Daily Chart Notes

Study Finds No Progress in Safety at Hospitals

2010-11-29T20:38:00.000-08:00

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

“It is unlikely that other regions of the country have fared better,” said Dr. Christopher P. Landrigan, the lead author of the study and an assistant professor at Harvard Medical School. The study is being published on Thursday in The New England Journal of Medicine.

It is one of the most rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States. That report, by the Institute of Medicine, an independent group that advises the government on health matters, led to a national movement to reduce errors and make hospital stays less hazardous to patients’ health.

Among the preventable problems that Dr. Landrigan’s team identified were severe bleeding during an operation, serious breathing trouble caused by a procedure that was performed incorrectly, a fall that dislocated a patient’s hip and damaged a nerve, and vaginal cuts caused by a vacuum device used to help deliver a baby.

Dr. Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.

But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.

The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.

“Until there is a more coordinated effort to implement those strategies proven beneficial, I think that progress in patient safety will be very slow,” he said.

An expert on hospital safety who was not associated with the study said the findings were a warning for the patient-safety movement. “We need to do more, and to do it more quickly,” said the expert, Dr. Robert M. Wachter, the chief of hospital medicine at the University of California, San Francisco.

A recent government report found similar results, saying that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths. That report, issued this month by the inspector general of the Department of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals.

Dr. Landrigan’s study reviewed the records of 2,341 patients admitted to 10 hospitals — in both urban and rural areas and involving large and small medical centers. (The hospitals were not named.) The researchers used a “trigger tool,” a list of 54 red flags that indicated something could have gone wrong. They included drugs used only to reverse an overdose, the presence of bedsores or the patient’s readmission to the hospital within 30 days.

The researchers found 588 instances in which a patient was harmed by medical care, or 25.1 injuries per 100 admissions.

Not all the problems were serious. Most were temporary and treatable, like a bout with severe low blood sugar from receiving too much insulin or a urinary infection caused by a catheter. But 42.7 percent of them required extra time in the hospital for treatment of problems like an infected surgical incision.

In 2.9 percent of the cases, patients suffered a permanent injury — brain damage from a stroke that could have been prevented after an operation, for example. A little more than 8 percent of the problems were life-threatening, like severe bleeding during surgery. And 2.4 percent of them caused or contributed to a patient’s death — like bleeding and organ failure after surgery.

Medication errors caused problems in 162 cases. Computerized systems for ordering drugs can cut such mistakes by up to 80 percent, Dr. Landrigan said. But only 17 percent of hospitals have such systems.

For the most part, the reporting of medical errors or harm to patients is voluntary, and that “vastly underestimates the frequency of errors and injuries that occur,” Dr. Landrigan said.

“We need a monitoring system that is mandatory,” he said. “There has to be some mechanism for federal-level reporting, where hospitals across the country are held to it.”

Dr. Mark R. Chassin, president of the Joint Commission, which accredits hospitals, cautioned that the study was limited by its list of “triggers.” If a hospital had performed a completely unnecessary operation, but had done it well, the study would not have uncovered it, he said. Similarly, he said, the study would not have found areas where many hospitals have made progress, such as in making sure that patients who had heart attacks or heart failure were sent home with the right medicines.

The bottom line, he said, “is that preventable complications are way too frequent in American health care, and “it’s not a problem we’re going to get rid of in six months or a year.”

Dr. Wachter said the study made clear the difficulty in improving patients’ safety.

“Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.”

Leah Binder, the chief executive officer of the Leapfrog Group, a patient safety organization whose members include large employers trying to improve health care, said it was essential that hospitals be more open about reporting problems.

“What we know works in a general sense is a competitive open market where consumers can compare providers and services,” she said. “Right now you ought to be able to know the infection rate of every hospital in your community.”

For hospitals with poor scores, there should be consequences, Ms. Binder said: “And the consequences need to be the feet of the American public.”

State Officials Fine 12 Hospitals for Major Patient Safety Issues

2010-11-24T23:24:00.000-08:00

On Friday, the California Department of Public Health announced fines levied on 12 hospitals for serious medical errors that sometimes led to patient injuries or death, the Los Angeles Times reports (Hennessy-Fiske, Los Angeles Times, 11/13).

The department issued 14 penalties totaling $575,000 (Clark, HealthLeaders Media, 11/15).

Background

Under a 2006 state law, hospitals must notify state regulators of all significant patient injuries.

For incidents occurring prior to 2009, the state issued $25,000 fines for each violation. Starting in January 2009, the sanctions increased to $50,000 for a hospital's first violation, $75,000 for its second and $100,000 for its third and subsequent violations (California Healthline, 5/21).

Since the law took effect, state regulators have issued 170 fines totaling $4.8 million against 112 hospitals. Hospitals are appealing 39 of those fines.

Latest Penalties

The 12 hospitals targeted in the latest round of penalties are:

California Pacific Medical Center in San Francisco, which received one $50,000 fine and one $75,000 fine;
Citrus Valley Medical Center in Covina, which received one $25,000 fine;
Hanford Community Medical Center, which received one $25,000 fine;
Kindred Hospital in Westminster, which received one $25,000 fine;
Palomar Medical Center in Escondido, which received one $50,000 fine;
Petaluma Valley Hospital, which received one $50,000 fine;
Placentia Linda Hospital, which received one $25,000 fine;
Scripps Memorial Hospital in La Jolla, which received one $50,000 fine;
Southwest Healthcare System in Riverside County, which received one $25,000 fine;
UC-San Francisco Medical Center, which received two $25,000 fines;
USC University Hospital in Los Angeles, which received one $50,000 fine; and
Western Medical Center in Santa Ana, which received one $75,000 fine (HealthLeaders Media, 11/15).

DPH requires all penalized facilities to submit plans to correct the patient safety issues. Hospitals also can appeal the fines (Los Angeles Times, 11/13).

Funds collected from the penalties are set aside for projects to improve patient safety (HealthLeaders Media, 11/15).

State Health Regulators Urge Some Hospitals To Recheck Error Reporting

2010-11-24T23:05:00.000-08:00

California health officials are urging 87 hospitals that have not reported a serious medical error in more than three years to recheck their records, the Ventura County Star reports.

A state law that took effect in 2007 requires hospitals to report any of 28 designated adverse medical events.

In October, state Department of Public Health officials sent notifications to the nonreporting hospitals in an attempt to ensure that administrators understand what qualifies as adverse event and their responsibility to report such errors.

The state told nonreporting hospitals that they have until the end of November to submit amended claims and report errors. Hospitals that report errors could receive a $100 per day fine dating back to when the adverse event occurred.

The nonreporting hospitals also could sign an attestation indicating that none of the designated medical errors have occurred.

Health Care Stakeholders Respond

Jim Lott, executive vice president of the Hospital Association of Southern California, expressed concern about the state's request for signed attestation. He said the state should "educate the hospital as opposed to setting them up for follow-up legal action." Lott added that some hospitals might not understand the reporting requirement.

Meanwhile, Anthony Wright of Health Access California praised the state's efforts to take a closer look at hospitals that have not reported any medical errors. Wright suggested that hospitals that have not experienced any adverse events should share their safety strategies with other facilities (Kisken, Ventura County Star, 11/17).

Lawsuit alleges substandard care led to deaths at Valley Medical Center

2010-11-05T19:18:00.000-07:00

By Lisa Fernandez lfernandez@mercurynews.com

Two doctors and a medical assistant have filed a workplace discrimination lawsuit against Santa Clara Valley Medical Center, claiming that more than one patient has died there as a result of "substandard care" and that they were ignored or embarrassed, and in one case, terminated, for speaking out.

Santa Clara County Executive Jeff Smith said several outside and internal inspectors found "absolutely no evidence'' that the patients in question died because of negligence.

But Smith acknowledged that the hospital's cardiology department is "dysfunctional" because of the many "personality conflicts" and "plethora of he-said, she-said arguments."

Filed Friday in U.S. District Court in San Jose, the federal lawsuit offers a rare glimpse into the mostly private goings-on in the county-run hospital hallways. Seventy-four pages of allegations paint a one-sided picture of death, backbiting and sexism.

The suit was brought by Thressa Walker, a medical administrative assistant in the cardiology department; Dr. Geeta Singh, a cardiologist; and Dr. Kai Ihnken, chief of cardiothoracic surgery.

"This was a last resort,'' said Charles Bonner, a Sausalito attorney who filed the suit with his partner and son, A. Cabral Bonner. "But the plaintiffs felt this was a moral imperative that they come forward. We have to tell the community what is going on here, that people are dying, and the administration will not change."

Named as defendants are Santa Clara County, Valley Medical Center; Dr. Hollister Brewster, chief of cardiology; Dr. Alfonso Banuelos, chief medical officer; Dr. Dolly Goel, medical director; and Dr. Peter Gregor, a cardiologist. Among other things, the suit alleges retaliation, discrimination, a hostile work environment, invasion of privacy, slander and intentional infliction of emotional distress.

One of the most serious allegations stems from the death of an unnamed patient in February 2009. Singh said she advised the patient not to get a stress test on his heart because of his fragile health and history of family heart attacks. Singh said she recommended a "cardiac catheterization" instead.

But other cardiologists ignored the patient's wishes and Singh's advice, the lawsuit alleges, and gave the patient a stress test anyway. The patient suffered cardiac arrest and died.

Both Walker and Singh allege that they were retaliated against by being ignored, verbally abused and embarrassed in e-mails, among other things, as a result of filing complaints with the Joint Commission of Accreditation Health Organizational regarding what they felt was "substandard" patient care.

This allegation does not surprise Smith, who was well aware of this complaint, and many others that the three plaintiffs have filed with county, state and federal officials. He said the negligence allegations have been thoroughly investigated internally and by outside experts, and they found "absolutely no evidence of poor or detrimental care."

The third plaintiff, Ihnken, states that in April 2008 he had wanted to perform surgery on a heart patient sooner rather than later, but "administrators denied him that possibility," and the patient died, the suit alleges. Ihnken said after he spoke out about this, he was slandered in public and that his contract wasn't renewed because of it. His last day of work will be in June, his lawyer said.

Smith insisted that none of the "three individuals" have been retaliated against, although he acknowledged that from their point of view, they probably would have liked to see more done on their behalf. Smith said the decision not to retain Ihnken was a cost-cutting move since the number of cardiac surgeries has been declining.

The multicomplaint suit also alleges misanthropy and inappropriate sex jokes at the hospital. In one example, the suit accuses Brewster of making a rude comment to a patient regarding his genital infection and sex with a pig, and using an expletive at a staff meeting after seeing a movie on personality types.

Smith said it's "natural" for the head of a department to receive the lion's share of criticism, and he added none of these allegations are new to him. The trouble has been long documented.

"This lawsuit is the last forum available to them," Smith said. "I'm not surprised, I'm disappointed."

Contact Lisa Fernandez at 408-920-5002.

Bandage changes color if wound becomes infected

2010-11-04T20:11:00.000-07:00

This is one of those things that is so obvious that you want to smack your head against the wall for not thinking of it first. Researchers in Munich, Germany have invented an indicator dye that changes color when bruises become infected.

The researchers at the Fraunhofer Research Institution for Modular Solid State Technologies EMFT say that the the dye works by measuring pH values. Regular human skin and healed wounds have a pH value around 5 — if the pH value goes up to 6.5 or 8.5, then the dye will change color from clear to purple. When it changes to purple is when you should start panicking because you'll likely have an infection.

EMFT is currently working hard to find an industrial partner to mass produce its dye for commercial sale. Hopefully bandage makers are seeing the full potential this dye has to offer.

We can't tell you how many times this infection indicating dye would have come in handy when we were little tots. Think about how many fewer wrinkles we would have on our foreheads if we weren't stressing the fear of an infection.

Solutions to hospital infections are sought

2010-10-24T23:26:00.000-07:00

Howard Fischer Capitol Media Services Arizona Daily Star | Posted: Tuesday, October 19, 2010 12:00 am | Comments

PHOENIX - A special panel studying how to cut down on hospital infections that kill 2,000 Arizonans a year is looking at solutions - everything short of actually telling would-be patients which hospitals have the worst record.

"It's more important to focus on prevention efforts in hospitals and other health-care organizations than it is to report rates," said Kris Korte, a member of the committee. She also is a nurse in charge of infection prevention at Banner Thunderbird Medical Center.

Korte acknowledged there's a more basic reason why hospitals oppose any sort of public reporting. She said patients would not understand the data.

"Infection rates are very difficult to explain to people that are not involved in creating those rates," she said.

State Health Director Will Humble, who said more Arizonans die from infections they get in hospitals than from motor-vehicle accidents, said he isn't going to push for a change in state law to make this kind of information available. That means not only is the public denied access to the information, but it's not provided to his own agency, either.

