Las Vegas Sun

July 21, 2019

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Preventing harm

Hospitals should be open about their performance and work to improve

It has been widely reported that the health care industry accounts for one-sixth of the nation’s economy, yet how much do people know about the quality of care they’re getting? If you buy a book, a cell phone or a car, you can find detailed reviews quite easily on the Internet.

But with health care, reliable information is much more difficult to come by. It shouldn’t be that way, but hospitals and the health care industry have fought attempts to make them more transparent.

For the past two years, Las Vegas Sun reporters Marshall Allen and Alex Richards have investigated the quality of care at Las Vegas hospitals. They analyzed 2.9 million inpatient records that hospitals send to the state to create a unique portrait of care that appears in today’s edition. Their reporting raises troubling concerns about “hospital-acquired conditions,” preventable injuries and life-threatening infections that patients can suffer in a hospital.

For example, they found that in 2008 and 2009 there were 969 cases of preventable injuries and infections in Las Vegas. Included were 21 cases in which a foreign object was left in a patient after surgery, 79 cases in which patients developed sores that hollow out the flesh and 248 cases of patient falls or other injury after surgery.

Some of the cases of harm are hospital horror stories about medical errors and neglect. In one instance, a surgeon removed what was thought to be a cancerous mass — it turned out to be the patient’s cancer-free kidney. In another instance, a patient who went in for heart surgery ended up with debilitating bedsores that go to the bone and are still healing two years later.

The Sun’s reporting is eye opening and is based on painstaking research. Hospitals have held the information close to the vest, and did not want to discuss it, complaining it would violate the federal law intended to protect patient privacy. But the information doesn’t violate the law — no names, birth dates or other personal information are in the data.

In 2007, lawmakers ordered the state to make the information available to the public. Hospital officials have tried to stop its release. One regulator said the hospitals suggested that making the information public could lead to a lawsuit against the state or could result in hospitals reporting fewer problems.

That lack of transparency is troubling, but it is common for the hospitals. Assembly Speaker Barbara Buckley, D-Las Vegas, has been an advocate for making information like this more accessible and said the hospitals “have been resistant to change every step of the way.”

Legislation requiring more hospital transparency passed during the 2002 special session over the objection of the hospitals. Lawmakers hoped it would push hospitals to improve care and drive down costly medical errors. The legislation created a state registry of “sentinel events” at hospitals, unexpected incidents in which a patient is seriously harmed or faces the risk of harm. Hospitals are supposed to report those events to the state.

In 2008 and 2009, hospitals reported 402 sentinel events statewide, but the Sun found 1,363 statewide incidents that fit the definition. The hospitals argue that many incidents the Sun identified don’t actually rise to the level of a “sentinel” event, instead calling them “adverse.” But that’s just a shameful game of semantics. Regardless of what they call these cases, hundreds of people still suffered some sort of injury or life-threatening infection at a hospital.

The release of such records is not only embarrassing for hospitals, it could be costly. Medicare has stopped paying for hospital-acquired conditions. Most insurance companies, however, still pay for them, but they may reconsider with a full understanding of the data. If there is pressure on hospitals to curb avoidable injuries and infections, that should reduce health care costs, which is good for patients and taxpayers.

Although curbing costs is important, patient safety is paramount and these data provide patients with a way to compare hospitals and make informed decisions.

“Do you have the right to know about the quality of care you’re receiving?” Buckley said. “I think you do. When you buy a car you can go to Consumer Reports. Isn’t someone’s life worth more than his car? I would think so.”

So do we. It is terrible to read stories of patients who enter a hospital for healing only to end up in worse shape, suffering from something preventable. This has to change.

Patients should have information about hospital quality before checking themselves in. The hospitals should stop trying to downplay the reality of the situation, and instead, the hospitals should study it and find ways to improve their care. And state regulators should make sure the hospitals are working to limit these preventable injuries and illnesses.

Hospitals aren’t supposed to make people sick.

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