Key takeaways for your own reporting on hospitals

My post on recent reporting on pediatric surgery programs raises serious questions about American hospitals and the care they provide. These series point to inadequate care given to some of the most vulnerable patients but may represent the proverbial tip of the iceberg. What else is going on in America’s hospitals that the public knows nothing about? Taken together these stories raise more questions for further examination. Here are a few that come to mind:   

What happened to “centers of excellence” for hospital procedures, where only the best facilities with the highest volumes perform the difficult surgeries or procedures?

Has the lure of big profits made this once-talked about solution impossible? The New York Times reported that the University of North Carolina medical center in Chapel Hill had considered combining its pediatric surgery program with Duke’s less than 15 miles away, but nothing came of it. The paper also noted that some countries like Sweden and the United Kingdom have consolidated programs to foster better care. Volume is paramount in achieving good surgical outcomes. In Sweden the mortality rates for pediatric heart surgeries dropped from 9.5% to 1.9% after programs were merged into two hospitals instead of four. In the UK, hospitals must have multiple surgeons who perform at least 125 surgeries each year. Why do places like Orlando, Phoenix, and San Antonio have three hospitals doing pediatric heart surgeries. Do they all perform equally well? Are such arrangements a good use of the country’s health resources?

Are you sure you’ve found a trustworthy expert?

Who is really an expert and who has conflicts? Dr. Jeffrey Jacobs, chief of the division of cardiovascular surgery at All Children’s who operated on some of the children discussed in The Tampa Bay Times series, had previously emerged as an expert reporters could go to for help and views other than the hospital’s. I spoke to him. CNN’s Elizabeth Cohen quoted him in her story. So did reporters in Philadelphia. According to The Inquirer, Jacobs said that every death in surgery should be scrutinized to “learn and potentially prevent that death from happening the next time.” He also said the best option would be for hospitals to make their complete track records public. In 2014 Jacobs participated in a state review panel examining St. Mary’s Medical Center. The panel found many vital tests and services for children’s hearts were lacking at the hospital. After The Tampa Bay Times’ revelations, Jacobs left the hospital. The hospital announced he resigned. According to the paper, his lawyer said he was “forced out of his position and prevented from speaking out on his own behalf.”

Are hospital regulations too weak and ineffective?

Laced throughout these stories are threads of trouble that occur when regulators look the other way or are otherwise absent. From the accreditation process of the Joint Commission to the tepid state regulatory oversight as reported in all of the stories we examined, this is a subject ripe for scrutiny. In Philadelphia, the Inquirer reported it began an investigation of St. Christopher’s hospital after it was clear that the hospital chose not to participate in a first-ever state evaluation of such programs. What kind of regulatory scheme allows the regulated to make that choice? In a press release, Florida’s Agency for Health Care Administration called the CNN stories “sensationalized reporting.”

And why is a private professional organization the repository of the all-important mortality stats families may want to consider? The New York Times noted that only 75 percent of pediatric heart surgery programs in the U.S. release their data to the thoracic surgeons website, and the paper ran a list of facilities that don’t report for various reasons. How many families even know such a list exists? Who can compel the hold-outs to participate? Where are the mortality stats for other types of risky surgeries? 

Karen Bouffard, one of the Detroit news reporters who exposed the dirty instruments problem at Children’s Hospital, where heart surgery on a 7-month-old baby had to be stopped because a tube was clogged with blood from a previous operation, told me they encountered systemic protection of the doctors and hospitals. “There’s a regulatory framework that’s designed to protect the interests of hospitals and physicians,” she said, adding that when it comes to privately owned facilities, “there’s so much you can’t FOIA. They don’t have to tell you how many nurses are on duty, staffing cuts or budget cuts, or if patients are in danger. Privately owned hospitals don’t have to tell you anything.”

The New York Times had sued to obtain UNC Health Care’s mortality data. The hospital announced last week it would release previously undisclosed numbers. The data showed that the mortality rate for heart surgery patients continued to rise after warnings from doctors several years ago that there were possible problems. “It’s concerning when a reporter has to spend so much time and effort to get what should be a public record,” reporter Ellen Gabler told me.

That’s precisely the point: Much of the useful data patients need is still difficult to get.

How useful are metrics and rating schemes of doctors and hospitals?

Many of the ratings currently available display a lot of information that doesn’t get to the issue of whether surgeons and special programs like pediatric surgery are really any good. As I’ve argued, checking ratings, even those that are more robust, is not something patients already in a hospital are likely or able to do. But for families seeking information before complex procedures, having good information is a must. Pediatric surgery falls in that bucket.

What an interesting project it would be for some enterprising journalist to match up a hospital’s advertising claims with what is really known about its quality of care, especially for the services hospitals so eagerly tout.