Humble said given the size and complexity of his agency, he has to "rely on stakeholder groups" to analyze problems and make recommendations to him.

"I'm not in a position to second-guess the committee," he said.

Humble said he understands the desire to have options on where to have a procedure performed to have access to that kind of information.

"On an intuitive level, it does make some sense to report," he said. But Humble said he told committee members to find what works elsewhere to bring down infection rates.

He said some of what the panel learned is that most of the effective infection-control practices are "really low-tech and simple." They're also inexpensive.

"It's things like doing a better job of hand washing, both surgeons but also the nursing staff," Humble said.

"It's paying attention to details when you're doing central lines" designed to provide medications directly into a patient's blood vessel, he continued. And it includes trying to prevent infection on cutting into the body, like swabbing anti-bacterial cream onto surgical patients.

And public disclosure?

"The data suggest that, in fact, it's not the most effective tool at driving down infection rates within hospital and health-care facilities," Humble said. "What I want to do is focus on those things that actually work."

But the Committee to Reduce Infection Deaths, headed by former New York Lt. Gov. Betsy McCaughey, reports that Arizona appears to be in the minority in keeping this information from the public.

It reports on its website that 27 states have laws requiring public reporting of what are formally known as "health-care-acquired infection rates." That allows, for example, New York residents to view a 135-page report that shows each hospital's rate of infection for various medical procedures.

Two other states have confidential reporting to state health officials.

Shoana Anderson, deputy chief of the health department's Bureau of Epidemiology and Disease Control, said raw data could be misleading.

"Some hospitals that are large research-level hospitals tend to get patients that are more ill," she said, at least in part because they are better capable of taking care of those people. Anderson said there needs to be a baseline that takes factors like that into account "to make sure you're comparing apples to apples."

Even without disclosure, Humble said there is financial pressure on hospitals to control infection rates because the federal government, which is increasing the paying for health care for the poor and the elderly, has "a big interest in driving down what the costs are."

The M.D.: Silence on bad doctors

2010-08-02T22:16:00.000-07:00

Not all physicians are well-qualified to practice medicine. And doctors who keep mum about their colleagues' incompetence have their own issues.

By Valerie Ulene, Special to the Los Angeles Times

August 2, 2010

Few doctors make it through their training without being involved in at least one case that goes awry. I was no exception.

As an intern, I was assisting in a routine hernia operation when the attending surgeon cut the vas deferens, the tube that transports sperm from the testicle. I expected to be grilled by my colleagues afterward on the details, pressed to explain how this largely avoidable mistake possibly could have been made. That didn't happen.

Everyone already suspected what had gone wrong and who was responsible — the attending surgeon was notorious for his careless surgical technique — and they were simply willing to let it pass.

The surgeon's technical error was the first of two mistakes made in this case. The surgeon's colleagues committed the second error post-operatively: They chose to overlook a pattern of seemingly suboptimal care.

As patients, we'd like to believe that every physician is well-qualified to practice medicine. It simply isn't so. Some doctors are impaired by substance abuse; others by medical conditions such as mental illness. And some simply lack the technical skills or knowledge to safely care for patients; they are, frankly, incompetent.

No one knows precisely how many such doctors are actively caring for patients. But, according to a study published in July in the Journal of the American Medical Assn., the numbers are likely substantial. Researchers at Massachusetts General Hospital surveyed thousands of physicians in a variety of medical specialties; 17% said they'd had direct, personal knowledge of an impaired or incompetent colleague in their hospital, group or practice in the last three years.

Weeding out physicians who threaten the quality of care is challenging. Hospitals must routinely undergo detailed reviews, but doctors are largely unmonitored. In large part, they are expected to police one another. "Physicians are really the first line of defense," says Catherine DesRoches, lead author of the JAMA study.

In many ways, this approach makes sense. After all, who better to judge the work of one professional than someone with the same training and skills? But without other methods of monitoring in place, many incompetent and impaired physicians are allowed to continue treating patients.

According to the American Medical Assn.'s Code of Ethics, individual physicians have an ethical responsibility to report colleagues who they suspect are unable to practice safely; in most states, including California, reporting is actually a legal requirement. Nevertheless, many doctors fail to follow through on concerns about fellow physicians. In the JAMA study, 1 in 3 doctors who had reason to report chose not to do so.

"Whether that's a good number or a bad number depends on where you sit," DesRoches says.

Two-thirds of doctors are acting responsibly, but patients naturally want that number to reach 100%.

Patients are destined to be disappointed. Some doctors simply don't believe that reporting is always the right thing to do. In fact, only 64% of physicians surveyed in the JAMA study completely agreed that they have a professional commitment to report a colleague who may be endangering patients or not adequately performing his or her job. Further, many doctors don't feel prepared to assume the role of overseer. For some, it's an issue of logistics; they don't know whom to contact or how the process works. Others simply don't feel qualified to determine whether or not someone should be reported.

"Sometimes determining who's competent and who's incompetent is difficult," says Dr. Matthew Wynia, director of the AMA's Institute for Ethics.

Not only can incompetence levels vary, but someone can be competent at one thing and incompetent at another. Then there's the issue of clinical opinion: Doctors frequently approach the same problem in different ways. Just because two doctors don't agree on the best way to care for a patient doesn't mean that either of them is wrong.

Sometimes doctors opt not to report because they worry about the potential repercussions — for both themselves and the physicians they're turning in. They fear that reporting one colleague will damage their own personal and professional relationships. If they're viewed as a "snitch," for example, other physicians may stop referring patients to them or avoid collaborating with them lest they be deemed incompetent too. In the JAMA study, 12% of physicians who failed to report a problematic colleague made that choice because they feared retribution.

Doctors also worry that their colleagues will be punished excessively. Even the suggestion of a problem can irreparably damage a physician's reputation within the medical community. And, if a physician's license is revoked, his or her career is over.

"We need to recognize that doctors are human beings," Wynia says. Like anyone else, they have difficulty being the whistle-blower and have trouble turning in their friends.

"It's not the only method we should use to monitor professional behavior," says Wynia. "There are other mechanisms for quality assurance that are equally, if not more, important." For example, physicians should be required to pass rigorous recertification exams. "You should have to not only maintain your competence to practice over time, you should have to prove it."

There are plenty of details about my internship I can't remember; the hernia surgery, however, remains vividly clear. None of my colleagues wanted to hear what had happened in the operating room that day; it would have put them in the awkward situation of having to do something about it. Because the error had been corrected and the patient was doing fine, everyone could rationalize that it was a case of no harm, no foul.

I was distressed by the response but, being new on the job, figured it wasn't my place to accuse anyone of practicing bad medicine. I also thought that ultimately someone with more authority would address the problem. As far as I'm aware, nobody ever did.

Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.

health@latimes.com

Copyright © 2010, The Los Angeles Times

Hospital Infection Deaths Caused by Ignorance and Neglect

2010-07-19T20:19:00.000-07:00

Hospital infection deaths caused by ignorance and neglect, survey finds

By N.C. Aizenman
Washington Post Staff Writer
Tuesday, July 13, 2010; A03

Deadly yet easily preventable bloodstream infections continue to plague American hospitals because facility administrators fail to commit resources and attention to the problem, according to a survey of medical professionals released Monday.

An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs -- which can occur when tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States.

Yet evidence suggests hospital workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly basic: (1) Wash hands with soap; (2) clean patient's skin with an effective antiseptic; (3) put sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dressing over the catheter site.

The approach also calls for clinicians to continually reconsider whether the benefits of keeping the catheter in for another day outweigh the risks and to use electronic monitoring systems that allow them to spot infections quickly and assemble a rapid response team to treat them.

A federally funded program implementing these measures in intensive-care units in Michigan hospitals reduced the incidence of CRBSIs by two-thirds, saving more than 1,500 lives and $200 million in the first 18 months. Similar initiatives across the country helped bring the overall national rate of these and related bloodstream infections down by 18 percent in the first six months of 2010, according to the CDC.

"Our research shows that the cost of implementing [such programs] is about $3,000 per infection, while an infection costs between $30,000 to $36,000," said Peter Pronovost, a professor at Johns Hopkins University School of Medicine who led the program. "That means an average hospital saves $1 million."

So why aren't hospitals leaping to adopt these best practices?

The survey released Monday, which was conducted by the Association for Professionals in Infection Control and Epidemiology and funded by Bard Access Systems, a maker of catheters, pointed to ignorance and neglect at the top.

More than half of the 2,075 respondents, most of whom were infection control nurses employed by hospitals, reported that they use a cumbersome paper-based system for tracking patients' conditions that makes it harder to spot infections in real time. Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.

Pronovost said part of the problem was that many hospital chief executives aren't even aware of their institution's bloodstream infection rates, let alone how easily they could bring them down.

When hospital leaders decide to create a culture in which preventing infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel have the best tools to monitor patients.

"If anyone in that chain of accountability doesn't work, you won't get your [infection] rates down," he said. "But it's the hospital's senior leadership that is ultimately responsible."

Doctors Okay with Industry Gifts

2010-07-19T19:43:00.000-07:00

MDs OK @industry gifts
Posted by medconsumers on July 19, 2010

One thing that adds to the inefficiency of our medical care system is the distorting influence of the pharmaceutical industry’s marketing techniques. A new survey of 600 doctors, surgeons, and medical students found that most have positive attitudes towards the marketing activities of the drug companies. Unfortunately, most seem to miss the fact that marketing is all about getting them to prescribe the most expensive drugs.

The most disturbing finding in this survey, published in Archives of Surgery, is the 58% of respondents who said they believe that drug samples improve patient care. Free drug samples to doctors—one of the pharmaceutical industry’s most effective marketing strategies—are all about increasing the sales of brand-name drugs. They tend to be the newest, most expensive drugs, offered to patients in this way, “Try this free drug sample and see how you do.” The patients who do just fine continue with the expensive drug, which might very well have a less expensive alternative that is just as good…or safer. So far, no one has come up with any good evidence that free samples improve patient care.

The pharmaceutical industry would have us believe that the free drugs go to low-income patients, but that didn’t hold up once researchers took a hard look. They found that the people most likely to receive free drug samples from their physicians are the financially well off and the insured. (Click here) Another study showed that the people who get free samples wind up with significantly more out-of-pocket expenditures than those who don’t.

Three-fourths of the doctors in the new survey believe that accepting free gifts and free lunches did not influence their own prescribing practices, but 52% said other doctors are likely to be swayed by such marketing tactics.

I think we can safely assume that the pharmaceutical marketing pros know exactly what works in terms of gifts to doctors, be it a free mug with drug company logo or a lavish dinner at the local French restaurant. One anti-drug industry documentary featured a former drug saleswoman turned whistle-blower. She said that her company could clock an uptick in drug prescriptions after something as seemingly minor as bringing a $10 take-out Chinese lunch for each person on the doctors’ staff.

You have no way of knowing how much marketing influences your own doctor’s prescribing behavior. A doctor too ready to prescribe the newest drug is a bad sign. So is the doctor whose waiting room often includes a well-dressed drug sales representative (usually female) and/or an office that is heavy on the industry-generated posters, pens, mugs, and brochures. One friend noticed the place she was expected to place her feet on the scale in her doctor’s office had a paste-on ad for Meridia, the weight-loss drug.

Revealing as this survey is, it centers on marketing tactics that are small potatoes compared to what’s happening at academic medical centers and is largely hidden from public view. It’s the fact that half of all continuing medical education is funded by industry. It’s the large consulting fees paid to key opinion leaders to “educate” their peers about the latest drugs. (For the definitive article describing how this works, click here.) Things have gotten so bad that medical students at Harvard are reportedly asking hard questions about which of their professors are paid consultants for the pharmaceutical industry (click here).

Reforms are on the way but still relatively new. Under a new federal law, drug and device companies will soon have to disclose, on a publicly accessible website, the names of doctors who accept speaking fees, as well as the value of all gifts. We already know that this will have an immediate effect. Vermont is one of three states that already put this law into practice in 2002. Early this year, the attorney general of Vermont release data showing that total payments to doctors dropped 13% in 2009 to $2.6 million. Vermont now plans to improve its law with an outright ban on most gifts, including food, which amounts to $800,000 of the 2009 total.

Several years from now we can look forward to another survey to see how doctors react to the new federal law.

Maryann Napoli, Center for Medical Consumers©

1,000 Nurses Call on Congress to Act Now on Patient Safety

2010-05-14T13:56:00.000-07:00

Gathering Highlights Growth of National Nurses Movement

More than 1,000 registered nurses from across the country rallied in Washington DC Wednesday, raising an unprecedented, unified voice for patient safety reforms and new, national standards for patient care conditions and standards for nurses.

