Slap: Talk With a Reporter, and Hospital Execs Will Expose Your Medical Records

by

CHJ Fellow

January 6, 2012

william heisel, prime healthcare, kwashiorkor, reporting on health Remember those supposedly hungry seniors living in California and suffering from kwashiorkor, a malnutrition disorder typically only found in sub-Saharan Africa?

Hospitals owned by Prime Healthcare Services have a knack for billing the government for kwashiorkor. California Watch found that they do this many times more than other hospitals, leading experts to question whether the hospitals actually treat that many kwashiorkor patients or are trying to game the system by billing for disorders that pay a higher premium than others. State and federal regulators are investigating this question right now. Calfornia Watch's Lance Williams reports:

Reports of kwashiorkor at Shasta Regional Medical Center exploded after Prime acquired the hospital in November 2008. That year, the hospital reported only eight cases of kwashiorkor. But in the two years that followed, 1,030 cases were billed to Medicare – more than 70 times the statewide rate for general hospitals.

One of these patients found out that Shasta Regional had billed Medicare as if she had suffered from kwashiorkor, and she, too, was confused. Williams writes:

As far as Medicare knew, Darlene Courtois fell ill last year with kwashiorkor, a dangerous form of malnutrition usually seen among starving children during African famines. At least that's what her hospital claimed in the bill it sent to Medicare, records show.

But Courtois, 64, says she wasn't treated for malnutrition during the five days she spent at Shasta Regional Medical Center after she was hurt in a fall. She's overweight, not emaciated, she said. And she said she never heard the word for the malady – a virulent illness with symptoms including emaciated arms, a distended belly and distinctive swelling of the feet or legs – until asked about it by a reporter.

Courtois talked with California Watch on her own terms and shared with California Watch the records she wanted to share. She either suffered from kwashiorkor or she did not. The records she shared with California Watch indicate that she did not. But Prime officials say otherwise, and - without asking Courtois - they shared more of her health records with the Redding Record Searchlight, which covers Shasta Regional. The Los Angeles Times' Michael Hiltzik reports:

The Record's editor, Silas Lyons, says two Shasta executives showed up at the newspaper with Courtois' medical chart. They were Randall Hempling, the hospital CEO, and Dr. Marcia McCampbell, its chief medical officer. They showed Courtois' chart to Lyons and proceeded to discuss it in detail, their goal being to prove that Courtois didn't accurately describe her experience to California Watch. Based on that discussion, Lyon says, the newspaper decided not to run the article.

Chalk up a win for Prime. But it was an ill-gotten win because Prime had no right to share those records. If you have done any reporting on patient care, you know how hard it is to get doctors or hospitals to talk about specific patients. They always cite the Health Insurance Portability and Accountability Act of 1996, known as HIPAA. Even when a patient has died, they cite the law. In most situations, a dead person has no right to privacy, but HIPAA extends beyond a person's death date. A hospital can't claim HIPAA blocks it from talking about patients in one case and then turn around and violate HIPAA when it wants to go on the attack.

Hiltzik writes:

Here's what state and federal laws have to say: A hospital can't disclose a patient's medical information publicly, such as to a newspaper, without the patient's written authorization. The authorization has to be very specific, designating exactly which records may be disclosed and to whom.

You might ask, "Was Prime right?"

Did Courtois suffer from this very rare malnutrition disorder? Do hundreds of people at Prime hospitals suffer from these disorders and, as Prime says, are they just not being properly diagnosed by physicians at other hospitals?

Just because a patient is overweight does not mean she could not have had a type of nutritional deficiency. As health writers know, people who are obese often aren't getting the right balance of foods in their diet and can suffer from all sorts of illnesses as a result, including diabetes and heart disease. John E. Morley and Dr. Andrew Jay Silver wrote in the Annals of Internal Medicine in 1995, "Protein energy undernutrition is endemic in nursing homes, with a prevalence ranging from 17% to 65%."

But kwashiorkor? This seems like a stretch. One of the main components of the disorder is severe weight loss, so it seems unlikely that an overweight patient, in particular, would have this problem. As the A.D.A.M. Medical Encyclopedia, used by the U.S. National Library of Medicine, explains, "Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods."

Hospitals and physicians should not use patient medical records to attack a patient's credibility or to intimidate a patient into silence. As Courtois' daughter told Hiltzik, her mom "was trying to do the right thing and stand up for Medicare Does that mean her life is an open book?"

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Slap: Talk With a Reporter, and Hospital Execs Will Expose Your Medical Records