Quake damage could cripple Calif. hospitals

In her series on earthquake preparedness at California hospitals, California HealthCare Foundation Center for Health Reporting senior reporter Deborah Schoch look at what she calls the “Achilles heel” of hospitals in earthquake territory: internal damage to pipes and equipment.

While much of the legislative focus has been on preventing structural damage, Schoch writes that recent seismic disasters in places such as Chile and Japan have demonstrated that a broken water pipe or sprinkler system can shut down a hospital every bit as effectively as a crumbled wall.

To better avoid internal damage, Schoch writes, hospitals need to bolt down equipment, anchor water tanks and set up back-up generators. According to Schoch, “Many facilities locally and statewide are still years or decades away from making those non-structural internal fixes, even though they are required under California law.” This is largely thanks to a variety of deadline extensions and loopholes requested by cash-strapped hospitals which refer to the law as the largest unfunded mandate in state history.

As of 2009, fully 1,357 hospital buildings statewide had not made fixes that should have been finished at the start of 2002, according to a December 2009 report from state regulators.

Another 1,233 buildings, or 95 percent of buildings statewide, had not yet done improvements that were due Jan. 1, 2013, according to the report. State officials caution that some hospitals may have completed upgrades, but they do not have up-to-date statistics.

In the second installment of the series, Schoch uses state records to show that more than 40 hospitals close to the fault are rated at high risk of collapse in a major earthquake.

California hospitals were supposed to have fixed hospitals by 2008 or the state would shut them down. But that deadline has been pushed back multiple times: “Championing the delays, the state Legislature repeatedly extended the 2008 deadline to 2013, 2015, even 2020, under pressure from hospitals that said they can’t afford the fixes.”

Former Practitioner Data Banks official says HRSA ‘erroneously interpreting the law’

A former federal official criticized a decision by the U.S. Health Resources and Services Administration for removing the Public Use File of the National Practitioner Data Bank from the agency’s website – a major development as journalism groups fight to restore access to the important tool.

Robert Oshel, who created the Public Use File in the mid-1990s and managed it until his retirement in 2008, said in a statement released to the Association of Health Care Journalists on Sunday that HRSA is “erroneously interpreting the law” governing the data bank.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

HRSA officials removed the public file from the data bank website last month because a spokesman said they believe it was used to identify physicians inappropriately.

But in his letter to AHCJ, Oshel said HRSA officials have confused the requirements of the law.

“HRSA’s current management seems to confuse the law’s requirement that a public data file not permit use of its records to identify individual practitioners with a very different requirement, and one not in the law: that the file not allow the records of previously identified practitioners to be identified in the file,” Oshel wrote.

Oshel further wrote that HRSA’s view will “seriously hinder use of the file for important public policy research.”

“For example, it will be impossible to identify state licensing boards which are not taking action to protect the public from physicians with records of repeated malpractice payments and serious sanctions against their hospital clinical privileges based on the quality of their care or their behavior,” he wrote.

As he notes in his letter, Oshel served as associate director for research and disputes for HRSA’s Division of Practitioner Data Banks, which operates the National Practitioner Data Bank, from 1997 *(updated) until his retirement in 2008. Among other duties, he personally designed the Data Bank’s Public Use File in about 1995 and oversaw its development and quarterly updating.

AHCJ President Charles Ornstein said Oshel’s letter reaffirmed what AHCJ and five other journalism groups are fighting for. He said the Public Use File has been a vital tool for journalists writing about insufficient oversight of physicians in their states. Without such articles, some unsafe doctors would very likely continue to be practicing with clean licenses and patient protection legislation in several states likely would not have been enacted.

“It is abundantly clear that HRSA made a mistake in taking the Public Use File offline, putting physicians’ interests ahead of patient safety,” Ornstein said. “With Robert Oshel’s detailed statement, we call on HRSA and HHS Secretary Kathleen Sebelius to make the right decision and restore access to the public version immediately.”

In his letter, Oshel also criticized the process that HRSA introduced as an interim way for reporters and researchers to request data from the data bank. To get information, individuals must disclose the focus of their work and HRSA officials must approve – or reject the request. If the request is granted, HRSA officials will be the arbiters of what data fields an individual needs to complete the research.

“I believe HRSA’s current policy is contrary to the law,” he wrote.