The event was sponsored by the nation’s largest nurses’ union and professional association, the 155,000-member National Nurses United, which came to Washington to press the case for quality of care legislation that was not part of the national healthcare bill enacted earlier this year, and to build on the unity of RNs who are NNU members from coast to coast.

In addition to a march, rally, and conference, the RNs visited nearly 100 members of Congress, prodding legislators to work on the unfinished business of healthcare reform, quality of care and patient safety. The actions coincided with National Nurses Week.

Noting recent national attention on the West Virginia mining disaster and the Gulf Coast oil spill, NNU Co-President Jean Ross, RN said that “similar accidents happen every day away from the media spotlight in U.S. hospitals and other healthcare settings. It’s time to act to protect our patients and our communities.”

"We're the voice of not only nurses but patients across the country,” said NNU Co-President Karen Higgins, RN. “When we leave this room I want everyone to remember that. When it comes time to make decisions about healthcare and people say 'leave it to the experts,' tell them 'I am the expert.' "

Among the legislative solutions are S 1031/HR 2133 that would, among other components, establish minimum ratios of nurses to patients for all U.S. hospitals, modeled after a successful California law, and S 1788/HR 2381 which would also promote nurse retention and reduce patient accidents and injuries by establishing safe patient lifting and handling policies.

Sen. Al Franken of Minnesota, author of S 1788, hosted a hearing on the bill Tuesday at which several nurses on hand for the week cited experiences that demonstrated the need for the bill.

Speaking Wednesday to an NNU rally across from the Capitol, Franken told the RNs, "You are the ones we look to for advice, comfort, expertise and care. You are tireless advocates for the country's well-being. You're the ones we trust to care for our loved ones, that's what your expertise is, and it's simply unacceptable that you're putting your own health on the line to care for patients."

"Now it's time to make sure that all nurses in all states have access to a safe workplace. One injured nurse is one too many. Employers have a fundamental obligation to put in place a safe working environment for all workers and nurses are no exception," Franken said.

Rep. Lynn Woolsey of California, speaking to the nurses, also emphasized why the bill is needed, "We don't need to create another patient in the process of caring for one."

U.S. Labor Secretary Hilda Solis, who also addressed the conference, told the nurses that more than 36,000 health care workers were injured by lifting and transferring patients, according to 2008 Bureau of Labor Statistics data. In addition, she said, 12 percent of nurses who plan to leave the profession cited back injuries as a contributing factor.

“What a waste when the career of an experienced nurse is ended years or decades too early because of an easily preventable back injury,” Solis said. “In these days of ever-rising health care costs, what a waste of money to pay workers compensation and disability for easily preventable back injuries.”

S 1031 author Sen. Barbara Boxer of California and HR 2133 author Rep. Jan Schakowsky of Illinois also spoke the NNU event about the ratio legislation which, according to a groundbreaking study from the University of Pennsylvania released last month, could have cut post-surgical patient deaths by 14 percent in New Jersey and 11 percent in Pennsylvania, two comparable states the researchers compared to California.

"We know that nurse-to-patient ratios work, and it is time to enact them around the nation. California was the testing ground and it's working," Boxer said. "Too often you are overworked because of staffing levels that are inadequate and that is unacceptable."

The Penn study, from noted researcher Linda Aiken, RN, PhD, documents “what California nurses have seen every day at the bedside since passage of the law -- safer care conditions, an enhanced quality of life for patients, and, as an added bonus, reduced burnout for nurses which mitigates the nursing shortage,” said California RN and NNU co-president Deborah Burger.

NNU is also seeking passage of HR 949/S 362 to restore equal collective bargaining rights for Veterans Affairs nurses.

Strengthening the rights of direct care RNs and their ability to more effectively advocate for patients and their colleagues, was another major theme of the NNU gathering.

"We've got to say something in a united way that tells employers it's a new day in America and RNs are going to stand up and not take it anymore," NNU Executive Director Rose Ann DeMoro said.

The RNs unanimously endorsed a resolution to establish national collective bargaining standards that notes the growing attack by many hospital employers against nurses and patient safety conditions.

The resolution notes that NNU will oppose “concessionary agreements that are injurious to our patients, our members, and our profession that undermine all represented RN contract standards” that include reductions in health coverage, pensions and other retirement security, two-tier programs for new hires, and reductions that impair patient safety.

Additionally, the resolution pledges NNU to fight for enhanced RN staffing and other improvements in patient care standards, improved retirement security for RNs, limits on the introduction of new technology that displaces RNs or RN professional judgment, and additional workplace safety measures.

Suit-Proof Physicians in Ohio?

2010-04-30T21:53:00.000-07:00

An Ohio Supreme Court ruling has limited a patient's opportunity to sue for medical malpractice based on where the treatment occurred and who was present for the treatment.

In Theobald v. University of Cincinnati, the Court ruled that when a physician is negligent in treating a patient, the physician will be immune from liability as long as a medical student or resident was present during the treatment. Basically, under these circumstances, the physician is legally considered to be a state employee acting within the scope of his or her employment, and therefore is immune from civil liability.

Keith Theobald, the plaintiff in the above-referenced case, was injured in a serious auto accident. Afterward, Theobald was treated at University Hospital, a private hospital, but one which is affiliated with the University of Cincinnati. After treatment, Mr. Theobald awoke to find himself blind and with worsened paralysis. He sued the treating physicians but, ultimately, was precluded from having his day in court.

The Supreme Court first determined that Theobald's treating physicians were immune from liability as employees of the state because they were “teaching” or supervising students from a state medical school. The physicians had privileges at University Hospital, and they performed the treatment resulting in this case at the hospital.

Even though the physicians were employees of the state, they would only enjoy immunity from civil liability if the Court determined that they were acting within the scope of their state employment during the time of the alleged negligence.

Theobald argued that because the doctors’ private practice billed for the procedure, this was evidence that the doctor was not “teaching.” However, the Supreme Court determined that the focus must be on the “employment relationship” as opposed to the business or financial arrangements. If the physician was “educating a student or resident when the negligence occurred,” then the physician will be immune. In other words, the doctor is immunized whenever negligence occurs in the presence of a student.

The Court's ruling in this regard creates a controversial precedent for Ohio citizens and physicians. One of the roles of an attending physician at University Hospital is to teach the medical students and residents. The Court determined that the treating physicians were acting within the scope of their state employment because they were teaching a resident while delivering medical care to Theobald. The Court found this to be true no matter what “percentage” of the procedure was actually teaching. However, as Justice Pfeifer noted in his dissenting opinion, “the mere presence of a student does not establish that instruction is taking place.” The ruling extends immunity to a physician merely because a student was present, even if the only thing the student was doing was observing. Pfeifer also noted that when the state is a defendant, the Court of Claims has jurisdiction. However, jury trials are not permitted in the Court of Claims. This would effectively deny medical malpractice plaintiffs their constitutional right to a jury trial.

This ruling will change the remedies available to Ohio patients who find themselves the victim of medical malpractice when a student is involved in any aspect of the procedure. By allowing physicians (and their malpractice insurance companies) to avoid liability by having a resident present for treatment, patients who are treated at hospitals will be left with no one to sue if they are injured and legitimately deserve to be compensated.

ABC6 News Report http://www.abc6onyourside.com/shared/newsroom/top_stories/videos/wsyx_vid_3942.shtml

Cleveland Primary Care Doctors Fired For Lack of "Productivity"

2010-04-30T15:49:00.000-07:00

Physicians for a National Health Program
April 29, 2010

Dear PNHP board members and activists,

We're writing to call your attention to an extremely significant event in the Cleveland area, which is sadly an increasingly frequent experience of physicians working for corporate entities.

Dr. George Randt and his colleague are board-certified internists who have had a contractual relationship with St. John Medical Center covering some 2,500 patients for several years. These two doctors have excellent records with the hospital, high patient satisfaction and retention rates, and have never had an unfavorable review. Both were awarded bonuses in 2009, and Dr. Randt's contract was renewed in January of this year.

This past month they were notified by the president of their hospital, Mr. Cliff Coker, that their contracts were being terminated due to lack of productivity and their having incurred excessive overhead expense. In other words, they weren't sufficiently profit-driven. At a previous staff meeting, the staff physicians were told by the CFO to admit just "one more Medicare patient a month" to improve hospital revenues.

If you can, please join Dr. Randt, his patients, and others at a rally at St. John Medical Center, 29000 Center Ridge Road, Westlake, Ohio, this Sunday, May 2, at 1:00 p.m. to call for the reinstatement of these two physicians and for the elimination of policies which are justified solely on the basis of maximizing the profits of a health care system. Speakers at the rally include PNHP's congressional fellow, Dr. Margaret Flowers, and Dr. Carol Paris. (See the press release below for more information.)

Call Mr. Cliff Coker today and demand that these physicians be reinstated to their position. His office number is (440) 827-5008. He can also be reached by e-mailing cliff.coker@csauh.com

We welcome you to share your views that patients should come before profits with the newspapers in the area by writing a letter to the editor to the The Plain Dealer or Sun News.

Dismissing these physicians without cause, merely to maximize hospital revenues, is the embodiment of the derangement of our system of health care finance. This was done without any semblance of due process. The livelihood and status of skilled professionals are being sacrificed to assure profitability; this is rapidly becoming the norm within our profit-driven system. As a result, it poses the gravest threat to professionalism and patient primacy. These issues would be greatly alleviated under a single-payer health financing system that places value on health outcomes, continuity of care, and quality.

Please join us in calling for the reinstatement of Dr. Randt, a longtime PNHP member, and his colleague and an end to health care practices that place the goals of profitability over the care of patients.

Health care for all,

Quentin Young, M.D.
National Coordinator, PNHP

Johnathon Ross, M.D.
Past-president, PNHP
State Coordinator, PNHP Ohio

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x8243878

C Difficile Surpasses MRSA as the Leading Cause of Nosocomial Infections in Community Hospitals

2010-04-11T15:55:00.000-07:00

Emma Hitt, PhD

March 23, 2010 (Atlanta, Georgia) — Hospital-onset healthcare-facility-associated Clostridium difficile infections (CDI) have increased in incidence and have surpassed methicillin-resistant Staphylococcus aureus (MRSA) infections, according to a new study of a large cohort of patients from community hospitals.

Becky A. Miller, MD, an infectious disease fellow from Duke University in Durham, North Carolina, presented the findings during an oral session here at the Fifth Decennial International Conference on Healthcare-Associated Infections 2010.

"This is the first time this has been described using patient-level data (i.e., with the number of cases as the numerator and the number of patient days as the denominator)," Dr. Miller told Medscape Infectious Diseases.

"We think this trend, particularly in community hospitals, would not have been captured without our large network of 39 hospitals where we perform infection control and surveillance," she said. "We were also unaware that cases of nosocomial C difficile infection had increased and surpassed MRSA."

The researchers performed a prospective cohort study in 28 community hospitals participating in the Duke Infection Control Outreach Network between January 2008 and December 2009.

The cohort consisted of 3,007,457 patient-days. Numerically, nosocomial CDI was the most common healthcare-associated infection (847 cases), followed closely by nosocomial bloodstream infection (838 cases).

Nosocomial infections due to MRSA and intensive care unit device-related infections were approximately equal, at 680 and 681 cases, respectively.

Patients with nosocomial CDI (n = 840) and nosocomial MRSA (n = 655) were equally likely to be male, and to have diabetes or end-stage renal disease requiring hemodialysis. However, patients who developed nosocomial CDI were, on average, older than patients who developed nosocomial MRSA infection (65 vs 59 years; P < .0001). In addition, time to infection was, on average, 8 days for CDI and 7 days for MRSA infection (P < .0001), and overall mortality was higher among patients with MRSA infection than CDI (P < .0001).

The rate of nosocomial CDI was 0.28 cases per 1000 patient-days, whereas the rate of nosocomial MRSA infection was 0.23 cases per 1000 patient-days. Thus, nosocomial CDI occurred 25% more frequently than nosocomial MRSA infection.

Since 2007, rates of healthcare-associated MRSA infection have steadily decreased, whereas rates of CDI have increased, Dr. Miller said during her presentation.

According to Dr. Miller, C difficile spores are shed in stool, and these spores can persist in the hospital environment for months. "These infections are not being prevented by methods that are clearly working to prevent nosocomial infections due to MRSA," she said. She added that "we think that this study represents the tip of the iceberg, as we did not include nosocomial C difficile cases diagnosed after patients leave the hospital."

In another presentation on C difficile, researchers described a targeted strategy to eliminate C difficile using ultragermicidal bleach wipes. Robert Orenstein, DO, from the Mayo Clinic in Rochester, Minnesota, reported the findings here in a poster session.

