Sunday, Nov. 28, 2010 | 2 a.m.
An investigation by the Sun has identified thousands of cases of patients having suffered preventable harm in Las Vegas hospitals. To better understand why these incidents occur and what should be done to address them, the Sun sat down with three people who have something to say about hospital care:
• Kathy Silver, CEO of University Medical Center, Clark County’s only public hospital.
• State Sen. Shirley Breeden (D-Henderson). Her father was infected with a deadly bacteria in a local hospital and she has sponsored legislation to require public reporting of hospital-acquired infections.
• Dr. Mitchell Forman, President of the Clark County Medical Society and dean of Touro University Nevada College of Osteopathic Medicine.
The Sun presented to them a series of statements and asked if they agreed or disagreed. These excerpts were edited for clarity.
Patients should be concerned about their safety in Las Vegas hospitals.
Things do happen in hospitals; however, I think there are far more good things that happen in hospitals than not-so-good things. So I don’t think as an overall general statement that would be true.
My father was hospitalized and acquired MRSA — a drug-resistant bacteria — and has consistently gone downhill. Within the last month he has been hospitalized twice. I believe that people need to be educated on what they can do to help while their loved one is in the hospital.
I would temper it by saying patients who are ill enough to be admitted to a hospital have a serious underlying medical problem. The hospital is a technical place for many patients who don’t know much about it, so being concerned about your health care and what will take place is different from being fearful of it. And I think fearing going to the hospital may not be the best thing.
The federal government reported last week that about 1 in 4 Medicare patients suffer some type of harm while in the hospital. About half of those cases are preventable, according to the inspector general for the Health and Human Services Department. This report shows hospitals have lost control of their ability to keep patients safe.
The hospitals can control certain things, and there are certain things that are human in nature that we can’t 100 percent control. I think if it was truly out of control, the hospitals wouldn’t be attempting to do some of the things they are doing in terms of quality and performance improvement.
I don’t think they’ve lost control. I think they’re not seeing the big picture or understanding that citizens have total trust in them when we come to hospitals to be cared for. Now that the information is out as far as how many hospital injuries have occurred, we all want things done quickly but what I’ve seen is that folks in the health care community were having pushback, and I don’t understand that.
I don’t think hospitals have lost control. Medicine and health care are not an exact science. It is technical and not always controllable. Many things are controllable and preventable, but things happen: People make mistakes, doctors make mistakes, hospital employees make mistakes, medical boards make mistakes. These are national figures and they don’t necessarily reflect what’s taking place here in Nevada.
In the upcoming legislative session, Nevada lawmakers must impose more transparency on hospitals and doctors.
We’re already transparent internally but I think we’re not as transparent with the public as the Legislature would like us to be. Arguably some measures are meaningful to us internally and less meaningful to the public. So to put a lot of emphasis and effort into reporting a lot of data that may or may not have any real benefit to the public, perhaps doesn’t do anyone any good. I would like to see us, as an industry, just agree that certain metrics would be useful to report. They may be humbling at first, but they’ll be useful.
We should have more transparency and along with that, educating the consumer, as well. I will be bringing legislation to improve transparency and also to educate the consumers.
Transparency presents data and facts that could be difficult to understand. When you talk about MRSA, how many people really understand what that means? It exists out there all the time. In the hospital, it goes to another level in terms of infection. In ads in the paper another hospital talks about LVDS, they talk about ARBS. This is the stuff they present as transparency. But what does it mean to the public? Transparency without education is not only meaningless, but potentially very harmful ... I really think the operative word is not so much transparency, but it’s enforcement of existing guidelines, laws, statutes, processes that are in place.
Legislators should mandate staffing levels in hospitals.
That happened in California and it has been devastating to a lot of hospitals. Mandated staffing ratios work if you have a supply of nurses who you can dependably count on who’ll be there to staff your hospital. What you find, though, if you mandate staffing ratios and you don’t have enough nurses to cover those ratios, you close beds and then you create unsafe consequences as a result. I would agree with the senator in that we ask our caregivers to take on too much.
I believe we need to revisit staffing formulas. People, when they’re stressed and busy, take shortcuts, and everybody does because you have a zillion things to complete. So we need to be cognizant of the staff that’s in the hospital working because they’re the ones who are in the trenches and they’re the folks who we need to talk to.
Forman: Did not answer
Doctors and hospitals are failing to police themselves.
It’s not always easy to police somebody who you have no ability to control. Where it gets complicated is where you talk about policing physicians. If you move down the path of discipline, it has all kinds of consequences for that physician, career-wise, obviously financially, and so it’s not something hospitals and physicians take lightly, and we do have to ensure that all the proper steps are taken to ensure due process.
I believe due process is very important. However, it’s important in any person’s position, whether they’re a physician or nurse. If they’re not meeting the expectations and completing their duties in the correct way then, unfortunately, they need to be disciplined.
We need to be held to a very high standard, because patients’ lives are a stake. I need to be responsible. I need to be my brother’s keeper. And if I see something of concern regarding ethics, legal matters or malpractice, I need to feel I have the ability to bring it forward without personal issues coming back to me. That’s something we need to do a better job of, to police our own profession. And I think the medical boards need to follow their charge.
There is reason to hope that Las Vegas hospitals will improve.
All of us are going to strive to have the safest and highest quality of care in the city. So I think there’s some peer pressure, not to mention incentives and disincentives associated with certain programs. There will be opportunities for hospitals to improve their financial performance if they can meet these goals and conversely, we’re going to hurt ourselves if we can’t, because we will be punished by Medicare and possibly singled out by the commercial players.
Hospitals and health care facilities do strive to take care of their patients. Now that the community is more aware of what’s going on, I think that it’s a top priority and folks will realize this issue is not going away. Some who go to the hospital are more aware now and they are asking questions, so I believe things will get better.
They will get better for a variety of reasons. One is the very fact we’re talking about these things right now and they’re out in the open. People are going to be asking questions. Legislators are going to be looking at this. Plus, it’s a business and you do whatever you can for your bottom line. For hospitals, that means taking the very best care that you can of your patients and preventing mistakes that can be prevented.
The conversation was transcribed by the Sun’s Nadine Guy.