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Remember Alexis: Five Tips for Investigating Hospitals from the St. Louis Post-Dispatch

Remember Alexis: Five Tips for Investigating Hospitals from the St. Louis Post-Dispatch

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When a troubled teen whose parents have left her in the care of the foster system dies, she could easily be forgotten, a bureaucratic footnote in some annual report. Blythe Bernhard and Jeremy Kohler at the St. Louis Post-Dispatch have made certain that Alexis Evette Richie will be a name that resonates with federal regulators, hospital administrators and patient advocates for years to come.

Their powerful and detailed investigation, Girl, 16, dies during restraint at an already-troubled hospital, is a follow-up to their story, "Who Protects the Patients?" that ran in May. It starts with Alexis "sprawled face down on a bean bag chair" at SSM DePaul Health Center, after being pinned their by two psychiatric ward aides who injected her with a sedative.

The story that unfolds from there illuminates the many problems with the way health care is managed and the way patients are informed about health care quality in hospitals nationwide.The story and a sidebar about how hard it is to find information on medical mistakes have generated a lot of notice from, among other places, Columbia Journalism Review, Health News Review and HealthCare PSI. Nearly a week later, it was still one of the five most-read stories on the Post-Dispatch's website.

Here are five tips to take away from this great piece:

Call the cops. One of the best details in the story comes from a police report.

Charge nurse Iris Blanks checked on her minutes later and didn't think Alexis looked right. An aide helped Blanks roll the girl over. Alexis wasn't breathing. Her pulse was faint. It was 12 minutes after she stopped moving before anyone tried to revive Alexis. By then it was too late.

"Why did they leave her like that?" Blanks wailed over the phone to her daughter that night, according to a police report. The "little girl," she said, "didn't have to die."

The medical examiner agreed, concluding that Alexis had suffocated on the bean bag chair. Her death on Oct. 26 was ruled a homicide.

Health reporters often leave the cop calls and the ride-alongs to the courts reporter or the intern working nights. It's always good to have a good relationship with a few key people at your local PD and, especially, the coroner or medical examiner. 

Keep your eyes open. The reporters had been investigating a case where a urologist had removed the wrong kidney from a patient. As Kohler detailed in a sidebar, they weren't able to find many details about that case. But they did find this patient death at the same hospital.

Alexis' death came less than two years after the Bridgeton hospital had been warned by the state and federal regulators that patients weren't safe. In January 2008, a patient with doctor's orders for constant supervision died alone after five days in seclusion. That led to a state inquiry that uncovered instances of improperly secluding and restraining patients and failing to report deaths to authorities. A health inspector was already investigating an operation in which a urologist removed the wrong kidney from a patient.

Don't sanctify the victims. Stories about patients who have died invariably talk about how they loved their children with every fiber of their being, how they coached soccer after working 80 hours at a food bank, or how they always wanted to see Celine Dion in concert and now will never have the chance. Alexis is introduced to readers in a very different way that makes her more human, puts what happened to her into the proper context and makes the story even more compelling.

Minutes earlier, the 16-year-old foster child had tried to hit, scratch and bite staff members in the adolescent psychiatric ward.

Read your own paper. As it turns out, the federal government had notified St. Louis Post-Dispatch readers, albeit in a very low key way, that DePaul was in trouble. As Bernhard and Kohler write:

The government found - again - that DePaul patients were in immediate jeopardy. A federal agency placed a three-paragraph legal notice in the Post-Dispatch classified section indicating that DePaul was scheduled to be "terminated" from the Medicare program because it was "not in substantial compliance with Medicare Conditions of Participation." 

Decode those acronyms. Medicine is full of acronyms. A fellow writer read one of my columns once and said, "Hundred of acronyms complicate the language of medicine. It is always wise to spell out what a acronyms mean. I don't know what you are referring to in this instance." Bernhard and Kohler did just that in going through the stacks of documents they reviewed for these stories. One of the most valuable was this: "CPI." They talked with staff members about what had happened before Alexis had died. They were told she had been placed in a "CPI hold." Being good reporters, they asked what CPI stood for and, upon hearing that it referred to the name of the company that had trained hospital staff in restraint techniques -- Crisis Prevention Institute – they called the company.

A CPI spokesman told reporters what Manetta described was "not something taught in any CPI training program."

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