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May 5, 2015

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Do No Harm: Hospital Care in Las Vegas:

You can’t kill my mother and get away with it’

Do No Harm: Brian Greenspun

Sun Publisher and Editor Brian Greenspun talks about the findings of the newspaper's series on hospital care. To address the problems raised by the series will require a change in attitude from executive suites down, including more openness with patients and a commitment to do no harm.

Portraits of Harm

Gabrielle Johnson, 17, who suffered from the genetic disorder Friedriech's ataxia, was revived at a local hospital after suffering cardiac arrest, and then taken to another local hospital with a trauma unit in October 2009. There, Gabrielle's mother, Iris, believes she was unnecessarily sedated because her only method of communicating, kicking her legs, was misinterpreted as combativeness. The teenager never woke up and died nine days later. Seen is her mother, Iris Johnson, and brother, Dominic Johnson, 10. Launch slideshow »

AUSTIN, Texas — This is an insurgency no one wanted to join.

The patient safety advocates who gathered last month for their annual strategy session were drafted by tragedy — a botched surgery, a preventable infection or some other hospital incident that launched them into battle to protect others from suffering harm when they seek healing.

If America’s patient safety movement has a war room, this is it. The annual Safe Patient Summit organized by the nonprofit Consumers Union is where activists plot strategy toward their goal: nothing less than the reformation of America’s health care culture.

There’s Patty Skolnik, whose son died after suffering brain damage because of surgical errors. A Colorado law named in his honor gives patients access to important quality information about doctors.

There’s Pat Mastors, who after losing her father to a hospital-acquired infection, lobbied successfully for patient safety laws in Rhode Island.

There’s Mary Brennan-Taylor of Buffalo, N.Y., who lost her mother, Alice Brennan, to three hospital-acquired infections.

“We’ve got a long fight, but I’m not going to give up, and I know you’re not going to give up,” she told the group of about 30 activists. “You can’t kill my mother and get away with it.”

The group is united through common experience and goals, but lacking a centralized authority to direct and organize its work. Hence, the need to gather and exchange notes. One session in the two-day summit included brainstorming about effective strategies and possible leverage points for reform.

It’s difficult to pinpoint when the patient safety movement began. But it was vaulted into the national spotlight in 1999 when the Institute of Medicine released a report, “To Err Is Human,” finding that as many as 98,000 people a year die in hospitals as a result of preventable medical errors.

The problem may be getting worse. A November report by the federal government estimated that nationwide 15,000 Medicare patients die every month as a result of being harmed in hospitals.

The Las Vegas Sun over the past six months has reported extensively on injuries and deaths in Southern Nevada hospitals, including 3,689 cases of preventable patient harm identified in billing records in 2008 and 2009.

“There’s no shortage of new victims,” said Helen Haskell of South Carolina, whose 15-year-old son, Lewis, died in 2000, four days after a minimally invasive cosmetic procedure.

Haskell, president of Mothers Against Medical Error and director of the Empowered Patient Coalition, said the movement is growing but has not yet had any noticeable effect in reducing the number of patients harmed while hospitalized.

Reform is slow in coming because hospitals and doctors are not directly accountable — financially — to patients and provide little transparency, said Haskell, who was named one of the “100 Most Powerful People in Healthcare” in 2009 by Modern Healthcare magazine.

“The customer doesn’t pay directly, and they (hospitals and doctors) keep everything to do with price and quality secret,” she said.

John James, a Houston toxicologist, lost his son in 2002 when cardiologists failed to diagnose — even though he was an avid summer runner — his levels of the electrolytes potassium and magnesium were dangerously low. James said hospital patients need a bill of rights. He proposes it require:

• Showing patients their records on a daily basis. “Medical records are a playground for doctors,” James said. “You should have a right to see them every day and see that they reflect what took place.”

• Informing patients about the competency of their physicians, including whether they are board certified or have been in drug rehab.

• That doctors use methods backed by medical research and administer medications only for Food and Drug Administration-approved purposes.

• Informing patients and getting their permission to perform surgeries in ways that clearly explain risks and do not use fear to manipulate decisions.

Compared with the wealth of the nation’s hospital industry, activists have negligible resources. What they do have, and what they say is hard to dispute, is a righteous pursuit of justice that’s fueled by pain.

