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.
AHCJ asks Supreme Court to permit broadcast of health reform arguments
Filed under: Government, Health care reform, Public records
AHCJ has asked Chief Justice John G. Roberts of the U.S. Supreme Court to permit live audio and video coverage of the oral arguments next March in the case challenging congressional authority to mandate health insurance coverage and other provisions of the Affordable Care Act.
The Court has long permitted print journalists to cover its proceedings and, more recently, began offering time-delayed audio recordings of oral arguments. But AHCJ is pushing for real time audio and video coverage in this case, due to the historic significance of this case and potential impact on millions of Americans.
In the letter to Chief Justice Roberts, AHCJ contends that these provisions are inadequate for such a historic case with potentially sweeping impact on the health care system and millions of Americans.
The Radio Television Digital News Association has filed a similar request with the high court, as has C-SPAN and U.S. Sen. Charles Grassley, R-Iowa. The New York Times weighed in with an editorial last week.
NYT reporters tease hip replacement numbers from difficult data
Filed under: Government, Health data, Health journalism, Hot Health Headline, Public records, Studies
Writing for The New York Times, Barry Meier and Janet Roberts analyzed a particularly tricky batch of federal reports detailing a variety of complaints with popular metal-on-metal hip replacements. They found that, since January, the FDA has received more complaints (5,000-plus) about the devices than it did, total, from 2007 to 2010.
Photo by Michael Simmons via FlickrWhile processing the data, the paper’s staff did their best to parse duplicate reports, international filings and other inconsistencies, but the reporters make it clear that the numbers are still best viewed in general terms. Even so, they demonstrate that the surge in complaints and lawsuits involving metal-on-metal hips — and the resulting mass defection of doctors who once implanted them — signals a broad shift in hip replacement surgery, one of the most common such procedures in the country. It also signals another blow for device manufacturers and patients, and a related windfall for the legal profession.
The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.
The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.
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As problems and questions grow, most surgeons are abandoning the all-metal hips, saying they are unwilling to expose new patients to potential dangers when safer alternatives — mainly replacements that combine metal and plastic components — are available. Some researchers also fear that many all-metal hips suffer from a generic flaw. Current use of all metal devices has plummeted to about 5 percent of the market, though a few of the models are performing relatively well in select patients.
Paper seeks redacted details from Vt. medical board
Filed under: Government, Health journalism, Hot Health Headline, Public records
Burlington Free Press reporter Adam Silverman writes that his newspaper is seeking the release of certain details redacted from a medical board inquiry into what he calls “allegations that a Vermont doctor engaged in conduct that might have exposed the public to harm” related to a lawsuit filed by a former board director alleging that he was forced to resign his post in 2010 after authorizing two inquiries despite objections from state health officials.
The missing information includes the exact nature of two doctors’ “official” positions with the State of Vermont, as well as the dates of the cases in question. Silverman found that the attorney who filed the suit blacked out the information from the public version because he “didn’t want to risk improperly disclosing details of Medical Practice Board cases before the state became involved in defending the lawsuit.”
In court Monday, Assistant Attorney General David Groff told Toor that judges often have to balance the public’s right to know against competing private interests — in this case, that of doctors whose good names could be besmirched by “spurious” accusations. For the Wargo lawsuit, though, Groff added, state lawmakers already have charted the course: Information about Medical Practice Board inquiries becomes public only if an investigation results in formal accusations. Here, the investigation is ongoing, he said.
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No one argued for releasing the records at Monday’s hearing, but the Free Press has written in letters to the court that the material should be unsealed because “there is an inherent public interest” in learning about a possible threat of harm to the public.
Investigations spotlight workplace safety
Filed under: Government, Health data, Health journalism, Hot Health Headline, Public health, Public records
Workplace safety got plenty of attention last week, from a public radio investigation in Seattle to a series by the Center for Public Integrity that includes plenty of opportunities for localizing.
KUOW’s John Ryan conducted hit the topic from all sides, with a five-part series on workplace safety in Washington. His story selection ranges from stats-directed investigations to features focusing on unique cases.
- Lineworkers Bring Power To The People, Without A Net
The curious case of one industry where its widely accepted for workers to work far off the ground with no safety equipment. - Workplace Safety Inspections Miss Their Target
Officials rarely enforce workplace safety rules, and even when they try, they miss the mark. - Violence In The ER
The most violent professions in Washington? Nurses’ aides and registered nurses. - Mental Hospital Staff Bear Brunt Of Workplace Violence
The state’s largest psychiatric hospital is also its most dangerous workplace. - Remembering Washington’s Fallen Workers
Chris Hamby did a two-part investigation in the Center for Public Integrity’s iWatch News on OSHA’s Voluntary Protection Programs, which exempt “model workplaces” from regular inspections (Part 1, Part 2).
