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Medical errors kill as many as 98,000 patients a year, so naturally readers want to know how dangerous it is to seek care at their local hospital, Los Angeles Times reporter Charles Ornstein said. Hospital public relations departments only want reporters to write about fund-raising triumphs, new construction, important new hires, celebrity patients or being accredited by the Joint Commission.
But these aren’t the stories that readers want and need, he said, and reporters can write a host of other stories – not generated by the PR folks – by digging into online databases filled with information about the quality of care provided by public and private hospitals, said Mr. Ornstein. He had plenty of tips about how to go about this.
An especially meaningless press release is the one announcing that a local hospital received full accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The fact is that 98 percent of hospitals fulfill accreditation requirements, so the only real story is the two percent of hospitals that fail or get some provisional or partial accreditation.
JCAHO reports are meant to be public and hospitals generally do not conceal their status. What they say can be checked on www.jointcommission.org. One caveat is that hospitals pay fees to be assessed by JCAHO, so the organization is not truly independent. Moreover, many rural hospitals do not seek JCAHO accreditation, even though this seal of approval means the hospital can have full access to insurance reimbursement. Although the situation is not unusual, Mr. Ornstein told reporters to ask why if this is what their local hospital did.
“Check the legislation in your state to see if your local hospital is required to release reports on ‘never’ events,” he said. “‘Never’ events are events that should never happen, such as performing surgery in the wrong side of the body or administering ten times the dose of a medication.” Some states, such as California, release rankings that make it possible to determine whether rates for hospital-related deaths are higher than the norm, especially for procedures such as heart bypass or serious but treatable ailments like pneumonia.
Nearly every hospital participates in a Medicare database that compares their performance with national standards for heart attack treatment, immunization against pneumonia, and prevention of post-operative infections. If your local hospital does not measure up on www.hospitalcompare.hhs.gov, find out why it does not meet the standard, said Mr. Ornstein. Because the database has so much information, he advised reporters to ‘eyeball’ the chart first. Is there a specific problem area? Does the hospital consistently underperform or overperform? If the local hospital does poorly on these measures, check state data on mortality rates. Does there appear to be a correlation?
To qualify for Medicaid and Medicare funding, hospitals need meet federal standards on pharmacy, nursing care, and physician care. When hospitals lose their funding because they fail these requirements, this is a story worth writing. These reports are public and easy to get, he said. They cover all hospitals reimbursed by Medicare, public and private, although public hospitals must disclose additional information such as physician salaries, how many surgeries each physician performs, overtime costs, and so on.
“The hospital cannot refuse to give you information” because they are taxpayer supported, noted Mr. Ornstein. Medicare is obligated to investigate all complaints, whether they are made by individuals or in a newspaper article. the complaint, he said. Newspaper headlines are sometimes considered a complaint, and the agency will investigate a hospital based on a newspaper article.
Once reporters begin to write stories about lapses in quality of care, they should expect to get tips. Mr. Ornstein knows this from experience. He investigated patient deaths, as well as other problems with quality of care and staffing, at the infamous King-Drew Medical Center in South Central Los Angeles. In 2003, Mr. Ornstein received a tip that two patients died while hooked up to cardiac monitors. King-Drew had just purchased new monitors, so he started out thinking his story would be about faulty new equipment. Then inspectors from the state health department arrived and found the problem lay with not the equipment but with nurses who did not respond when the alarms sounded. For Mr. Ornstein, the take-home lesson was to get every report.
A key document is the so-called “2567” form, a report filled out by inspectors that describes deficiencies in care and lays out a plan for correction. Each of these should be accompanied by a response from the hospital.
“Just begin looking at the 2567 forms (the state’s inspection report for the facility), and people will call you.You will get a sense of what is going on. Ask to see all public records, including surveyor notes, if available. Bring your own copier or computer or notebook. You can buy a portable copier for 60 or 70 bucks if you think you will have a lot of copying.
“At the beginning, I made lunch appointments with departmental chairpersons, residents, doctors, and nurses who left King Drew to work elsewhere,” said Mr. Ornstein. “I got the names of staff online. I called competing hospitals to see what new employees came from King Drew. Even if these individuals will not talk on the record, they can give you information. Because there was so much controversy, I did not include these anonymous sources in the article.”
Federal regulators from Medicaid and Medicare services conducted their own survey, finding the hospital was out of compliance not with only state rules, but also with federal Medicare rules. For example, the hospital prohibited its nurses from assigning patients to the sickest category, called class 4, instead restricting care to the second highest level for the sickest patients. “If you cannot assign class 4, then that patient’s illness is downgraded, and he doesn’t get the care he should,” said Ornstein. A patient who does not get appropriate care is a patient in danger.
Hospital spokespersons claimed that their record was no worse than that of any other hospital. They claimed the cause of their problem was that the hospital was under-funded. In response, Mr. Ornstein requested data to compare every public hospital for the previous four years. He checked the state health department’s database and found that the King Drew hospital fell in the top tier of number of deficiencies reported. The hospital’s claim of being short on funding also did not prove true. “King Drew had a ton of money, far higher salaries for doctors, paid out more in worker compensation, and paid more for temporary staffing because its own staff often did not show up for work.” He looked through the civil service records and found the “where are you?” letters written to staff members who did not show up for weeks at a time. “A lot of money was spent, but not necessarily on patients,” he said.
Mr. Ornstein investigated the malpractice payments the hospitals had paid out, lawsuit case numbers, and amount of money spent on settling suits. He also looked at the number of people who sought care from the hospital. “I looked at number, not severity, because hospitals are not rated by severity as are nursing homes. I asked statisticians to adjust payouts for inpatient and outpatient visits. King Drew came out at the top of expenses,” he said.
Ornstein said that King Drew hospital also spent more on worker compensation, so he asked the hospital for the data on claims. “They had a big problem with employees falling off chairs over 10 years. A hundred chair falls costing over three million dollars.”
Mr. Ornstein’s experience is that critical stories do not shut down the flow of information. As distressing or outrageous stories appear, people working for or with the hospital will feel a prick of conscience and decide to talk with reporters. “You have to put it on the line if there is not good quality of care,” he said.
Another perspective on hospital quality can be gotten by checking the status of their residency training programs. Reporters can check www.acgme.org/adspublic to find out whether these programs meet expected standards, are on probation, or have had their accreditation withdrawn. Specialty websites such as www.abim.org and www.abp.org post summary data that will tell you what percentage of a hospital’s trainees pass their certification exams.
Mr. Ornstein said that the Georgia Hospital Association had a website that could theoretically be used to compare hospitals, but he found the site quite unfriendly to use. Georgia reporters may be better off using www.hospitalcompare.hhs.gov Whatever database you’re using, it’s important to make sure that comparison data are “risk adjusted,” so that calculations take into account the different patient populations served by different institutions.
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