* There was a typo in the date in an earlier version of this post.

Earlier coverage

• AHCJ, other journalism organizations protest removal of data from public website
• Journalism organizations offer data government blocked from public
• More journalism groups join effort to restore access to National Practitioner Data Bank
• Agency declines to restore public data
• Journalists turn to Sebelius for access to National Practitioner Data Bank file

Investigation finds chart falsification endemic in Calif. nursing homes

In a two-part series (one | two) in The Sacramento Bee, Marjie Lundstrom reveals the results into the widespread falsification of patient records in California nursing homes.

While regulators have dogged facilities for years over fraudulent Medicare documentation, the issue of bogus records is more than a money matter. In California and elsewhere, nursing homes have been caught altering entries and outright lying on residents’ medical charts – sometimes with disastrous human consequences, according to a Bee investigation.

Medications and treatments are documented as being given when they are not. Inaccurate entries have masked serious conditions in some patients, who ultimately died after not receiving proper care, The Bee found.

Lundstrom writes that while chart falsification is a misdemeanor, nursing home workers are rarely prosecuted, because it’s difficult to prove and time consuming to track down. Instead, she found, sources say its become a pervasive part of the culture in such workplaces. Based on a review of 150 incidents that occurred over the course of two decades, Lundstrom spells out the most common reasons for such mistakes – reasons that will be immediately familiar to anyone with experience in a checklist-driven workplace.

• Covering up bad outcomes. A patient dies or is injured, and the nursing home staff or administrators rewrite the records to minimize blame or liability.
• Fill-in-the-blank charting. Overworked or lazy staff members take massive shortcuts, filling out charts en masse, not knowing whether treatments took place or if the information is accurate.
• Missing medicines. Medications are checked off as being given, but investigators later find unopened boxes or discrepancies with pharmacy records.

She explores each of these bullet points and ideas in subsequent headings and, in the process, lays out a blueprint for other reporters interested in looking for similar issues in their neck of the woods. The first story includes a number of heavy-hitting anecdotes, but Lundstrom doesn’t fully dig into one of the most affecting cases until the second installment of the series.

In two key paragraphs, Lundstrom lays out all you need to know about the significance of the story, one that began with the falsification of medical records. The whole story is well worth a read, and you’ll emerge with a deeper understanding of what makes records falsifications such a unique and tricky subset of nursing home infractions.

Johnnie Esco’s death on March 7, 2008, led to a contentious civil lawsuit, investigations by California’s Department of Justice and Department of Public Health – and the exhumation of her body from Arlington National Cemetery.

Last week, amid inquiries from The Bee, the state Department of Justice reopened its criminal investigation into Johnnie Esco’s treatment at the facility.

In a response published in The Bee, an industry representative took issue with significance of Lundstrom’s findings, accusing her of sounding the alarm “on behalf of trial lawyers” and not putting the problem in perspective.

…in a single day in California there are 30 million entries made on medical charts. The Bee examined 20 years of charting history from 1990 to 2010 – or 219 trillion entries – and found that during that period, regulators issued 209 citations for willful material falsification.

Journalists turn to Sebelius for access to National Practitioner Data Bank file

The Association of Health Care Journalists and five other journalism groups appealed to Health and Human Services Secretary Kathleen Sebelius to intervene in the dispute over the Public Use File of the National Practitioner Data Bank and restore access to this important data tool.

AHCJ was joined in its letter to Sebelius by Investigative Reporters and Editors, the Society of Professional Journalists, the National Association of Science Writers, the Reporters Committee for Freedom of the Press and the National Freedom of Information Coalition. The groups have more than 15,000 members.

The U.S. Health Resources and Services Administration removed the Public Use File (PUF) from the data bank website earlier this month because officials believe it was used to identify physicians inappropriately.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

The groups took issue with a letter written last week by HRSA administrator Mary Wakefield, in which she defended the decision to remove the Public Use File from the agency’s website.

“We believe the stance taken by administrator Wakefield and HRSA staff is overly restrictive based on the law governing the data bank. We do not dispute that federal law precludes the administration from sharing confidential information from data bank reports, including the person being reported and the institution filing the report. We disagree with HRSA that the Public Use File, removed from the web earlier this month, did this.”