John Torello of the Connecticut Center for Patient Safety stood at the front of the room during one work session, holding his laptop for an impromptu screening of a home movie of his twin 4-year-old boys, Michael and Matthew.

When Michael was born he had jaundice that went untreated despite the Torellos’ pleas to doctors and nurses. Jaundice is easily cured by placing a baby under special lights.

As a result, Michael suffers from kernicterus — severe brain damage that makes it impossible for him to control motor functions.

In the video, Michael sits in a chair, barely able to respond to his mother’s voice and unable to control his muscles, while Matthew chatters and bounds about the kitchen like a typical boy.

The Torellos have worked with the hospital to produce a video stressing the importance of patient safety to medical residents, new employees, students and staff.

“They have their lobbyists and all their money, but you have your story,” Torello told the group. “Those stories are really what get people moving.”

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  1. This is an all too familiar story, especially for hospitals in Las Vegas, NV. My mother acquired 3 strep infections after a surgery, and the hospital was indifferent and absolutely defensive. They claimed this was not their fault. The aftercare at home cost thousands of dollars, and the hospital told us in essence, too bad. Your problem. The first tenet of medical care is 'first do no harm'. The hospital and doctors were all pointing fingers, and accepted no responsibility. Thankfully, after three months of antibiotic infusions at home, the infection cleared. But the hospital and doctors accepted no responsibility. If hospitals and doctors want to command the fees that they do, there needs to be some level of acceptance of wrong doing. It's interesting that a doctors parking lot is chock-full of expensive cars, yet they claim poverty. Hospitals charge absurd fees to insured patients, yet accept no responsibility for their actions. The days of the heavy handed medical establishment acting high and mighty is coming to an end, thankfully. Paying a kings ransom for medical care needs to be consistent with responsibility for ones actions. That includes both hospitals and doctors accepting responsibility for a sterile environment. It's absurd to contract an infection in a hospital; they can control the environment. Las Vegas hospitals are notorious for infectious disease. Nonsense to the hospitals and doctors that purport this is beyond their control.

  2. How about staffing?? 30 years ago the nurse was responsible for the care of the patient now its all about the money!! Insurance companies dictate your care you rarely get whats recommended. It's all about numbers do it faster nobody cares about DO IT RIGHT. not to mention the caliber of staffing a warm body will do knowledge is not neccessary, and there are no rewards for knowledge you don't get placement according to your skill level even if thats your desire. how could any pediatric or nicu nurse possibly miss the jaundice mentioned in the story above? That would be basic assessment 101! the doctor too are you kidding me? This is exactly what our "system" has evolved to, maybe she didn't even get the time to assass the baby REALLY assess the baby. We are to busy trying to make up for all the non paying individuals with all their civil rights just to keep these places open, If you have private insurance you will get inferior care.

  3. Dear MPTLasVegasSun:

    As a physician in the community, I must say I felt quite distressed at your lack of understanding and disrespect of how medicine works.
    From what you write, I don't think it was anyone's fault that your mother acquired an infection in the hospital. Infections are known risk factors for surgery. Everyone having surgery can acquire an infection. Every patient signs a consent form which outlines this. So why is this surprising to you that it happened?
    Second, I have been driving the same car for 10 years due to student loans. I doubt you have been driving the same car for 10 years also. This is after going to school for 11 years with no income and sacrificing my youth for the cause to serve patients. My friends from college who are in business who did much less schooling and have much less student debt are making the "kings ransom" that you speak of; last I checked it is not a crime to try to be middle class and make a living in this country and support a family.
    Also, doctor's can bill what they want, but it is the insurance companies that decide what is paid! Often, the reimbursement is much less than what one should be reimbursed for the level of education.

  4. Good series, a little more focus on insurance companies and medical device suppliers might be a good idea.

  5. Surely the insurance companies are culpable for the state of affairs. As for schooling and student loans, it's a hollow argument. No one forces anyone to go to medical school. Many qualified applicants to medical schools are rejected because the market artificially limits the number of doctors. Rather than having insurance companies dictate reasonable rates, perhaps a market solution would help to reduce costs by offering real competition for services. Train more doctors and let the market flourish. As for acquired infections, I disagree that the hospital is not responsible for doing further harm to patients. A consent form is always signed under duress, and is a legal tactic. What choice does a patient lying on a bed have but to agree to give up their rights, and just hope nothing bad happens? If ones doesn't agree to consent, then no surgery? That's coercion. Albeit very costly and difficult to control infectious disease, hospitals can do a much better job than they do. They devil may care attitude about nobody's fault is alarming.