"The beauty of this project was that implementation was relatively simple — it required putting together a committed team and emphasizing our goal of improving patient outcomes," Dr. Orenstein told Medscape Infectious Diseases.

The researchers targeted 2 units with a focused intervention of daily cleaning of all patient rooms with Clorox brand ultragermicidal bleach wipes containing 6.15% sodium hypochlorite, and cleaning after the patient had been discharged.

Cleaning was assessed by environmental services supervisors, and Clean-Trace technology was used. Patients and environmental services employees who cleaned the rooms responded to a survey regarding satisfaction and tolerance of the cleaning procedure.

Before the intervention was initiated, the incidence of CDI was 18.4 per 10,000 patient-days; after the intervention was initiated, the incidence was 3.76 per 10,000 patient-days, "far exceeding" their goal of a reduction in incidence of 30%, Dr. Orenstein said.

According to the authors, patients tolerated the cleaning well, and although environmental services "employees initially had concerns regarding odor and irritation, these were resolved." The cost of the intervention was estimated at $18,671 per year.

"I am struck by the fact that our highest-risk unit has gone 6 months without a hospital-acquired case attributable to their unit, despite the fact that the overall incidence (i.e., cases admitted with this infection) continues to rise," Dr. Orenstein said. "This suggests what we did really had a great impact," he added. "This is especially gratifying knowing the impact that C difficile disease can have on our patients lives."

"C difficile has been in the news for the last decade," said Carlene A. Muto, MD, medical director for infection control at the University of Pittsburgh School of Medicine in Pennsylvania. "What has taken focus this year is that the environment matters," she said.

According to Dr. Muto, an analysis by their group presented in the late-breaking session described the undetected reservoir in patients who asymptomatically carry C difficile (~6% of the patients tested).

"Many studies have described noncompliance with cleaning patient rooms and how a focused effort can change this behavior," Dr. Muto told Medscape Infectious Disease. "Our group implemented a bleach/detergent cleaning program years ago, but since June 2009, we have used this product on every surface, every time, not just in the rooms of patients known to be positive."

She noted that "patients not known to be colonized/infected one day may be so the next. We did see a decrease in C difficile healthcare-associated infections using this approach."

Neither study was commercially funded. Dr. Miller, Dr. Orenstein, and Dr. Muto have disclosed no relevant financial relationships.

Fifth Decennial International Conference on Healthcare-Associated Infections (ICHAI) 2010: Abstract 386, presented March 20, 2010; Abstract 142, presented March 19, 2010.

New State Regulation Could Affect California's Low Physician Disciplinary Rate

2010-04-09T21:41:00.000-07:00

California is one of the least likely states to take serious disciplinary action against physicians, according to a new study. But a new state regulation might soon change that.

Starting in June, California's 125,000 physicians will be required to post signs in their offices or otherwise inform patients about how to contact the Medical Board of California to file quality of care complaints.

The new regulation comes in response to concerns that California patients are not lodging complaints about quality of care very often, a position given credence by a report released this week showing California ranks 41st in the country in disciplinary action against physicians.

Using data from the Federation of State Medical Boards, consumer group Public Citizen found an average of 3.05 serious disciplinary actions per 1,000 physicians nationally. In comparison, California's medical board took 2.36 serious disciplinary actions per 1,000 doctors last year. Researchers defined serious discipline as license revocations, surrenders, suspensions, probation or restrictions.

Under the state's new regulations, physicians must provide a notice with the name, phone number and Web site of the medical board. Proponents hope more consumer information will help uncover misconduct and increase quality of care in the state.

The California Medical Association criticized the new rule, claiming it could undermine the doctor-patient relationship.

Meanwhile, here's a rundown of health care bills making their way through the Legislature.

Health Plans

AB 2586 by Assembly member Wesley Chesbro (D-Santa Rosa) would require health insurers to demonstrate that a planned modification to its health care provider network meets certain standards. The measure also would require insurers to provide consumers with an accurate list of contracting providers upon request. In addition, the bill would require insurers post an interactive map on their Web sites to help consumers locate providers in their area (Bill text, 4/5). The bill is before the Assembly Committee on Health (Bill status, 4/5).

Doctors and Nurses

Under AB 2699 by Assembly member Karen Bass (D-Los Angeles), health care providers licensed in another state would be exempt from California's medical licensure requirements if they provide care on a short-term, voluntary basis in association with certain registered sponsoring entities. The bill also would state the intent of the Legislature that the voluntary services be primarily provided to uninsured and underinsured populations (Bill text, 4/5). The bill is before the Assembly Committee on Rules (Bill status, 4/5).

Prescription Drugs

SB 1106 by Sen. Leland Yee (D-San Francisco) would require prescribers who dispense prescription drug samples to either provide patients with a copy of the FDA-approved package insert for the medication or ensure that the manufacturer's warnings are on the packaging of the samples (Bill text 4/5). The bill is before the Senate Committee on Appropriations (Bill status, 4/5).

Health Care Reform

SB 1378 by Sen. Tony Strickland (R-Moorpark) would prohibit the state from enacting any Medi-Cal expansions mandated under the national health care reform law unless the federal government fully funds the expansion. Medi-Cal is California's Medicaid program (Bill text, 4/5). The bill is before the Senate Committee on Rules (Bill text, 4/5).

CEOs are less concerned about quality and patient safety

2010-02-15T21:03:00.000-08:00

Healthcare CEOs Focusing on the Now
Philip Betbeze, for HealthLeaders Media, February 12, 2010

Here's a statement that should get your attention: CEOs are less concerned about quality and patient safety this year than last year. Actually, that broad conclusion is tough to draw from the data contained in the HealthLeaders Media Industry Survey 2010, which went live on our site yesterday. But what's clear is that long-term goals are dropping in importance in favor of initiatives that can bring near-immediate returns.

Without a doubt, CEOs are spending more of their intellectual capital this year on patient experience/satisfaction as well as cost reduction, according to the survey.

CEOs, obviously, drive their organizations, so what they say about their priorities carries a lot of weight. We actually asked CEOs to rank their top three priorities for the next three years, and what came back showed us that CEOs, perhaps in light of the turbulent economic times, are trimming back the importance they give to quality and patient safety (only 39.5% selected it this year, compared with 69% in 2009) while patient experience/satisfaction (33.98% vs. 25%) as well as cost reduction (35.36% vs. 19%) recorded big increases.

Interestingly, physician recruitment and retention dropped from 43% in 2009 to 35.36% for 2010. So what conclusions can we draw from this data? Perhaps CEOs feel like after years of concentration, their quality levels don't need as much attention. Perhaps more of them have achieved their short- and medium-term goals with physician recruitment.

But in the bigger picture, quality still leads the herd, and physician recruitment isn't far behind. They just have much less of a commanding lead than they did before. I think some areas simply have improved so much that they aren't highest priority anymore, at least at the top levels of the organization. That certainly seems true for revenue cycle, for example, which only 7.73% of CEOs ranked as among their top three priorities for 2010, compared with 23% in 2009.

But I think there's something else at work here. Short-term thinking has invaded the decisions emanating from the C-suite.

On first glance, that seems myopic. But it's not necessarily a bad thing: Sometimes a crisis requires you to dramatically shift your priorities, and if 2009 wasn't a crisis year with the recession and healthcare reform looming on the horizon, I don't know what would qualify. For example, physician recruitment is a long-term investment in a single human being. Improving quality also takes time, and while it generates an ROI, its ROI doesn't flow directly to the bottom line.

Banner Health, for example, spent big bucks on driving quality at their organization. They don't regret it. In fact, their quality scores in the obstetrics department recently meant they could reduce their reserves for malpractice to near zero for 2010. But it took at least three years of low or no claims to make the actuarial team comfortable with reducing those reserves and letting them flow to the bottom line.

CEOs in 2010 don't necessarily have that luxury of waiting for results, no matter how impressive they might eventually be. And that's the key for CEOs in 2010. They want to expend their energy on initiatives that bring immediate or near-immediate return because frankly their jobs, the jobs of others in the organization, and in some cases, their hospital's existence, are on the line.

Obviously, this is just very narrow snapshot of the wealth of information available in our survey. I encourage you to spend a half-hour on it in the next week or so. We've broken the results down by pillar, meaning there's one for CEOs, one for quality, one for CFOs, etc.

I've focused here on one question from the CEO pillar and have been able to draw several conclusions from it. But there's a story behind every question and knowledge to be gleaned from every pillar. Delve into the survey's findings now. You won't be sorry.

--------------------------------------------------------------------------------
Philip Betbeze is a senior leadership editor with HealthLeaders Media. He can be reached at pbetbeze@healthleadersmedia.com.

Texas Nurse On Trial After Reporting Doctor

2010-02-09T19:42:00.000-08:00

February 8, 2010 A nurse in Texas is standing trial for reporting a doctor she thought was practicing bad medicine. Prosecutors have charged 52-year-old Anne Mitchell with making inflammatory statements about a doctor at a rural hospital in Kermit, Texas. She faces up to 10 years in prison. Mitchell says she was just trying to protect her patients. Kevin Sack of The New York Times says much of the case stems from local politics.

http://www.npr.org/templates/story/story.php?storyId=123502251

Hospital comparisons soon to be a click away

2009-12-21T19:25:00.000-08:00

Monday, December 21, 2009 3:12 AM
By Suzanne Hoholik

THE COLUMBUS DISPATCH
While you watch parades and football games on New Year's Day, you can fire up your computers and compare Ohio hospitals.

A state law passed nearly four years ago requires hospitals to provide extensive quality and pricing information to the Ohio Department of Health. A consumer-friendly Web site with this information goes live Jan. 1.

Hospitals already report some of this information, but it's difficult for consumers to compare hospitals.

"A lot of that information was out there but was never in a user-friendly format for everyday users of health care," said Jim Raussen, the former state legislator who sponsored the legislation.

"It has to be transparent for the average citizen so they can feel comfort that the information they're getting makes sense to them and is accurate," Raussen said.

The site is called Ohio Hospital Compare and will feature more than 100 quality measures, including mortality and infection rates and how often specific medical procedures are performed at a hospital. There is even information about whether a hospital has a hand-washing program for its health workers.

On the main page, consumers will be able to pick hospitals to compare on quality measures.

Consumers need access to this kind of information, said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio.

"Hospitals need to be reporting publicly their quality measures such as hospital-acquired infections and preventable complications, so they feel public pressure to improve patient quality and safety," she said.

The Web site also will link to lists of hospital charges, but they won't be in an easy-to-use format until the end of 2010, said Sara Morman, a Health Department spokeswoman.

At that time, consumers will be able to compare charges such as for private and semiprivate rooms, the 30 most-common X-rays, and services in emergency, operating and delivery rooms.

Hospitals caution that these charges aren't what the 88 percent of insured Ohioans will pay. Private and government insurance pay lower, negotiated rates.

"Each one of our health plans has a negotiated rate that's substantially less than those charges," said John Stone, chief financial officer at Ohio State University Medical Center. "We don't have two like payments from any one payer."

Even so, knowing what hospitals charge for the same thing will be helpful, said Kelly McGivern, president of the Ohio Association of Health Plans.

"It's a good barometer just for educating consumers on what these services actually cost," she said. "They need to know it's not going to cost them $10 to have a baby, that it actually costs more than that."

On Jan. 1, consumers will be able to compare hospitals by going to http://www.odh.ohio.gov/ and clicking on Ohio Hospital Compare.

Sebelius Announces Release of Recovery Act Funding to Improve Care in Nation’s Ambulatory Surgical Centers

2009-11-10T16:11:00.000-08:00

To reduce healthcare-associated infections (HAIs) in stand-alone or same-day surgical centers, the HHS Secretary Kathleen Sebelius today announced the availability of up to $9 million in funding from the American Recovery and Reinvestment Act (ARRA) to state survey agencies in 43 states. HAIs are infections some patients acquire when they are in a health care setting such as a hospital or outpatient clinic.

“Because of the Recovery Act, millions of patients who go to stand-alone surgical centers will have greater assurance that they won’t come home with a new infection,” said Health and Human Services’ Secretary Kathleen Sebelius. “Residents in these 43 states will continue to see the benefits from the Recovery Act not only by addressing health care associated infections, but by putting people to work to solve an important issue and improve the quality of life for Americans.”

“Healthcare-Associated Infections kill nearly 100,000 people and add an extra $30 billion in healthcare costs every year. But with a little bit of knowledge, and some extra effort, much of that can be prevented. I’m glad to see these funds going to help put people to work combating this tragedy around the country,” said Congressman Dave Obey (D-WI), the Chairman of the House Appropriations Committee, who was a lead author of the Recovery Act and has been an outspoken advocate for efforts to reduce HAIs.