The letter also criticized HRSA’s research protocol under which reporters can now request data from the data bank as intrusive and unfair. The agency’s new web page about the Public Use File and how to make requests for data says: “At this time, a researcher must provide a proposal (including table shells) for their need of data. DPDB will review the request and approve or deny the request for data. DPDB will provide only the variables needed to complete the research.”

“We find it troubling that a federal agency now wants to judge the quality of reporters’ stories and make individual decisions about which one is worthy –perhaps putting officials in the position of denying requests that may make HRSA or the data bank look poor,” the letter said. “We don’t see any provisions in the act governing the data bank that gives HRSA the authority to deny research data as long as it doesn’t identify individuals.”

The groups said they stood ready to meet with Sebelius and work with her on a solution that will provide continued access to the Public Use File.

“Reporters have exposed dangerous lapses in oversight by state medical boards, prompting legislation to increase transparency and improve patient protections,” the letter said. “We hope you will agree that this is a matter of public concern and that you will urge HRSA to change course and immediately restore the Public Use File of the data bank.”

The letter to Sebelius followed a request for assistance to members of Congress last week.

Agency declines to restore public data

The U.S. Health Resources and Services Administration resisted demands by three major journalism organizations for the immediate restoration of a Public Use File of the National Practitioner Data Bank, a tool that reporters have used to expose lapses in oversight of troubled physicians.

HRSA removed the Public Use File from the data bank website earlier this month because officials believe it was used to identify physicians inappropriately.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

In letters to the Association of Health Care Journalists, Investigative Reporters and Editors and the Society of Professional Journalists, HRSA Administrator Mary Wakefield said her agency regretted having to remove the Public Use File from its website and hopes to bring it back in some form “as quickly as is possible.” She did not provide a date.

“The statute that governs the NPDB clearly states that we are obligated to keep data about individual practitioners housed in the NPDB confidential,” Wakefield wrote. “We now know that the PUF in its current form can be manipulated to identify individual practitioners, and therefore were compelled to act.”

Wakefield said HRSA shared the groups’ interest in transparency and patient safety but was compelled to act in the way that it did.

Wakefield was responding to a Sept. 15 letter from the three groups, which called for the Public Use File to be returned online without delay.

AHCJ President Charles Ornstein took exception to Wakefield’s comments, noting that reporters have used the Public Use File responsibly for many years and that the agency only acted after a single complaint from one doctor’s lawyer. He said HRSA has been well aware of how reporters have used the database and even assisted them in their statistical analysis.

“It is not true that the Public Use File can be ‘manipulated’ to identify individuals,” Ornstein said. “Nothing in that data can be used to identify individuals if reporters or researchers don’t already know who the bad actors are. We remain troubled that it appears HRSA is more interested in protecting doctors accused of harming patients than protecting the patients themselves.”

Wakefield’s response came the same day the journalism groups – joined by the National Association of Science Writers, the Reporters Committee for Freedom of the Press, and the National Freedom of Information Coalition – wrote letters to members of Congress asking for their help in getting the old version of the Public Use File restored. The groups would like to see that file regularly updated.

Wakefield said HRSA is reconfiguring the Public Use File to prevent identification of a health care provider or patient, and that researchers and members of the media can request data in the interim on the agency’s website. She also said there would be a call at 1 p.m. Eastern on Oct. 13 to hear from the public about what they would like from the Public Use File.

But Ornstein said it remained unclear how useful the information would be if the agency removes unique identifiers for individuals, which had allowed reporters to see what type of follow-up action was taken against doctors who repeatedly made malpractice payouts or had been disciplined repeatedly by hospitals.

On Wednesday, AHCJ and its partner journalism groups released a report on how reporters and news organizations have used the Public Use File in the past to expose dangerous lapses in oversight by state medical boards. Several of those articles led to new laws and rules to increase transparency and implement patient protections.

“As result of our investigation – and the solid documentation provided by the NPDB, malpractice suits and patient records – Virginia passed a law giving its state medical board more authority to crack down on doctors … ,” wrote Liz Szabo, a USA Today reporter who used the data bank in 2002 while at the Virginian-Pilot. “Patients in Virginia are safer today due to our reporting, and due to the data provided by the NPDB.”

