Five Lessons from The New York Times' "Heart Tests at Hospital Went Unread"

Have you ever gone in for an oil change and left with the suspicion that the mechanics didn't do anything beyond opening your hood?

Anemona Hartocollis at The New York Times has exposed this same type of behavior in a much more critical venue: a local hospital. She wrote:

Nearly 4,000 tests for heart disease performed over the last three years at Harlem Hospital Center - more than half of all such tests performed - were never read by doctors charged with making a diagnosis, hospital officials acknowledged Tuesday. The echocardiogram tests, a type of ultrasound used to evaluate heart muscle and valve functions, were ordered by doctors at the hospital. The tests were stored on a computer and basically forgotten, officials said.

Here are five great takeaways from her story.

1. Get to know the hospital staff. Health writers know a lot of doctors and hospital PR folks. They don't tend to know many nurses, technicians or any of the hundreds of other staff members who are the lifeblood of a hospital. Hartocollis doesn't say how she was tipped to the story, but my guess would be that she heard about an internal investigation and then worked sources within the hospital to shake something loose. Perhaps a doctor with an axe to grind could have talked about this, but chances are better that a nurse or some other staff member was concerned about all of these unread tests and couldn't keep the secret any longer.

2. Keep track of who said what when. Harlem Hospital Center did the advisable thing when Hartocollis called officials there. The hospital owned up to the problem and revealed that it had already started firing people:

The city's Health and Hospitals Corporation, which runs the public hospital system, including Harlem Hospital, and Columbia University, whose medical school supplies the cardiologists who work at Harlem Hospital Center, acknowledged the problem in a joint statement on Tuesday, after being asked about it by The New York Times.

It's easy for an organization to claim that they found the problem independently and had been working to solve it before you pointed it out. It's important to keep track of when specific actions were taken and whether anything was being done purely to keep the story out of the press. By chronicling the true chain of events, you shouldn't be interested in taking credit as much in making clear how the problem came to light.

3. Empower patients. I can't stress enough how important it is that every time a patient contacts you about a problem they have had that you ask them to get copies of their medical records. It's better for them to have them, and it's a road map for you should you choose to do a story.  In this case, there are now thousands of patients in New York City who have good reason to get a second opinion about their echocardiograms.

4. Don't assume the first answer is the right answer. Hartocollis followed her great piece about the heart tests Tuesday with a story Wednesday that showed how truly messy the situation has become.

New York City's public hospital system said on Wednesday that some of the thousands of heart test results that were never sent to doctors at Harlem Hospital Center since 2007 had shown signs of abnormal heart function. Hospital officials made the admission a day after acknowledging that results of 4,000 of the tests, called echocardiograms, had never been seen by doctors because of a practice of allowing technicians to read them first. On Tuesday, they said that no harm had been caused by the process because they believed that the technicians were so good at reading the tests. On Wednesday, they said their review undercut that belief.

Of course this won't be the last piece of bad news about these heart tests and there may indeed be good news. The important thing is to stay on top of the story as it develops, because you have now hooked a massive and vulnerable patient population that is awaiting truly life-or-death information.

5. Be respectful, but skeptical. This could be an example of simple bungling. And it could be something worse. Hartocollis did the right thing in asking a well-regarded cardiologist for some context:

Having 4,000 tests done and unread is unheard of, and is "unconscionable and unacceptable and malpractice as far as I'm concerned," Dr. Douglas Zipes, a cardiologist at Indiana University Medical Center, past president of the American College of Cardiology and editor of HeartRhythm, said on Wednesday. "I can't use more adjectives than that."

The next question should be, "Were patients at Harlem Hospital being given echocardiograms at a higher rate than similar hospitals?" Was this, in effect, an EKG mill aimed solely at generating reimbursements?

If you think that doctors and hospitals would never put patients at unnecessary risk from radiation for a test they didn't need, you might consider the hospital in Redding, California, where patients were operated on unnecessarily, a scam that ended up costing the doctors and the hospital's owners more than $500 million.