal and replace stage of the health wars isn’t over. But I think we are entering another phase. The dominant national discussion topic is the deficit and the debt – and that leads into Medicare, Medicaid and other entitlements. I’ve done a tip sheet on Medicare and “premium support.” Medicaid is next up.
The proposals in the House-passed version of the budget are not brand new; Medicaid block-grant proposals have been around since at least the Reagan years, and they were definitely part of the Gingrich era. I remember hearing about variants of premium support and/or Medicare vouchers in the late 1990s, and I suspect they were around before that.
We don’t know every detail of what the Ryan plan would do; the budget plan is a federal framework, and the details aren’t filled in. And of course the Ryan budget won’t be accepted by the Democratic-controlled Senate or President Obama. But this idea isn’t going to go away. We need to watch how it plays into reforms being considered at the state level, and see what kind of steam it picks up (or loses) after 2012.
If your governor or state legislature favors block granting Medicaid, it’s time to start asking questions.
- What would Medicaid look like under a block grant?
- Who would still get it?
- Would there be enrollment caps and waiting lists?
- How much of the costs would be shifted to the beneficiaries and families?
- Would providers get paid less?
States can already get waivers for Medicaid, and that can allow for innovation in red and blue states alike. States will have a lot more flexibility under some of the ACA provisions in the next few years, including ways of doing a better job caring for people with chronic disease and the “dual eligibles” on Medicaid and Medicare.
Here are a few articles I’ve seen recently that describe some of what the states are already doing – or considering – as they confront rising Medicaid costs today.
Looking at the coverage
Carol M. Ostrom of The Seattle Times had an April 17 piece: “Doctors: State plan to limit Medicaid ER trips risks lives.”
Several of the Florida papers have had pretty good coverage of Gov. Rick Scott’s plans to transform Medicaid. But a solid hour of Googling didn’t net me one good big clear step-back story (it may be out there somewhere … send it if you see it) that tells out-of-state readers the whole story. But I still found work by John Kennedy and Stacey Singer at The Palm Beach Post (here’s one) and Marc Caputo of The Miami Herald (click here - you have to read down a bit to get the state overview) helpful.
The Oregonian has been taking a look at some of Gov. John Kitzhaber’s agenda, which should be worth watching as he has a track record as an innovator (and knows CMS administrator Don Berwick quite well). And of course we’ve all heard a lot about Arizona.
A lot of the stories I looked at from around the states were written by state capitol reporters, not health beat folks, so they were heavy on process and “Republican said X, Democrat said Y” kind of coverage. They didn’t always do a great job of getting beyond a fusillade of quotes. I guess if I’ve been Googling for more than an hour and can’t find a really solid health overview story, I should stop here and invite you to send me any you’ve seen (or written).
Don’t forget about Medicaid
Medicare is getting an awful lot of ink – after all, old people vote, and most of us expect to get old someday and need Medicare. We’ve got to look harder at Medicaid which covers poor kids and their parents, some of the disabled and mentally ill, some of the HIV population, and lots of the residents of nursing homes. That isn’t who votes. That isn’t who decides what reporters cover. And it’s certainly not a benefit most of us hope to use someday.
Last comment for today - and you’ll probably hear me return to this theme frequently because, to me, it’s some of the most interesting reporting we’ll be able to do in the coming years: Remember the Affordable Care Act, the health reform law, isn’t only about coverage and insurance exchanges. It makes countless changes to Medicare and Medicaid - changes that will affect the current fee for service model, changes that affect the private managed care sections of it and changes that will add new dimensions as we explore new ways of delivering care (medical homes, ACOs, a number of Medicaid programs aimed at getting people care in the community, not just nursing homes).
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
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New at HealthJournalism.org
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- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
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- Transparency & medical errors: Public reporting of patient harm is a potent force