Wakefield noted in her letter that the amount of information in the databank has increased dramatically in the past 18 months. Journalism leaders say what she failed to state was that a huge number of reports came in only after journalists (including Ornstein) showed that state agencies were not reporting discipline to the data bank and that HRSA was not following up on glaring inconsistencies and irregularities.

Wakefield did not address a request by the journalism groups to seek legislation permitting the continued disclosure of the Public Use File in the same form as before it was pulled Sept. 1.

She also did not apologize, as requested, to Kansas City Star reporter Alan Bavley, who was threatened with sanctions if he wrote a story based on information from the data bank. She said Bavley will not be pursued but was reminded that the Public Use File was for “statistical analysis only.”

Ornstein said the issue is larger than Bavley. “The threat to Alan is not a moot point just because HRSA didn’t fine him. Such threats by the federal government could have a chilling effect based on a news’ organization’s ability – and willingness – to stand up to government fines and local lawsuits.”

“There needs to be an apology and a promise that reporters won’t be threatened by the federal government when they plan to report public information,” Ornstein added.

IRE has made available free on its website a copy of the Public Use File, downloaded last month, along with documentation and instructions.

Journalism organizations offer data government blocked from public

Another development in the protest by three key journalism groups to the Obama administration’s decision to block public access to a public database of physician discipline and malpractice: Now, Investigative Reporters and Editors, working with the Association of Health Care Journalists and the Society of Professional Journalists, has posted the data for download, free to the public.

The data are posted for the entire U.S. in the original text format with documentation. IRE has also made available state-by-state Excel spreadsheet files.

On Thursday, the groups sent a letter protesting the decision to pull offline a the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

The public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

“We applaud IRE for making this data available for free to the media, researchers and the public,” said Charles Ornstein, AHCJ’s president. “While the government has decided that this ‘public use file’ should no longer be public, our organizations believe that it continues to be a critical resource. I encourage reporters, even those who have never used it before, to look for stories within it now.”

Journalists have used the data for years to draw attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and The Kansas City Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

The U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

Several news outlets - The New York Times, Los Angeles Times, Reuters and the St. Louis Post-Dispatch - are following the story.

AHCJ, other journalism organizations protest removal of data from public website

The Association of Health Care Journalists, joined by the Society of Professional Journalists and Investigative Reporters and Editors, sent a letter to the Obama administration today protesting its decision to pull offline a public database of physician discipline and malpractice payments.

AHCJ, SPJ and IRE called for the government to immediately restore access to the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

Pursuant to the law, the public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

As an example, the database would allow a reporter or researcher to discover that certain, unnamed physicians have been sanctioned repeatedly by their hospitals but never were disciplined by their state’s medical board. It would also be possible to find doctors with lengthy trails of malpractice who continued to enjoy clear licenses.

The groups also expressed their deep disappointment that the U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

The government said that it had to act now because reporters were able to link information in the data bank to specific doctors, and the law prohibits the public use file from identifying doctors. A HRSA spokesman said the data bank will be offline for at least six months and may never return unless the physician privacy concerns are adequately addressed.

AHCJ President Charles Ornstein said he was puzzled by HRSA’s sudden action because reporters have used the public version of the data bank for years to assist in their reporting and learn additional details about physicians they already had been researching.

“We are troubled that the Obama administration appears to have placed the interests of physicians ahead of the safety of patients,” Ornstein said. “Attempting to intimidate a reporter from using information on a government website is a serious abuse of power.”

Stories written by reporters using the public version of the National Practitioner Data Bank have drawn attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and the Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

Some of these stories have resulted in new legislation and other steps that protect patients, by increasing transparency and sometimes toughening requirements on doctors.

The groups wrote that if HRSA determines the public version of the database violates the law in any way, it should seek swift legislative changes to remedy the problem and once again make the database available.

“In one stroke, the very administration that promised greater transparency not only excludes information of obvious public value to patients across this country but threatens legal action against a reporter for using public records,” said SPJ President Hagit Limor. “This is clearly outrageous.”

IRE President Manny Garcia said, “The removal of the Public Use File - whose very name means for public use - eliminates a valuable tool for journalists whose goal is to educate and protect the public. This database has allowed reporters to uncover flaws that have toughened legislation, and without a doubt, saved the lives of patients across the country.