Accredited facilities are surveyed by CMS-approved private accrediting organizations. As part of the new initiative, surveyors in the 43 states will survey approximately 1,300 ambulatory surgical centers (ASCs) across the nation, one-third of the more than 3,800 non-accredited ASCs across the country during the next 12 months. State surveyors will employ a new CMS survey process for ASCs that uses an infection control tool developed in conjunction with the Centers for Disease Control and Prevention (CDC).

Across the United States, health care services are being shifted to outpatient settings such as ambulatory care facilities, long term care facilities, and free-standing specialty care sites. The number of ASCs participating in Medicare grew from about 3600 in calendar year 2002 to 5200 in early 2009, a 44 percent increase. ASCs account for more than 43 percent of all same-day (ambulatory) surgery in the United States, amounting to about 15 million procedures every year. Typical surgical procedures conducted in ASCs include endoscopies and colonoscopies, orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries.

HAI outbreaks in outpatient settings continue to occur according to the CDC. In several ASC-related communicable disease outbreaks, failure to employ very basic infection control practices were implicated, leading CMS to identify this as an area for additional oversight.

In the last fiscal year, 12 states volunteered to get a head start on this nationwide effort to reduce healthcare-associated infections in stand-alone or same-day surgical centers by beginning to survey ASCs with funding of nearly $1 million provided through the Recovery Act.

In addition to the funds being made available for the inspection of ASCs, the CDC has also made $40 million available to state public health departments to create or expand state-based HAI prevention and surveillance efforts, and strengthen the public health workforce trained to prevent HAIs.

These funds support activities outlined in HHS’ 2009 Action Plan to Prevent Healthcare-Associated Infections. The plan also establishes national goals, prioritizes recommended clinical practices, and coordinates a national research agenda. Development of this national plan, available at http://www.hhs.gov/ophs/initiatives/hai, is coordinated by HHS’ Office of Public Health and Science, and involves participation from the Agency for Healthcare Research and Quality, CDC, CMS, the Food and Drug Administration, the Indian Health Service, the Health Resources and Services Administration, the National Institutes of Health, the Office of the National Coordinator for Health Information Technology, and other HHS offices, and the Department of Veterans Affairs.

Where Are the Firing Offenses in Medicine?

2009-11-03T09:56:00.000-08:00

Patrick Malone
Posted: October 29, 2009 04:04 PM

The recent news about the two Northwest Airlines pilots whose licenses were revoked, less than a week after they let their plane wander 150 miles off course, raises the question: Where are the firing offenses in medicine?

The pilots injured no passengers, and the event didn't even qualify as a "near miss." But because they egregiously violated safety rules by working on their flight schedules on a laptop in the cockpit, the aviation authorities did not hesitate to pull their licenses.

In the medical industry, by contrast, it is well known that a doctor will lose his or her license for only flagrant patterns of drug or alcohol abuse or other criminal behavior, with a trail of dead and injured patients usually lasting years before the practitioner is finally put out of business.

Medicine's big safety emphasis in recent years has been to create a "no blame" culture that encourages reporting of errors, injuries and "near-misses" by promises of confidentiality and non-punitive action. The idea has been to bring systemic problems out into the open so they can be corrected by implementing "systems" changes, such as checklists to make sure all appropriate steps are taken to prevent infections when inserting catheters into blood vessels.

But what about a doctor who repeatedly puts patients in jeopardy, in small or big ways, by ignoring the rules? Many don't wash their hands routinely when they enter a patient's hospital room, and deadly infections sometimes get spread from patient to patient. Others don't "sign out" their patients at the end of a shift by a person-to-person encounter with the provider taking over.

Some surgeons still won't follow the now routine practice of "signing the site" to prevent wrong-site surgery. If the surgeon is a prominent "feeder" of patients to the hospital, such transgressions can easily be overlooked by administrators who don't want to lose the business. That helps explain why an estimated 4,000 wrong-site surgeries still are performed every year in the United States, more than a decade after the "sign your site" campaign by orthopedic and other surgical specialties.

The good news is that medical safety leaders are starting to call for accountability for rules violations. Dr. Robert Wachter of UC-San Francisco and Dr. Peter Pronovost of Johns Hopkins recently wrote about this in the New England Journal of Medicine. Comparing medicine to aviation (the article was published before the Northwest Airlines incident), they noted: "Every safe industry has transgressions that are firing offenses."

They proposed a short list of offenses in the hospital that should call for suspension of the doctor's practice for one or two weeks: failing to perform hand hygiene, skipping the sign-over to a new provider at the end of a shift, not marking the surgical site, and failing to use a checklist at the start of surgery to make sure everyone in the operating room knows the special needs of the patient. These penalties, they suggested, should only apply after the doctor has failed to respond to an initial warning and counseling.

These modest, tentative steps forward are proposed by the authors to their colleagues as a way of fending off intrusive government regulation. But they also say: "The main reason to find the right balance between 'no blame' and individual accountability is that doing so will save lives."

Amen to that.

Patrick Malone
Attorney and Author of "The Life You Save"

Safety Gurus: Penalize Doctors Who Don’t Follow the Rules

2009-10-06T15:10:00.000-07:00

October 1, 2009, 3:50 PM ET
By Laura Landro

Should hospitals start penalizing doctors and nurses who fail to follow patient safety rules?

That’s one solution proposed by Peter Pronovost of Johns Hopkins and Robert Wachter of the University of California at San Francisco. Writing in the New England Journal of Medicine, the doctors contend that the failure to hold clinicians accountable for patient safety is the main reason health care is still riddled with errors, adverse events, and just plain non-adherence to some of the most basic rules.

(Compliance with hand hygiene rules ranges from 30% to 70% at most hospitals, and few have sustained rates over 80%, the authors note, while there are about 4,000 wrong-site surgeries in the U.S. annually despite a universally accepted protocol for preventing them.)

In the decade since the Institute of Medicine’s landmark “ To Err is Human” report, which estimated that up to 98,000 people a year die of medical errors, many hospitals have embraced a “no blame” model: Instead of focusing on a single individual to blame for a mistake, they’ve tried to set up systems to prevent mistakes, catch them before they cause harm, or mitigate harm from errors that do reach patients. That’s all well and good if it works, but many hospitals are now finding that a blame-free culture creates its own safety risks, Pronovost and Wachter write.

Punishments such as revoking privileges for a chunk of time tend to be used for administrative infractions that cost the hospital money – things like failing to sign the discharge summaries that insurance companies require to pay the hospital bill. By contrast, hospital administrators may just shrug their shoulders when it comes to doctors who fail or refuse to follow rules like a “time out” before surgery to avoid operating on the wrong body part.

Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.

Pronovost — best known for his development of medical checklists designed to improve patient safety — tells the Health Blog that he still sees a tremendous amount of “pushback” when he speaks to doctors. Many still resist checklists and don’t feel bound by hand washing rules, even though they’ve been shown to prevent harm to patients.

“Some of these doctors just come to the meetings to throw spears at me,” he says. “We know how important these things are for patient safety, but there needs to be some accountability for infractions,” he adds. The suggested penalties “are an attempt at a practical way to hold people accountable.”

Doctors Want to Roll Back Policies Curbing Gifts Between Doctors And Drug Company Reps

2009-07-26T22:13:00.000-07:00

Perks policy for doctors challenged
Physician organization wants limits rolled back
By Liz Kowalczyk,
Boston Globe July 23, 2009

A growing number of hospitals, universities, and states are barring drug companies from buying physicians dinner, hiring them as speakers, and giving them even token gifts.

Now, a new organization of doctors - several from Boston - wants to roll back policies curbing interactions between doctors and drug company representatives, saying restrictive rules ultimately will hurt the patients they’re designed to protect.

The group, called the Association of Clinical Researchers and Educators, plans to hold its first conference today at Brigham and Women’s Hospital to promote “productive collaboration’’ between industry and physicians, which they say leads to better medicines and treatments. Dr. Jeffrey Flier, dean of Harvard Medical School, is one of 25 speakers and will give the welcoming remarks to about 200 attendees.

Flier, who is unaffiliated with the organization, will not endorse its views, said David Cameron, spokesman for the medical school, which is revising its conflict-of-interest policy. “He will welcome vigorous debate and analysis on the issue of academic collaborations with industry and encourage individuals with varied perspectives to participate in the discussion,’’ Cameron said in a written statement.

Dr. Thomas Stossel, an oncologist at the Brigham; Dr. Jeffrey Garber, chief of endocrinology at Harvard Vanguard Medical Associates; and Dr. Paul Richardson, an oncologist at Dana-Farber Cancer Institute, are among the founders of the group. Stossel said they want “to convey that there is a silent majority out there. And to restore some balance to the debate,’’ he said.

The group’s website says its long-term goals include reversing restrictive new conflict-of-interest policies and establishing chapters at universities and within medical specialty societies.

Massachusetts public health officials plan in two years to review the state’s new conflict-of-interest regulations, which went into effect July 1 and include a ban on gifts to doctors from drug and medical device companies, and Stossel said his group “wants to create an outcry against’’ the law. The law also requires drug and device companies to disclose publicly most payments made to doctors for consulting.

Partners HealthCare, which includes the Brigham and Massachusetts General Hospital, passed its own restrictions in April, which go further than the state law, banning all industry-paid gifts and meals and also forbidding doctors from traveling the country as paid members of company “speakers bureaus.’’

The association’s goals, which run contrary to the widespread movement in medicine to create more distance between doctors and pharmaceutical companies, have been widely discussed - and often derided - on healthcare blogs in the past several weeks.

Patient advocacy groups and lawmakers leading the charge for more restrictive policies say Stossel and his colleagues are misguided. Advocates of the restrictions believe drug companies, by giving doctors gifts and paying them to speak and consult, create bias in favor of their products, causing doctors to write more prescriptions for expensive new drugs even if patients don’t really need the medication or if an older, less expensive drug would work just as well.

Dr. Peter Slavin, president of Mass. General, has said that company-funded meals, gifts, and other practices don’t promote a positive image of doctors and increase healthcare costs.

“The rules benefit consumers by removing the conflicts that we know cloud judgment, and let doctors make decisions free from market pressures,’’ said Brian Rosman, research director for Health Care For All, a Boston-based patient advocacy group.

But Stossel and his colleagues said the new rules stifle invention. They believe the impact of small gifts and meals on doctors is negligible compared with the benefit of collaboration.

“I’ve been in medicine 40 years, and medicine is incomparably better than when I started out,’’ Stossel said. “I don’t think anyone can challenge the fact that it’s because of the tools we’ve gotten from industry.’’

Stossel is a former member of Cambridge-based Biogen Idec’s scientific advisory board. He said he now does occasional consulting to companies on conflict-of-interest policies. The conference is funded by attendees’ fees, though participants who work for drug and device companies are charged more, he said.

2009-07-16T00:41:00.000-07:00

Schwarzenegger Replaces Most of State Nursing Board
by Tracy Weber - July 13, 2009 9:55 pm EDT
Tags: Arnold Schwarzenegger, California, California Board of Registered Nursing, Nurses

California Gov. Arnold Schwarzenegger (John Moore/Getty Images)California Gov. Arnold Schwarzenegger replaced nearly everyone on the Board of Registered Nursing late Monday, citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.

Correction (July 14, 2009): This story incorrectly referred to former Board of Registered Nursing vice president Elizabeth O. Dietz as a professor of nursing at San Jose State. Although the board’s web site lists that as her current affiliation, the university said she retired in July 2008.

Update (July 14, 2009): Nursing Board Executive Officer Ruth Ann Terry Resigns [1]
Gov. Arnold Schwarzenegger replaced most members of the California Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct.

He fired three of six sitting board members [2] – including President Susanne Phillips [3] – in two-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, the governor's administration released a list of replacements.

The shake-up came a day after the Los Angeles Times and ProPublica published an investigation [4] finding that it takes the board, which oversees 350,000 licensees, an average of three years and five months [5] to investigate and close complaints against nurses.

During that time, nurses accused of wrongdoing are free to practice – often with spotless records – and move from hospital to hospital. Potential employers are unaware of the risks, and patients have been harmed as a result.

Reporters found nurses who continued to work unrestricted for years despite documented histories of incompetence, violence, criminal convictions and drug theft or abuse. In dozens of cases, nurses maintained clean records in California even though they had been suspended or fired by employers, disciplined by another California licensing board or restricted from practice by other states.

"It is absolutely unacceptable that it takes years to investigate such outrageous allegations of misconduct against licensed health professionals whom the public rely on for their health and well-being," Schwarzenegger said in a written statement.

