December 3, 2018
Hospitals are on a desperate run to improve their bottom lines as they compete with the ever-encroaching medical “shops” being opened by major new players in the healthcare game. First, it was small shops for immediate medical attention for coughs, cuts or similar problems. These have now been aligned in corporations that include chain-store pharmacies and insurance companies. The burgeoning number of offsite surgical and imaging sites had already made inroads into lucrative hospital procedures.
Seeking yet more control over profitability and patient loads, hospitals across the country have been buying up medical practices. The result of this is not only increased cost to the patient and insurance companies but a hold on where patients can seek treatment without going to a hospital-affiliated practice. It should be noted that Medicare has played a role in this practice by way of its reimbursements. Hospitals are paid at a higher rate than medical practitioners. For example, a recent blood panel for a diabetic patient outpatient hospital charge was $1600 while the same diagnostic was just over $200 in a private physician’s office.
Has this rush to compete resulted in cutbacks on staffing, lack of oversight into sanitation and infection control and an overall quality-control issue? A disturbing number of instances of problems found in JCAHO inspections is now rising to the attention of the media. And the media is writing about it.
A recent investigation by WebMD and Georgia Health News found disturbing instances of inadequate care. One patient, desperate for assistance, went to the local ER where he found almost no staff. Waiting proved no benefit as he received no attention and his family called 911 for an ambulance to take him to another ER. He was told that ambulances don’t pick up patients at hospitals for transfer to another hospital and they should take him out to his vehicle in the parking lot where the ambulance could pick him up. The scenario went downhill from there and the man ultimately died at that same hospital where the 911 ambulance crew had taken him via a special ambulance entrance not used by walk-in patients.
Further, a report indicated, according to the investigation, that the hospital “failed to follow standards of care established by the Federal Emergency Medical Treatment and Labor Act, or EMTALA.” Additionally, the investigation found that although “…EMTALA has been on the books for more than 30 years, hospitals are still violating it hundreds of times a year, sometimes with devastating results for patients.” Altogether over 4300 violations at just over 1600 hospitals were noted in the records made available by a Freedom of Information request.
The reader has to wonder if these are only small, regional hospitals or whether major hospitals are also violating this act. AXIOS has discovered the problem is much wider spread than being confined to small hospitals and those with major reputations at stake are sited.
Baylor St. Luke’s Medical Center in Texas, with a reputation as being first in the nation in lung and liver transplants, was deficient. ProPublica noted, “Of 85 patients who received a liver transplant at St. Luke’s in 2017, at least 15 have died within a year, up from previous years and worse than the national average.”
Another article in The Tampa Bay Times described disturbing treatment instances at the Johns Hopkins All Children’s Hospital. The world-renowned Johns Hopkins had taken over a hospital with the intention of turning it around into a premier facility for children. Instead, the reverse appeared to happen, according to the newspaper article. “Nearly one in 10 patients died last year. The mortality rate, suddenly the highest in Florida, had tripled since 2015.” The description of distraught nurses can only provide a glimpse into the disastrous circumstances.
A trip to a local hospital, which is growing at a fast clip, didn’t show up anything supporting the circumstances laid out in the articles, but other indications were evident. Previously, water fountains there had to be shut off and cradled in yellow tape because of water contamination. The water had been used to prepare infant formula and families had to be alerted to the danger. Dust bunnies were under equipment, sterile tubing in the ER was in plastic bags which were pierced to hang them on hooks, violating the sterility. One had to wonder what wasn’t evident.
At another major hospital in a major US city, a patient implored an x-ray tech not to take more than the two-ordered views because she had had excessive x-ray exposure. She feared for her health. The tech went ahead and took four views indicating that she couldn’t get good views on the first two. Was it poor procedure, inadequate training, inferior equipment or hospital reimbursement here?
A well-respected physician at another major hospital ordered a series of tests. When the test results were returned and the patient received a copy, the patient asked what one of the tests meant. The physician didn’t know and said she hadn’t ordered it. The order form clearly indicated she had. In fact, if the test were to be performed, it was not properly collected in a specific type of container and was, therefore, even if ordered, clearly useless.
Giving the wrong medications should have been resolved with the use of automated hospital pharmacies, but that’s not the case. Vanderbilt Hospitalwas cited for a death related to the wrong medications provided to a patient. One patient, in another hospital, saw a nurse crush a med and put it in applesauce to administer to the patient. The information material supplied with the medication is clear that it should never be crushed. When the patient indicated the pill should not be crushed, the male nurse told her to go ahead and take the medication anyway. Clearly, the patient’s concerns here, too, were disregarded.
The seriousness of the subject is clear when even a casual conversation at a supermarket turns to the state of medical care today. One woman told another, “That hospital killed my father and the other one (in the same area) killed my mother.” Perhaps not entirely correct, but certainly demonstrative of how hospitals are increasingly being viewed negatively.
When medical check-ups in physicians’ offices are increasingly being limited to 15–20 minutes, how thorough can an exam be? How much dialogue is possible between provider and patient? How many questions can be adequately addressed?
As consumers, we are always told to abide by the “caveat emptor” imperative (buyer beware) and now it seems that must be applied to hospitals and physicians’ offices, too.