“We are also stunned that a public servant has the hubris to threaten a health care reporter for doing his job. HRSA should be delighted that journalists are using public information to help saves lives, but in this instance the response is: get lost or get fined.”

Reporter finds the story behind food code violations

All the time that The Muskegon Chronicle’s Brian McVicar has been spending with his county health department’s inspection records has paid off with a slew of stories, with the most recent turning the spotlight on the thousands of food code violations area businesses have racked up in recent years.

For this particular story, McVicar crunched the numbers on 22,000 violations, 37 percent of them critical, logged over a four-year period. Among the most salient, he writes, were “Raw chicken and crabmeat sitting out at room temperature, food kept past its expiration date, cockroaches, mice and fruit flies living in kitchens, employees not following proper hand washing procedures.”

In addition to the typical rogue restaurants, McVicar found that a wide range of local businesses were guilty of health code violations, including “Schools, hospitals, and food stands found in places such as Michigan’s Adventure Amusement Park.”

With his broad-based, data-oriented methodology, McVicar provides a model for other local reporters looking to move beyond the typical “cherrypick the cockroach horror stories” approach that is so often found in inspection-record stories.

Stories in the series:

• Food code violations rampant; food poisoning outbreaks rare
• Management is key to cleaning up food code violations
• Handwashing, temperature storage key to keeping foods safe
• Are some restaurants allowed to get too many health violations?
• Day in the life of a Muskegon County health inspector
• Food poisoning outbreaks rare, but serious
• Some states grade restaurants based on health inspections
• Food code violations: Public health risk or over-burdensome government regulation?

Public becoming more active in pursuit of goverment information, media less active

The public’s interest in government transparency is growing and citizens are “becoming more active in asserting their right to government information,” according to a new survey from the Media Law Resource Center and the National Freedom of Information Coalition.

The survey also found, perhaps less surprisingly, that news organizations are less likely to sue for access to public information because of a lack of resources.

The new findings include both good news and bad, said Kenneth F. Bunting, executive director of the National Freedom of Information Coalition.

“If ordinary citizens are becoming more aware of their access rights, and more assertive regarding them, it is indeed a reason to be gratified,” he said. “However, if news organizations are trending toward being less gung-ho in an area once regarded as a matter of responsibility and stewardship, there is the frightening potential that journalism could suffer, as could the health of our democracy.”

Among the findings:

• Media lawyers and representatives of the NFOIC member coalitions said they had seen an increased number of open government violations in recent years.
• The number of open records requests made by private citizens and other non-media organizations has increased.
• 60 percent of media lawyers surveyed noted a decrease in open government lawsuits by media organizations over the past five years.

The survey also looked at the prevalence and effectiveness of FOI hotlines, finding that they “got generally high marks from all respondents.”

Read more:

• Press release
• Results of both surveys (PDF)
  
• Results of survey to media lawyers (PDF)
  
• Results of survey to NFOIC members (PDF)
  

(Hat tip to Joey Senat, Ph.D.)

Reporter’s investigation exposes inefficient charity

In the Minneapolis Star Tribune, Jane Friedmann used simple tax documents and a local woman’s complaint to show that most of the money raised by the Austim Spectrum Disorder Foundation goes toward sustaining the foundation’s fundraising, not toward families living with autism. It’s a brief, effective piece of reporting of the sort that can and should be localized more often. For the record, here are the numbers Friedmann got from the return.

The charitable group pulled in $1.2 million in 2009, according to its IRS filing, but the charity listed a negative balance of $29,679 at the end of the year. It listed three employees and 89,128 “volunteers” …

The group hired two companies to raise funds for ASDF in 2009, but neither did much to help the cause. Ohio-based Infocision kept all $876,832 it raised, while Missouri-based Precision Performance Marketing kept all but $37,842 of the $203,227 it raised.

The tax form reveals the group held no “structured, formal meetings” in 2009. It spent $313,751 on “materials and fulfillment” and $120,241 on postage.

She also called local and national autism charities for their perspective on the dubious foundation, then included a few paragraphs which helped readers make more informed choices when doling out charitable contributions.

To investigate charitable organizations in your area, find out how to to understand an IRS 990 form, the tax return that nonprofit organizations file. It tells you the organization’s revenues and expenses, and its assets and liabilities. You can see whether or not it is making a profit, and how its fund balance, or net assets, has changed over the past year.

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