Board member Andrea Guillen Dutton, in a resignation letter Sunday [6], said she was leaving in frustration. "Certain ‘bad actors' are jeopardizing the reputation of the entire nursing profession," she wrote. "This deeply saddens me."

"I have fought to defend the integrity of patient care throughout the state by holding the negligent accountable," she wrote. "However, I have grown increasingly frustrated by the board's lack of ability to achieve its stated objectives in a timely and efficient manner."

Besides Phillips, the other fired board members were vice president Elizabeth O. Dietz, a former professor of nursing at San Jose State, and Janice Glaab, a public affairs consultant.

Schwarzenegger's action Monday fills two of three vacancies on the board [2] and replaces four of the board's sitting members – all of whom had been appointed by him.

The two remaining members are Nancy L. Beecham, appointed by the governor in 2006, and Dian Harrison, who was appointed last year by Assembly speaker Karen Bass.

Neither Beecham nor Harrison could be reached late Monday, nor could any of the departing board members.

Schwarzenegger's statement said his "administration is dedicated to protecting public health and safety, and the new board will act quickly and decisively to achieve that goal."

Fred Aguiar, secretary of the State and Consumer Services Agency, said in an interview that the new board would be asked immediately to come up with a plan to eliminate the case backlog. "This plan needs to include how many more investigators are needed, how much that will cost. … I want to know now."

California Board of Registered Nursing executive officer

Ruth Ann Terry (Liz O. Baylen/Los Angeles Times)

The governor's decision does not directly affect the standing of Ruth Ann Terry, who has been the board's executive officer for nearly 16 years and a staff member for 25. Only the board has the power to hire and fire the executive.
Terry, reached late Monday, hung up on a reporter, saying, "We don't have anything to say."

But Aguiar suggested Monday that Terry and other staffers could be vulnerable. The governor "supports the new board in its commitment to protecting patients – and if that means cleaning house, including board staff, so be it," he said. "The days of excuses and status quo are over. It's broken and we're going to fix it."

The Times and ProPublica

In an interview last week, Terry acknowledged that the system needed to be "streamlined" but blamed other parts of the state's bureaucracy for delays.

Early Monday, Terry and her assistant executive officer, Heidi Goodman,

"Ruth and I are aware of the grim picture painted by this article," they wrote, "however, the board members, managers and supervisors know that you work very hard to carry out the mission of the board to protect the healthcare consumers in California and we appreciate all that you do."

Presented with the investigation's findings Thursday, board President Phillips, a family nurse practitioner and associate clinical professor at UC Irvine, said she supported Terry "absolutely – without question."

"The issue of patient safety is of the utmost importance to this board," she said. "It's not that we are ignoring a situation where there are delays. We absolutely are not."

Questions about the board's leadership were first raised last fall

In addition to the governor's action, the state Senate Business and Professions Committee, which has jurisdiction over the board, plans to hold a hearing next month to address the issues raised in The Times' article.

The committee will look at introducing legislation that would appoint an "enforcement monitor" to evaluate the board's discipline process and make recommendations, said Bill Gage, the committee's chief consultant. Such a monitor was appointed at one time to work with the Medical Board of California, which regulates the state's doctors.

Consumer advocate Ken McEldowney said the board members need to do more than just fill seats.

"The leadership is key," said McEldowney, executive director of Consumer Action, a San Francisco-based national consumer advocacy and education membership organization.

"It just appears to me that they don't care."

The six new board members are: Ann Boynton, 47, of Sacramento, a former undersecretary for the Health and Human Services Agency; Judy Corless, 58, of Corona, a clinical nursing director at the Corona Outpatient Surgical
Center since April 2009; Jeannine Graves, 49, of Sacramento, a staff nurse for the Capitol Surgical Associates and the Mercy San Juan Medical Center; Richard Rice, 60, of Imperial Beach, a former chairman of the Unemployment Insurance Appeals Board; Catherine Todero, 57, of La Mesa, director of the school of nursing at San Diego State University and a professor there; and Kathrine Ware, 50, of Davis, a nurse practitioner for the Vascular Center Clinic at the University of California Davis.

These positions do not require Senate confirmation, and the compensation is $100 per working day.

[8] when The Times and ProPublica reported that nurses with serious or multiple criminal convictions kept their licenses for years before the board acted against them. As a result, the board now requires every nurse to submit fingerprints [9], which can be matched against arrest records. Renewing nurses must also disclose any convictions or discipline by other states.sent an e-mail to all board staff members encouraging them not to lose heart [7].found that the board relied heavily on Terry and her staff [4]. At five public meetings attended by reporters since November 2007, Terry never focused on the delays in disciplining errant nurses. Neither did board members, even though they must vet all disciplinary actions.

Consumer Reports Profiles Survivor Alicia Cole

2009-07-04T22:56:00.000-07:00

Reform should make it easy to get information on quality
August 2009

'I lay in my hospital bed watching my stomach turn black and purple and rot. It looked as if I had been snapped in half by a shark.'— Alicia Cole, 46, of Sherman Oaks, Calif.Photo by Melanie Eve Barocas

This article is the archived version of a report that appeared in the August 2009 Consumer Reports magazine.

When Alicia Cole learned she needed surgery for benign fibroids, she did her homework on the surgeon and the hospital. "I looked at HealthGrades, Leapfrog, Hospital Compare, and other Web sites," says Cole, a 46-year-old actress from Sherman Oaks, Calif. "But one thing I didn't check was the hospital's infection rate."

Even if she had tried to check, California hospitals didn't have to make such data public, and hers didn't. Cole had the operation there anyway. During her hospital stay, she came down with a post-surgical flesh-eating infection that turned her entire midsection into something worthy of a horror movie. After two months in the hospital and two years of painful rehabilitation, she still can't work. "The skin and scar tissue is so delicate that the least pressure will tear or scratch it," she says. Federal inspectors subsequently found unsterile conditions in the hospital's operating area.

Enraged by her experience, Cole joined the fight against hospital infections and helped persuade the California legislature to pass a law requiring public reporting; she now sits on the advisory board for the law. Did she ever learn the hospital's infection rate? Sadly, no. The law has not yet been implemented. "What we really need is a national law," Cole says, noting that hospital-acquired infections are a leading cause of death in this country. "It's the elephant in the room," she says.

CU recommends

Health reform should make it simple to get good information on health-care quality. You should be able to find data not only on infection rates, a reform we've backed for years, but also on doctors, drugs, treatments, and errors. Yet most states still allow doctors to shield a history of malpractice settlements. And infection rates, if reported at all, are often kept secret, which doesn't provide enough incentive for improvement.

What does work is disclosure. Pennsylvania, which passed the first statewide reporting law, remains the only state to require disclosure of all major types of hospital infections. And infections there have dropped 8 percent in the last two years.

Read about our latest reform efforts and our analysis of legislation as its being debated in Washington, D.C. in our Guide to Health-Care Reform.

Surgery Tech Suspected of Exposing 5,700 to Hepatitis C

2009-07-04T20:47:00.001-07:00

Colorado Springs surgery tech suspected of exposing 5,700 to hepatitis C
July 2, 2009 - 6:28 PM
JOHN C. ENSSLIN AND BRIAN NEWSOME
THE GAZETTE

Federal officials Thursday warned that about 5,700 surgery patients, including 1,000 at a Colorado Springs surgery center, are at risk of having been infected by an operating room technician with hepatitis C.

On Thursday, federal authorities filed criminal charges in U.S. District Court in Denver against Kristen Diane Parker, a former scrub technician at Rose Medical Center in Denver and Audubon Ambulatory Surgery Center in Colorado Springs.

According to the criminal complaint, Parker - a former heroin addict - admitted swapping her own dirty syringes filled with saline solution for syringes filled with Fentanyl, a narcotic 80 to 100 times stronger than morphine.

The drug is supposed to be used to help major post-surgery patients manage pain. Instead, they got no relief while Parker injected herself with the painkiller at home and in the hospital bathrooms before and after a surgery, according to the seven-page complaint.

"I know I (expletive deleted) up," Parker told Denver Police Detective Dale Wallis after he confronted her during a videotaped interview on June 30. "I can't take back what I did, but I will have to live with it for the rest of my life, and so does everybody else."

She told Wallis she expects to spend the rest of her life in prison. She told the detective that she had used heroin from July 2008 to September 2008 while living in New Jersey. She said she had used dirty needles and "was 99.9 percent sure" that is how she was exposed to hepatitis C.

A MySpace page for a woman with the name Kristen Parker describes her as a 26-year-old Colorado Springs resident with interests in heavy metal rock, tattoos and needles.

"I have a crazy fascination with needles.. I just like the way they feel!" the Web page states.

According to an affidavit by Mary F. LaFrance, an investigator for the U.S. Food and Drug Administration, at least nine surgery patients at Rose have tested positive for the incurable disease.

As a result, authorities are advising 4,700 Rose patients and 1,000 Audubon patients that they may have been exposed and need to be tested.

Parker worked at Rose from October 21, 2008 until April 2009. She resigned on April 20 from Rose, but the hospital refused to accept her resignation and instead fired her.

She went to work for Audubon shortly after being fired from Rose. She worked there from May 4 until Monday, said Dr. J. Michael Hall, Audubon's medical director.

Hall said certified letters are being sent to all patients who had outpatient surgery at the center's Circle Drive and Union Boulevard location May 4-July 1 advising them they may have been exposed and with instructions on what to do. Patients at Audubon's two other locations, one near St. Francis Medical Center and a pain management center, are unaffected.

In the criminal complaint she is charged with tampering with a consumer product, creating a counterfeit controlled substance and obtaining a controlled substance "by deceit and subterfuge."

If convicted, she faces up to 10 years in prison and a maximum $250,000 on the most serious charge of tampering. She also faces state charges.

Parker is not a nurse and holds no medical degree although she is trained as a surgical technician. Her job involved preparing operating rooms prior to surgery.

Prior to being hired at Rose, she submitted to a pre-employment blood test which tested positive for hepatitis C. She was allowed to start work but hospital officials counseled her about the disease and exposure possibilities.

Rose placed her on administrative leave following an incident in which a co-worker was pricked by a needle in Parker's pocket on March 23, 2009.

According to the affidavit, Parker quickly disposed of the needle and denied any use of narcotics. She was allowed to return to work after a drug screening test came back negative.

The hospital placed her on administrative leave again after a co-worker reported seeing Parker in an operating room to which she was not assigned. She was tested again for drugs and this time the results were positive for Fentalyn.

The hospital had a press conference Thursday and released a prepared statement that apologized to patients who have been affected.

"It is impossible to adequately express how deeply sorry and angry we are that the unconscionable acts of this terminated employee may have put some of our patients at risk," the statement reads.

The hospital will offer free testing to surgery patients of the hospital or the outpatient surgery center. Also, hospital officials have created a phone line for affected patients and their families who have questions.

After an investigation by the Colorado Department of Health, Parker was ordered by the state to "immediately cease and desist any employment that requires contact with patients and/or pharmaceuticals."

Hall said his center learned of the situation Thursday from the Colorado Department of Public Health and Environment. State and local health authorities, as well as Atlanta physicians with the federal Centers for Disease Control and Prevention, are assisting in tracking the exposures.
Hepatitis C facts

According to the Centers for Disease Control Web site, about 15 to 25 percent of people infected with hepatitis C clear the virus and do not develop chronic infection for reasons that are not well known.

Those who do develop acute hepatitis C develop symptoms such as fever, fatigue, dark urine, abdominal pain, loss of appetite, clay colored stool, nausea, vomiting, joint pain and jaundice.

For every 100 people who contract the disease, 75 to 85 will develop a chronic infection. About 60 to 70 will develop chronic liver disease. About 5 to 20 will develop cirrhosis over a period of 20 to 30 years. Between 1 and 5 will die of liver cancer or cirrhosis.

Chronic hepatitis C infections account for about 8,000 to 10,000 deaths each year in the United States.

No vaccine for hepatitis C is available.

Health Insurance Insider: 'They Dump the Sick'

2009-06-24T22:13:00.000-07:00

Retired Health Insurance Executive Blows the Whistle on His Former Industry
By ALICE GOMSTYN ABC News Business Unit June 24, 2009

Frustrated Americans have long complained that their insurance companies valued the all-mighty buck over their health care. Today, a retired insurance executive confirmed their suspicions, arguing that the industry that once employed him regularly rips off its policyholders.

Retired health insurance executive Wendell Potter told Congress today that insurance companies routinely rip off customers.

"[T]hey confuse their customers and dump the sick, all so they can satisfy their Wall Street investors," former Cigna senior executive Wendell Potter said during a hearing on health insurance today before the Senate Committee on Commerce, Science, and Transportation.

Potter, who has more than 20 years of experience working in public relations for insurance companies Cigna and Humana, said companies routinely drop seriously ill policyholders so they can meet "Wall Street's relentless profit expectations."