Over the course of his eight-month investigation, Hamby pored over thousands of pages of documents which revealed, among other things, that “Since 2000, at least 80 workers have died at these sites, and investigators found serious safety violations in at least 47 of these cases.”
Workers at plants billed as the nation’s safest have died in preventable explosions, chemical releases and crane accidents. They have been pulled into machinery or asphyxiated. Investigators, called in because of deaths, have uncovered underlying safety problems — failure to follow recognized safety practices, inadequate inspections and training, lack of proper protective gear, unguarded machinery, improper handling of hazardous chemicals.
Yet these companies have rarely faced heavy fines or expulsion from the program. In death cases in which OSHA found at least one violation, VPP companies ultimately paid an average of about $8,000 in fines. And at least 65 percent of sites where a worker has died since 2000 remain in VPP today.
The program, with its emphasis on cooperation between regulators and industry, began under the Reagan administration and greatly expanded under the most recent Bush regime. There are some success stories, Hamby found, but he also uncovered a hearty helping of dirty laundry. Those included preventable deaths traced to OSHA violations, failures to self-police and an emphasis on expanding program participation at the expense of quality and safety.
In the second installment, Hamby spotlights oil refineries to illustrate what became a familiar pattern.
Recognition of “model workplace” status, missed opportunities to detect and fix hazards, a serious mishap or fatal accident, detection of safety violations and, ultimately, continuation of the government’s stamp of approval.
Hamby backs up these strong words with even stronger numbers. Here’s just one sample:
During 2009 and 2010, at least 21 of 55 fires at refineries falling under federal jurisdiction occurred at VPP sites, an iWatch News analysis of regulatory and news media reports found. VPP sites make up about 30 percent of these refineries, so these government-recognized sites have experienced more than their proportionate share of fires.
Reporters have already produced local versions of Hamby’s story throughout the country, particularly in Florida and Louisiana.
Related: OSHA lists 147 employers as “Severe Violators” of worker safety standards
Emails show Texas council’s disregard for EPA regs
Filed under: Government, Health journalism, Public health, Public records
Thanks to an order from the Texas Attorney General, Mark Greenblatt, of KHOU-Houston, obtained emails (2-page PDF) which demonstrate the state water advisory council’s conscious effort to effectively defy certain EPA water quality regulations related to radionucleotide content.
Texas Commission on Environmental Quality accomplished this trick by subtracting the counting error from otherwise dangerous test results, thus successfully dropping them below necessary thresholds. With the numbers below the threshold, there was no formal violation and authorities could get away with not warning residents about their potentially harmful water supply. The dodge continued until 2008, when it was caught by federal auditors.
Ontario considers exempting some hospital records from FOI law
Filed under: Health journalism, Hot Health Headline, Public records
Legal Feeds blogger Glenn Kauth, of the Canadian Law Times, reports that Ontario’s legislature is currently considering a law containing a little-known provision that would exempt from FOI law “information provided to, or records prepared by, a hospital committee for the purpose of assessing or evaluating the quality of health care and directly related programs and services provided by the hospital” starting Jan. 1, 2012 (scroll down to Schedule 15).
The leader of a provincial nurses’ organization took issue with the provision, telling the London Free Press that “The public has a right to know what’s happening in its local hospitals,” but Ontario health officials say hospitals need the exemption.
Health Minister Deb Matthews has defended the move to exempt information related to quality of care from public release. According to the Free Press, Matthews believes subjecting hospitals and doctors to greater scrutiny would prevent open dialogue about problems and how to fix them. “They must have a very open and frank discussion,” she said.
(Hat tip to Paul Levy, whose post on the matter also has some great first-hand material from Denmark)
Officials, reporters offer conflicting advice on getting public documents
By Michelle Rupe Eubanks
For AHCJ
Lillian Peake, M.D., M.P.H.
The fight by journalists to obtain public documents isn’t likely to get any easier, according to the four panelists who led the discussion “Right to know: Getting information from government agencies” as part of Health Journalism 2011.
Peter Ashkenaz, director of communications for the FDA Office of Regulatory Affairs, said his best advice for reporters looking to get these documents is to develop a relationship with the press officers at federal and state agencies.
“That means being friendly over the phone,” he said. “The worst thing that happens is to get a call from reporter who immediately starts demanding anything - information or data or anything like that.”
