Illinois Deserves the Truth

Doctor Bullies: Shape Up!

Hospitals must make really stressful workplaces.  Have you ever seen a doctor lose his or her temper, and wondered how it affects your safety?  Luckily, our largest hospital accreditation organization has, and it decided to take action.

Outbursts and condescending language threaten patient safety and increase the cost of care, according to a safety alert issued Wednesday by the Joint Commission, an independent organization that accredits most of the nation's hospitals.

Hospitals will be required by next year to have codes of conduct and processes for dealing with inappropriate behavior by staff, said the group's president, Dr. Mark Chassin. Hospitals without such systems risk losing their accreditation, he said.

Good for the Commission taking preventative measures against dangerous behavior.  Now, if only we could go a step further and do more to properly discipline doctors after they make errors!

Strong Reactions to Marion VA Mismanagement

Here's an update on the Marion VA medical center that was scourged by reports of poor care and abuse.  The VA just released another report on wrongdoing at the hospital, this one about poor management (the first one dealt with actual medical care).  As The Southern reports, Illinois' federal lawmakers are sounding off.

Democratic Sens. Dick Durbin of Springfield and Barack Obama of Chicago made a joint statement.

"This new report from the VA confirms many of our suspicions about the problem that existed at the Marion VA Medical Center," they said. "The report paints a disturbing picture - a management culture that compounded problems at the facility; management at the regional level that did not serve as a quality check on the Marion facility; and no way for employees to complain or make meaningful suggestions about problems when they arose."

The senators said, "Our veterans and their families have made incredible sacrifices for this country, and when they return home, we owe them access to the best health care. Today's report proves that this was not the case at the VA medical facility in Marion."

People are rightly suspicious of how serious legislators are about seeing improvements and holding people accountable.  Like this reader, who recently commented on one of our posts.  Illinois congressional delegates meet with the Secretary of Veterans Affairs this week, so we shall see what comes of it.  In the meantime, we can hope that the widows of victims, who are seeking redress through the civil justice system, force accountability themselves.

Thanks to John Homan for helpful correspondence

The cost of infection

Medical mistakes of any kind are tragic, but they are most frightening when the victim is an innocent child.  A new study from this month's issue of the journal Pediatrics looks at quality of care at children's hospitals.  Researchers studied 38 children's hospitals nationwide and estimated the cost of extended stays caused by infections and other preventable complications.  Among the findings:

• Of the 430,000 children in the study, more than 6,600 suffered complications caused by their care.
• Some complications occurred in up to 4 percent of children treated.
• Children are three times more susceptible to infections in hospitals compared with adults.
• Eliminating infections due to medical care would save over $700 million each year.

See the actual report from Pediatrics or click here to read the Post-Dispatch's article on it.

Hospitals are catching on to full disclosure

Last week we wrote about a hospital program at the University of Illinois Medical Center of full disclosure in reporting physician errors.  This isn’t the only place with such a policy.  The NY Times yesterday ran a story about how full disclosure programs have been successful all over the country.  These programs encourage physicians to admit fault and apologize when they make mistakes.  Hospitals then compensate the patient so they don't have to worry about fighting a lawsuit.  It works, and look no further than the program here in IL for proof.

The number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago, said Dr. Timothy B. McDonald, the hospital’s chief safety and risk officer. In the 37 cases where the hospital acknowledged a preventable error and apologized, only one patient has filed suit. Only six settlements have exceeded the hospital’s medical and related expenses.

The program in Michigan that inspired McDonald has also been successful.

At the University of Michigan Health System, one of the first to experiment with full disclosure, existing claims and lawsuits dropped to 83 in August 2007 from 262 in August 2001

Patients deserve this kind of honesty and fairness in their medical care.  Many victims of malpractice each year don't file a lawsuit and never get any compensation.  If this is something hospitals care about, we should see more of these programs.  Plus, they have shown to decrease malpractice claims, so they're good for everyone!

Loyola medical liability conference

Last week we went to a Loyola sponsored conference on “Medical Liability and the Illinois Civil Justice System”.  Speakers were lined up to talk about various topics, some tired (no-fault insurance schemes), some fresh (full disclosure malpractice programs).

CJ&D’s Executive Director Joanne Doroshow was asked to talk about “health courts,” which are basically administrative panels designed to replace civil courts as a way of settling malpractice claims.  “Tort reformers” like to think they would speed up the settlement and payment process, but really they are a terrible idea. The health care industry would be the "experts" that the administrative panel would have to turn to, so the courts would almost always favor corporate interests over injured victims. In any case, health courts don’t have much support, since they are impractical and unconstitutional (read the CJ&D report "Why Health Courts are Unconstitutional" for more).