"They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment," Potter said. "…(D)umping a small number of enrollees can have a big effect on the bottom line."

Small businesses, in particular, he said, have had trouble maintaining their employee health insurance coverage, he said.

"All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether," he said.

Potter also faulted insurance companies for being misleading both in advertising their policies to new customers and in communicating with existing policyholders.

More and more people, he said, are falling victim to "deceptive marketing practices" that encourage them to buy "what essentially is fake insurance," policies with high costs but surprisingly limited benefits.

Insurance companies continue to mislead consumers through "explanation of benefits" documents that note what payments the insurance company made and what's left for consumers to pay out of pocket, Potter said.

The documents, he said, are "notoriously incomprehensible."

"Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point," he said. "If they were more understandable, more consumers might realize that they are being ripped off."

For the rest of the story go to:

http://abcnews.go.com/Business/Health/story?id=7911195&page=1

Keeps Coming Back to Hygiene and Cleanliness!

2009-04-09T20:38:00.000-07:00

Study finds hospital mobile phones transmit message of MRSA
Stressed Out Nurses Weekly, March 16, 2009

A study recently published in the Annals of Clinical Microbiology and Antimicrobials suggests hospital phones could be spreading more than information.

Medical researchers from the Ondokuz Mayis University, located in Samsun, Turkey, tested samples from the hands of 200 ICU and OR healthcare workers from various hospitals, and performed cultures on 200 mobile phones, and found 95% of the phones were contaminated with bacteria including MRSA. Other microorganisms that surfaced have been linked to hospital-acquired infections. The study, which states the bacteria from both examinations was similar, suggests the hospital phones may allow for increased patient-to-patient transmission of bacteria in hospital settings.

In addition, researchers found only 10% of healthcare workers routinely cleaned hospital phones.

Study authors stress the need for healthcare workers to be trained on firm infection control practices, hand hygiene, and environmental disinfection.

They recommend preventative measures, such as regular decontamination of hospital phones with "alcohol containing disinfectant materials" and the use of "antimicrobial additive materials" to cut cross-infection.

Source: Annals of Clinical Microbiology and Antimicrobials

Hazards: Ambulance Stethoscopes May Pose Risk

2009-04-09T20:24:00.000-07:00

The New York Times
By ERIC NAGOURNEY

Stethoscopes carried by ambulance crews are not always cleaned as often as they should be, and as a result they may be exposing some patients to drug-resistant bacteria, a new study reports.
Researchers who looked at stethoscopes used by emergency medical services workers in New Jersey found that a significant number carried methicillin-resistant Staphylococcus aureus, bacteria known as MRSA that are resistant to standard drugs.

Some of the ambulance workers could not recall the last time the instruments had been cleaned, said the researchers, whose report appears in the current issue of Prehospital Emergency Care.

The study’s lead author, Dr. Mark A. Merlin of Robert Wood Johnson Medical School, said it was unclear how big a threat MRSA on a stethoscope posed to a patient. But as incidents of infection by the bacteria become more common, and with the possibility that it will become more resistant to antibiotics, it is important to reduce its spread, he said.

Researchers asked ambulance crews arriving at an emergency department over a 24-hour period to let their stethoscopes be tested. They also asked when the instruments had last been cleaned.

Of 50 stethoscopes tested, 16 had the bacteria, which a simple alcohol swab is usually enough to kill, the researchers said. “The concept of cleaning an entire ambulance after every patient is not practical,” they wrote. “Cleaning a stethoscope, however, is not labor-intensive, does not require much time, and does not require any special equipment beyond currently stocked items.”

Children's Staph Infections Increasingly Resistant to Drugs

2009-03-22T23:20:00.000-07:00

New York Times
By RONI CARYN RABIN
Published: January 20, 2009

Children are picking up more stubborn staph infections that don’t respond to common antibiotics, and the proportion of ear, nose and throat infections resistant to standard drug treatment increased dramatically over a six-year period, a new study has found.

Methicillin-resistant Staphylococcus aureus infections, known as MRSA, accounted for 28.1 percent of children’s head and neck staph infections in 2006, up from just 11.8 percent in 2001, according to researchers at Emory University in Atlanta. It once was rare for an ear, nose and throat doctor to see MRSA infections, noted Dr. Steven E. Sobol, the paper’s senior author and director of pediatric otolaryngology at Emory University School of Medicine.. “That was the impetus for the study,” he said.

The report was published in this week’s issue of Archives of Otolaryngology - Head and Neck Surgery.

“Over the past four or five years, we’ve seen an increased prevalence of these infections that used to be caused by other organisms that are now being caused by MRSA,” said Dr. Sobol. The researchers excluded from their analysis skin infections not caused by staph.

Though the study captured information from only a limited number of laboratories, the report’s authors said the overall trend is clear, concluding that there is “an alarming nationwide increase” in the prevalence of MRSA infections in children. The change parallels an increase in so-called community-acquired cases of MRSA among relatively healthy people who aren’t hospitalized or infirm.

The scientists analyzed 21,009 head and neck staph infections occurring among children from January 2001 to December 2006. The data came from a national electronic microbiology database that collects strain-specific drug resistance test results from labs affiliated with 300 hospitals around the country. The average age of the patients was 6.7 years old.

The proportion of drug resistant head and neck staph infections increased dramatically over the six-year period, the researchers found. Overall, 21.6 percent, or 4,534 samples, were methicillin-resistant, the greatest proportion of them involving the ear, nose and sinus and pharynx.

Only 11.8 percent of childhood head infections were resistant in 2001, but the figure jumped to 12.5 percent in 2002, 18.1 percent in 2003, and 27.2 percent in 2004.

The rate fell to 25.5 percent in 2005 and rose again to 28.1 percent in 2006, the researchers reported.

Almost 60 percent of the head and neck infections occurred among children who had not been in medical settings beforehand and were seeing doctors as outpatients, the researchers said, suggesting that children were exposed to resistant bacteria in the community.

Op-Ed Columnist

World MRSA Day

2009-01-12T16:52:00.000-08:00

MRSA SURVIVORS NETWORK
Dedicated to Providing Awareness, Education and Support
For Immediate Release:January 12, 2009

"Activism Marks First World MRSA Day"

Chicago-based MRSA Survivors Network announces the first "World MRSA Day" to be held October 2, 2009 and commemorated each year after on this date. October will also be designated "MRSA Awareness Month" and will call attention to the worldwide epidemic. MRSA was first discovered by Patricia Jevons, a microbiologist in the UK on Oct. 2, 1960 and nearly fifty years later, MRSA has spread worldwide.

Leading consumer patient advocates in their countries are lending their voice to the call of world unity in leadership and commitment in preventing and stopping MRSA, which is pandemic and rising at alarming rates in healthcare facilities and in the community. They call upon healthcare officials and leaders to step up and take a more aggressive and comprehensive approach to eradicate this preventable disease and focus on a broad and pro-active prevention program.

The hope of "World MRSA Day" is to bring people together every year to remind them of those who have lost their lives or have diminished health because of a preventable disease. By working together, whether as an advocate, scientist, healthcare worker, policy maker, student, caregiver or a patient living with MRSA we can collectively heighten the awareness and educate others on prevention.

To help provide education and awareness, a variety of events, exhibits, materials, candlelight vigils and commemoration programs are being planned and will be announced later.

For more information contact: MRSA Survivors Network
Jeanine Thomas – National Spokesperson for MRSA - USA
630 654-4588
jthomas@mrsasurvivors.org
www.mrsasurvviors.org

MRSA: Patients Revolt Against Hospital Secrecy

2008-11-25T23:01:00.000-08:00

By Michael J. Berens and Ken Armstrong
Seattle Times staff reporters

A night-shift nurse slipped into Jeanine Thomas' hospital room and whispered, "I don't know how you're taking this so well. If I were you, I'd be curled up in a ball crying."

The remark mystified Thomas. She'd had ankle surgery, and yes, there had been complications. But she thought she was recovering. Was there something she didn't know?

In November 2000, Thomas, then a 45-year-old antiques dealer, had slipped on ice and shattered her left ankle outside her suburban Chicago home. But days after surgery at her local hospital, the skin surrounding the incisions turned black, and her body swelled. Doctors wanted to amputate, but Thomas, an avid tennis player, refused to let them.

Then, a friend told Thomas about her mother's battle with MRSA, an antibiotic-resistan t germ. Their symptoms matched. Thomas confronted a doctor and learned the truth: She, too, had MRSA. Only now did the nurse's comment make sense.

Thomas asked doctors how many people get MRSA. She was met by silence.

"That's when I knew — a light bulb went on in my head," she says. "They don't want anyone to know about this."

Today, Thomas is exposing MRSA's staggering toll as one of the nation's most influential patient advocates. Because of her persistence, Illinois hospitals now must disclose MRSA infection rates and screen for the germ. She's also pushing for federal legislation that could enhance patient safety in Washington and every other state.

Thomas epitomizes a revolt in health care. A growing number of consumer advocates — many bound by ordeals with MRSA, or methicillin- resistant Staphylococcus aureus — have vowed that if the U.S. Hospital system will not heal itself, they will do it.

Five years ago, not a single state forced hospitals to reveal how many patients contracted infections while under their care. Now 25 states have some form of "report card" disclosure that can make hospitals more accountable.

Washington has a report card; it tracks three kinds of infections — but not MRSA.

MRSA rates in Washington have increased 33-fold in the past decade, a Seattle Times analysis shows. Last year, 4,723 hospital patients were diagnosed with the infection.

With fanfare, the state launched two initiatives last year to combat the epidemic. But in the end, neither made much difference.

In Washington, no patient advocate like Thomas has emerged.

Advocates gain ground

Across the country, consumer advocates have embraced two tools — MRSA screening and hospital report cards — to make hospitals more transparent and aggressive when dealing with infections.

The more popular has been report cards, often a byproduct of patient frustration with hospital secrecy and inadequate infection control.

Chris Cahill, a consumer advocate, worked with legislators to pass a report-card law this year in California.

Before retiring in 2006, Cahill worked for 12 years as a hospital surveyor for the California Department of Health Services. She inspected dozens of hospitals and saw how they could become easy targets for contagion. Some hospitals are "so filthy and dirty it's just incredible," she says.

Many infection-control departments, a cornerstone of patient safety, have so little staff and equipment that it's impossible to track every germ or consistently enforce standards, she says. Even large hospitals often put infection control in the hands of just one or two nurses.

"Many hospitals see infection control as a necessary evil. All they see is the bottom line," Cahill says.

That so many states have recently adopted hospital report cards shows how influential consumer advocates have become. But the hospital industry has often pushed back.

Some hospital officials believe consumers will draw unfair comparisons from report cards, without considering how each hospital has different patient populations. A hospital with a trauma center will have more patients who are vulnerable than one that focuses on elective surgeries.
Lawmakers in some states have passed report cards that provide little information to the public.
In Nevada and Nebraska, hospitals now must report infections to state health officials. But to the public, the numbers remain locked away.

Arkansas encourages hospitals to report infection rates — if they want to. Most don't.

"Not essential right now"

Washington passed its own report-card act in spring 2007. But hospitals have to report only one kind of infection this year: bloodstream maladies in patients who receive a central-line intravenous hookup. The report card will add a second type of infection next year, and a third by 2010. But MRSA is not among them.

Twice before, report-card legislation had died in Washington, after drawing fierce opposition from the hospital industry. The current measure represents a compromise or a first step, said state Rep. Tom Campbell, R-Roy, who sponsored the bill.

In Washington, MRSA has been linked to 1,217 deaths in the past decade, a Seattle Times analysis of hospital records shows. At least 23,707 hospital patients have been diagnosed with MRSA infections.

One Seattle hospital estimates that it costs $20,000 to treat a MRSA infection. Using that figure, MRSA's financial toll in Washington exceeds $474 million.

In the report-card bill, Washington lawmakers had included $240,000 for state health officials to investigate MRSA outbreaks, establish surveillance programs and educate health-care workers and the public about stopping the germ's spread.

The Washington Hospital Association supported the measure, which would have allotted public money to address MRSA.

But Gov. Christine Gregoire stripped the provision out, along with all kinds of other spending items. Her veto notes called the measure "valuable" but "not essential to do right now."

The Illinois fight begins

While hospital report cards have been enacted in much of the country, legislation requiring hospitals to screen patients for MRSA has been difficult to pass.

When Jeanine Thomas contracted MRSA in 2000, no state had even considered such a law. Her success in changing the culture has become a strategic blueprint for consumers in other states, where hospital resistance to mandated screening remains steadfast.

After her ankle healed enough that she could walk, Thomas cobbled together bits and pieces of information about a germ that few seemed to know about.