Even with kindness, Ashkenaz was clear that immediate answers weren’t always possible. In fact, at the Centers for Medicare and Medicaid Services, or CMS, the organization for which he used to work, the backlog is at 6,000 unanswered Freedom of Information requests.
“And that’s down from where it used to be,” he said.
Another of the panelists, Lisa Chedekel, said she has never made a request for documents in the form of an FOI as it “means the process gets locked into paper and lawyers.” As a reporter at The Hartford (Conn.) Courant, she wrote a three-part investigation on a nursing home chain that prompted state reform and led to the owner of the chain being jailed. She is now with the Connecticut Health I-Team.
In response to Ashkenaz’s request that reporters “be friendly” when making their requests, Chedekel said, “I hate, as reporters, that personalities matter. It shouldn’t matter if you’re nice or crabby when you call CMS.”
Instead, she offered three tips to journalists: “You’ve got to schmooze, negotiate and stand your ground. If you don’t know how to schmooze, ask your friends. It doesn’t mean you’re not strong about asking your question. It’s still your demand. You’ve got to be human and nice, but that alone might not get you the information you’re after.”
The Reporters Committee for Freedom of the Press has developed a Web-based tool, the Open Government Guide on their site, rcfp.org, that’s designed to help reporters to compare the open meetings laws and open records acts from state to state.
Panelist Lucy A. Dalglish, the executive director of the Reporters Committee explained the site, but she was clear, too, that nothing can speed the process of making a request for public documents for virtually any agency.
“You have to be prepared to wait,” she said. “The backlogs are incredible. Some agencies are better than others, but prepare to wait.”
So how do reporters deal with public officials on whom they depend for this information?
Building the relationship might be the only method, if the goal is to get the documents, especially on deadline, according to Lillian Peake, M.D., M.P.H., the director of the Thomas Jefferson District for the Virginia Department of Health.
“I do think a relationship is important, but not because I feel reporters need to be nice to me,” she said. “What’s nice to know is that, after you’ve spent time with a reporter, the information will be reported accurately. If you work with a reporter who does their homework and will report it accurately, I feel more comfortable going in. I never try to withhold information, but I hope it comes out right. We’re working toward the same goal, after all, and that’s information that will benefit the public.”
Michelle Eubanks reports on health care for the TimesDaily newspaper in Florence, Ala.
WSJ sues for release of Medicare provider data
Filed under: Government, Health journalism, Public records
If successful, a legal move by The Wall Street Journal could open a flood of now-confidential Medicare data about providers to the public and journalists.
The filing, by parent Dow Jones & Company, seeks to overturn an injunction that “prevents the public from knowing how much taxpayer money individual doctors receive from the Medicare program,” according to a press release.
The Journal has been running a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. To report the series, the paper and the Center for Public Integrity obtained the data from the U.S. Department of Health and Human Services but is barred from using the identities of individual providers.
Information about doctors in the Medicare claims database is kept confidential as a result of a lawsuit brought by the American Medical Association more than 30 years ago.
A press kit about the suit includes statements from reporters Maurice Tamman and Mark Schoofs and editor Michael Allen, as well as documents in the case and links to the WSJ series.
For more information, see “WSJ explains why Medicare data is hidden and “WSJ exposes flaws of Medicare’s pay now, investigate later culture.
Update
The board of directors of the Association of Health Care Journalists has released this statement:
AHCJ strongly supports the release of Medicare payment data that can help journalists better cover both the quality of care provided to patients and the finances of this critical government program. Publicly available information should include physician names connected to these payments. We see little reason why information on payments to doctors should be subjected to greater secrecy than payments to hospitals and nursing homes. The Wall Street Journal’s coverage demonstrates that data linked to doctors would help inform the public and likely would expose fraud and abuse in the program.
After 8 years, Quebec’s adverse event reporting law remains unenforceable
Filed under: Government, Health care reform, Health data, Health policy, Hospitals, Hot Health Headline, Public health, Public records
The Montreal Gazette’s Charlie Fidelman has assembled a round-up of what has, and hasn’t, happened in the eight years since Quebec passed a law requiring hospitals to tell patients about all adverse events as soon as staff became aware of them.
According to Fidelman, “the provincial Health Department has yet to set up its registry of adverse events,” which it was supposed to track in order to improve patient safety. It’s expected to finally get started next year.
Until then, hospitals are supposed to track their own events and report them each year, yet “no hospital contacted by The Gazette includes adverse events in its annual reports.” This may have something to do with the fact that the requirement came with no clear enforcement mechanism.
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- 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
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