I thought the most interesting topic discussed was full disclosure programs for reporting physician errors at hospitals.  Tim McDonald, the chief safety officer at the University of Illinois Medical Center Chicago, talked about how the full disclosure program he installed has resulted in across-the-board improvements in areas like quality of care and speedy malpractice payouts.  I was pleased that the first statement out of his mouth was that he was not in favor of tort reform and never will be.  He went on to talk about how much of a struggle it was to implement his philosophy at the medical center.  For example, he told a story about how in interviewing defense firms, he opened with this hypothetical situation: a man undergoes surgery to have a leg removed, but doctors mistakenly amputate the wrong limb.  There is no question the hospital is at fault.  What would you advise?, he asked them.  13 out of 16 firms interviewed advised the hospital to deny fault anyway.

His talk was the most popular of the day, which was surprising since much of the crowd came from the health care industry or from defense firms.  Hopefully this is a sign that more hospitals are open to exploring ways of improving patient safety and increasing accountability, instead of just toeing the insurance company line of avoiding payouts by denying fault at all costs.

When is a nonprofit worried about profits?

No this isn't a trick question.  What I am talking about are nonprofit hospitals.  Today the Chicago Tribune featured an informative piece about "nonprofit" hospitals.  (An interesting side note this article comes days after the Wall Street Journal also featured an article about this issue on Friday, April 4, 2008.)  The battle concerns what percentage of charity should a nonprofit hospital have to do for their community. 

While many may say that this isn't a big problem, until you consider that over 60 percent of hospitals in the United States are nonprofit hospitals.  Also, according to the American Hospital Directory (AHD),

[Nonprofits hospitals] are faring even better than their for-profit counterparts: 77% of the 2,033 U.S. nonprofit hospitals are in the black, while just 61% of for-profit hospitals are profitable...

What this boils down to is: Who is really hurt by all of this?  Consider the example of SSM Healthcare, a Catholic-run organization that operates 20 hospitals and makes a  profit, partly because it has tax-exempt status, is closing St. Francis hospital in Blue Island because it is too much of a financial drain on its profits. This is not just an Illinois problem.

"Not-for-profit systems all around the country are closing unprofitable inner-city hospitals while building Taj Majals in wealthy white suburbs," said Joe Novak, a hospital critic who regularly raps the non-profit industry on his blog, WhereTheMoneyGoes.com. "Systems like SSM argue this hospital or that one is losing money—we have to shut it. Carry that logic out and the argument becomes not-for-profit systems only want to operate hospitals that make a profit."

This means that hospitals that were truly established for the good of the less wealthy communities have a shortage of charitable healthcare institutions, while many fully insured have plenty.    

The Trib article reports that this growing concern is gaining national attention,

A proposal by Sen. Charles Grassley (R- Iowa) would require that non-profit hospitals spend at least 5 percent of their budgets on charity care. Analysts say many U.S. hospital operators ... would not meet that target, based on criteria provided by Grassley. Hospitals falling short would lose federal tax exemptions.

In Illinois, Lisa Madigan would like to see similar legislation.  She "is pushing for ways to require hospitals to provide a specific percentage of revenue as charity care, or information on the discounts hospitals provide for some patients." 

To give you an example Northwestern Memorial Hospital, the largest hospital in Chicago, spent less than two percent ($241.8 million) of its annual revenue ($1.3 billion) in 2007 and a fraction of what they received in tax breaks.  And if this doesn't seem that odd then add on the $16.4 million payout their former CEO received in 2006.  (I obviously am working for the wrong nonprofit.) Under the proposed federal legislation Northwestern would lose it's tax benefits, totally more than $50 million (not including the tax benefits it receives on its investments.)

All of this makes me wonder if the millions of dollars in tax breaks going to these hospitals would be better going into resources to fund universal healthcare plans.  (Of course hospitals typically are against this type of legislation.)

How bad are our hospitals?

As you may have remembered a little while ago we blogged about the failure of the Illinois Hospital Report Card.  The law was supposed to give consumers an easy to use system to get information about how safe and well run Illinois' hospitals are, a great idea that fell far short of its potential.

Well Forbes Magazine has just published an investigative report into the safety of America's hospitals.  One of the most disturbing passages states that:

One in 200 patients who spends a night or more in a hospital will die from medical error. One in 16 will pick up an infection. Deaths from preventable hospital infections each year exceed 100,000, more than those from AIDS, breast cancer and auto accidents combined. (emphasis added)

WOW! I must say that these statistics are mind boggling, especially when some claim that we have the best healthcare system in the world.  Let me forewarn you, this report does not paint a pretty picture of some U.S. hospitals.

Hopefully, Springfield can get their act together and get the Report Card up and running, so Illinoisans can make better decisions when choosing their hospitals.  (If indeed patients actually have a choice of where they end up.)

Knowledge equals power.