    I don't mean to castigate doctors ability to earn a decent living, but over the past 30 years, a license to practice medicine far exceeds any definition of a middle class income. It's only of late that many doctors are making a middle class income, and feel robbed they don't have the lavish lifestyle they desired. Drug companies share some blame, and of course insurance companies focused solely on profit. The profit motive of insurance is incompatible with proper care.

    The medical market needs to rationalize costs and salary potential. The amount of schooling has a very loose correlation with ones income. If that were the case, professors and teachers would be among the most highly paid professions in our society. Entering a profession is not a money machine, but an honorable vocation with a modest income.

    In the end, no matter how much money is changing hands, the hospitals must find a way to secure the environment. A consent form just doesn't cut it. Difficult problems cannot be solved through signing away ones rights. I'm alarmed at this perspective, and speaks volumes to why hospitals are under such scrutiny.

  6. Dr. "Bluecloudvegas" comment explains a lot about what is wrong and why patients get infections. His attitude is appalling.

    He said:
    "As a physician in the community, I must say I felt quite distressed at your lack of understanding and disrespect of how medicine works.
    From what you write, I don't think it was anyone's fault that your mother acquired an infection in the hospital. Infections are known risk factors for surgery. Everyone having surgery can acquire an infection. Every patient signs a consent form which outlines this. So why is this surprising to you that it happened?"

    The reality is that infection rates can be brought down to practically zero if physicians and other health care workers follow well known and accepted procedures. Indeed, infection rates have been reduced to near zero in some hospitals.

    But it is easier for physicians and other health care workers who don't really care to fail to always follow the procedures to prevent infections, and instead just say infections are a known and apparently acceptable risk.

    The erroneous idea that infections are inevitable and acceptable would never be put forth by an informed and caring physician. Dr. "Bluecloudvegas" needs to reconsider his attitude and how he cares for his patients.

  7. To MTP and woodsidepark:
    Certainly preventing infections is a goal that everyone aspires to. I certainly would hope that no patient undergoing surgery would develop an infection. Even under perfect conditions and following all procedures, it just isn't possible to prevent all infections. Bacteria, especially resistant bacteria, are hardy creatures. A good example of this would be Methicillin Resistant Staph aureus: once colonized in a hospital, it is very difficult if not impossible to eradicate it.
    Consent forms are not signed under duress, especially when the surgeries are elective.
    Anyways, I don't really care to continue this conversation. So to MPT and woodside park bob, good luck with your endeavors and your goals of decreasing hospital infection rates. Please do not include me in any further conversations as I will not be reading these comments from this point onwards.

  8. Thank you for the voice of reason woodsideparkbob. Dr. Bluecloudvegas exemplifies everything that is wrong with medicine, and the sorry state of medicine in LV. His attitude of don't question me, I'm the doctor, is appalling and outdated. Consent forms not signed under duress? Is he a joker? How would someone lying on a gurney with a condition such as appendicitis or gall bladder condition which surgery is the only option, not be under duress to agree to sign a consent form? As I said before, if one doesn't sign the form, then no surgery. Most surgery is not elective, but life saving. This is a typical example of doctors acting high and mighty and refusing to be questioned. Fortunately, those days are numbered. I find it amusing he folded like a playground bully. His logic would spell doom for any other industry. Imagine car companies saying that driving is inherently dangerous, therefore we have no responsibility to build in safety features into our cars. So long seatbelts, antilock brakes, crumple zones, and on and on.

    I think enough said on this topic. Clearly, hospitals and doctors are responsible for keeping the environments sterile. If you can't do it, step aside, and let someone else do the job. It can be done.

  9. My grandma went in with a stomach ache, got drugged with morphine, had bruises all on her arms, and wound up some how slipping and falling causing a broken hip (of course no camera in that room). From that point on she never recovered and past away in this Cess Pool of a city.

    Its to hard to sue hospitals and hospice, but we do have photos of everything.

    This city is just a failure in every way imaginable. There are much better cities where you'll be a lot more valued and enjoy your life a lot better.

    Vegas is a place people come to vomit, nothing more. Please do not raise a family here.