In 2003, she helped muster support for a bill requiring Illinois hospitals to disclose infection rates. A state senator named Barack Obama co-sponsored the legislation, which passed that year.

The experience inspired Thomas. She began campaigning for a law that would require hospitals to screen patients for MRSA. The screening test, which costs about $20, allows hospitals to identify who has the germ and to isolate them, to protect other patients.

Thomas wrote letters to state legislators and spoke out at health-care meetings. She said doctors undecided about screening had adopted a "compromise of doing nothing."

To combat the medical establishment, she received help from two of the nation's leading infection-control experts. One was Dr. Barry Farr, who was retired from the University of Virginia. Farr had urged hospitals since the 1980s to adopt aggressive screening programs, but he often met with resistance.

The other was Dr. William Jarvis, former acting director of the Centers for Disease Control and Prevention (CDC). Jarvis also supported screening, and sparred with its opponents at infection-control conferences.

"The public is tired of waiting for us to decide this debate and move into action," he says.

By late 2005, Thomas had forged an alliance with Illinois state Sen. Christine Radogno, who agreed to sponsor legislation that would mandate MRSA screening. If passed, the law would be the nation's first.

Thomas later wrote a note about her meeting with Radogno: "She told me tell no one."

They agreed that stealth was necessary because a war was about to begin.

Maryland bill fails

In Maryland, a home contractor from Baltimore had already started a similar war.

Michael Bennett created the Coalition for Patients' Rights after his 88-year-old father, Mark, contracted MRSA at a local hospital. A week after getting MRSA, his father picked up two more antibiotic-resistan t germs. Those infections touched off necrotizing fasciitis — also called flesh-eating disease — and his leg was amputated.

Bennett's father was transferred to a series of rehabilitation centers. There he picked up three more infections, which destroyed his kidneys and poisoned his blood before killing him in June 2004.

While his father was in the hospital, Bennett says, doctors let two months pass before revealing the MRSA diagnosis. During that time, he says, dozens of staffers could have spread the germ. They only occasionally wore gloves or gowns or washed their hands after caring for his father.

In 2005, Bennett helped get legislation introduced to mandate MRSA screening in Maryland.
"Hospital infections have been killing too many for far too long," he says.

But the bill received what Bennett calls a "barrage of criticism" from hospital-industry officials, and it went down to defeat. Bennett tried again in 2006 and 2007, but with the same result.

The first breakthrough

When the Illinois MRSA legislation was introduced in January 2006, a firestorm erupted.

National medical groups attacked the bill, challenging screening's benefits and costs while touting existing infection-control measures, such as hand hygiene. The bill died in a House committee.

But Thomas tried again.

The first public hearing was held in February 2007 in downtown Chicago, during a fierce snowstorm. Many opponents showed up; Thomas was the lone supporter.

The Illinois Hospital Association originally opposed Thomas, fearing her proposal would force hospitals to test every patient. Later, when assured the scope was limited to critically ill patients and others at high risk of contracting MRSA, the association supported the measure.

The association had conducted research of patient-discharge data — the same kind of analysis The Seattle Times did in Washington — and was stunned at how many MRSA cases it found, Thomas says.

In May 2007, the bill passed the Illinois Legislature. The House vote was 106-0.

Thomas immediately called Farr: "He was overcome. He said he had waited so long for this."
But in August, an aide to Gov. Rod Blagojevich called and told Thomas the governor intended to veto the bill. His office issued a news release saying as much. Thomas, crying, began working the phones, rallying legislators to flood the governor with calls.

A few hours later, the governor changed his mind and signed the bill.

Three other states — Pennsylvania, New Jersey and California — have since passed similar screening laws.

"Impractical or extreme"

Washington, like the rest of the country, was rattled last October by the highly publicized announcement of the federal Centers for Disease Control and Prevention that MRSA now kills more people than AIDS.

Some schools closed temporarily over a single MRSA infection, or canceled football games so locker rooms could be disinfected.

In November, Gregoire wrote to the state Health Department, saying: "We need to do more." She ordered the agency to collect MRSA test results from medical laboratories statewide, and to create a panel of experts to recommend ways to curb MRSA's spread.

"Gregoire takes on superbug," a Seattle Times headline said.

But a year later, these two unfunded initiatives have had little effect.

The reporting of test results was voluntary, so some labs did not submit them. In other cases, the information was so sketchy that state officials couldn't tell where people caught the germ.
"We didn't find a whole lot of meaningful data," says Judith May, the Health Department's acting director of epidemiology.

As for the expert panel, it was stacked with hospital representatives, without a single consumer advocate. In January, the 18-member panel published its MRSA report — an 82-page rehash of existing medical literature.

The panel opposed screening all patients for MRSA, calling it "impractical or extreme ... with little added value."

Instead, it recommended that hospitals use infection-control guidelines from the CDC. But those guidelines have been widely criticized by congressional investigators, who call them confusing and conflicting.

In Washington, most community hospitals make these guidelines the core of their infection-control programs. None tests every patient for MRSA.

Last month, a representative of the Illinois Hospital Association met with a few dozen Washington hospital officials and touted the benefits of widespread MRSA screening.

For the first time, Illinois is getting a true picture of MRSA's toll, the representative told them.
Last year, the Illinois hospital group found approximately 11,300 MRSA cases. But this year, with screening in full force, the group estimates the number could be close to 30,000.

The fight continues

Today, Jeanine Thomas runs the MRSA Survivors Network.

She's haunted by memories of her time in the hospital, when she rolled up and down the corridors in a wheelchair, or grabbed coffee in the cafeteria, or used the drinking fountains.
"For two months I didn't know I had this infectious germ. The hospital let me go wherever I wanted.

"How many people did I infect?"

These days, she is campaigning for a federal law to mandate hospital MRSA screening in every state.

She criticizes Washington's refusal to embrace widespread screening, saying many of its hospitals are endangering patients.

Her Web page links to survivor stories, from a mother who lost her 7-week-old daughter to MRSA to a 58-year-old man who lost much of his left leg.

Thomas points to these survivors when confronting critics of MRSA screening.

"I'm trying to save lives," she tells them. "What are you trying to save?"

Michael J. Berens: mberens@seattletime s.com or 206-464-2288; Ken Armstrong: karmstrong@seattlet imes.com or 206-464-3730. Reporter Justin Mayo and researchers David Turim and Gene Balk contributed.
Copyright © 2008 The Seattle Times Company

Bet the Hospital & Doctors are Doing Fine

2008-11-25T19:41:00.000-08:00

Staph infections have ruined the life of Brook Park man
by Harlan Spector/Plain Dealer Reporter
Saturday November 22, 2008, 7:26 PM
Photo Marvin Fong/The Plain Dealer

Roger Chorich has battled staph infections for years, culminating in amputation of both his legs.

BROOK PARK -- Roger Chorich's days are a blur of TV watching and bumping around the house in a wheelchair. He pops painkillers and antidepressants, and obsesses about bill collectors.

He will never know for sure how he got to such a dark place. Wracked with intractable infections since double knee replacements four years ago, he finally had to have his left leg amputated in August 2007. Then last month doctors took the right leg.

How was infectious staph able to burrow deep into his joints and render him a double amputee?

Was the hospital less than sterile?

Who's at fault?

Anyone?

The questions become more searing with time, as he and his wife, Anita, fall further behind on bills. He stares out the windows of their small brick ranch, at the yard he once planted with impatiens and marigolds, waiting for a certified letter announcing foreclosure proceedings.

He's 58 and lives on a $1,600-a-month pension from the U.S. Postal Service. They're in bankruptcy. His medical needs are too great for Anita to take on full-time work. She's always hauling him to the doctor, sliding him into the Ford Taurus with a board placed under his torso.

"We're probably going to lose the house," Chorich said, his voice tight with tension. "I'm just angry with the whole world, I guess. I just don't know where to go."

His long battle with staph has been chronicled twice before in Plain Dealer stories about hospital infections. Antibiotic-resistant staph, the same type that has sidelined a growing roster of pro football players, spread throughout Chorich's body after the knee replacements. He turned to Dr. John Sontich, an orthopedic surgeon at MetroHealth Medical Center, who again and again has cut into Chorich's ravaged knee implants and infected bone.

The final blow to Chorich's right knee was an uncontrollable yeast infection caused by years of antibiotic use. It was his third knee implant on that side, and it harbored resistant staph bacteria as well. Sontich had no choice but to amputate one-third up the femur.

Sontich said he's hoping that without artificial joints to hide in, the staph infections are gone for good.

No more antibiotics.

No more painkillers.

"He's going to be able to walk with crutches or maybe a cane," the doctor said.

Chorich has been down this road before, thinking the staph was gone, only to feel piercing pain return.

"It's like cancer," said Anita, who was treated for breast cancer six years ago. "I'm already afraid it's [staph] going to come back."

Chorich is hoping to eventually walk on prosthetics. The left one is now gathering dust in a corner in the bedroom, while he awaits a prosthetic for the right. He hopes to work again, and chip away at a debt pile of about $150,000. Anita has a temporary job running the kiddie train at Great Northern Mall three days a week. She applied to be an usher or ticket taker at Progressive Field in the spring.

"Maybe I could be doing something inside," Chorich said. "I've never done it. I've been a laborer. If someone would train me, I'd do it."

People have helped out here and there.

Leona Osrin of Beachwood wrote to Chorich and sent a check after reading about his ordeal. She recently sent him another $100.

"To have to live this way is absolutely horrific," Osrin said in an interview. "My few dollars isn't going to change his life, but it shows somebody cares about him."

Anita has hope. She thinks they will be able to renegotiate terms of a $90,000 home equity loan. "I don't worry as much as him. I always hope things are going to get better," she said.
Chorich bristled. "If we don't pay for the house, they're going to come after you," he snapped at her. "We're in trouble."

The combination of pills, depression, immobility and idle time has taken a toll.

She grabbed her packed lunch from the kitchen. "He needs to talk to somebody," she confided as she passed. Then she kissed him goodbye and left for the mall.

Meet Logan, The Sky Angel Cowboy - CBN News

2008-11-04T12:43:00.001-08:00

If you have lost someone that you care about, if you have endured a long and painful illness, if you find yourself feeling isolated and alone...angry at God and the world. You will be inspired by this young boy.

Don't Mess with Maria!

2008-10-02T00:56:00.000-07:00

Schwarzenegger creates hospital privacy oversight office
The move comes months after his wife, Maria Shriver, and other celebrities had their medical records peeked at by employees at UCLA.

By Patrick Mcgreevy October 01, 2008

SACRAMENTO – Gov. Arnold Schwarzenegger took action today to enable the state to impose stiff fines on hospital employees who snoop in their patients’ files, months after California First Lady Maria Shriver was one of several celebrities whose privacy was invaded at UCLA Medical Center.

The governor approved the creation of a new state Office of Health Information Integrity with power to review security plans and violations and assess fines of up to $250,000 against violators of patient privacy.

The governor’s decision follows a series of reports by The Times during the last year that at least 127 employees at UCLA peeked at the confidential medical records of celebrities including Britney Spears, Farrah Fawcett and Shriver.

“Repeated violations of patient confidentiality are potentially harmful to Californians, which is why financial penalties are needed to ensure employees and facilities do not breach confidential medical information,” Schwarzenegger said in a statement after signing AB 211, by Assemblyman Dave Jones (D-Sacramento), which creates the new oversight office and fines on individuals.

He also signed a companion bill that allows fines of up to $250,000 against hospitals and health clinics for such breaches and increases the maximum fine for serious medical errors from the current $50,000 to $125,000. SB 541 was written by Sen. Elaine Alquist (D-Santa Clara).

Schwarzenegger was outraged when his wife’s records were breached by an employee, saying no one should have that happen.

“Californians seeking care at a hospital or health facility should never have to worry that their private medical information will be shared,” the governor said today.

patrick.mcgreevy@latimes.com

Unsanitary Dialysis Center Shuts Down Over Hepatitis

2008-09-18T20:09:00.000-07:00

By ANEMONA HARTOCOLLIS
Published: September 16, 2008

A Manhattan dialysis center closed down after State Health Department inspectors found blood on chairs and machines and discovered that at least one patient had contracted hepatitis C because of the unsanitary conditions.

More than 600 other patients treated at the center, going back nearly five years, were urged to get hepatitis and H.I.V. tests.

Claudia Hutton, a spokeswoman for the Health Department, said on Tuesday that it inspected the clinic, the Life Care Dialysis Center, at 221 West 61st Street, for a week in mid-August and found that employees had failed to wash their hands properly, disinfect equipment or change gloves between patients. Inspectors also found blood on treatment chairs.

“It was repulsive,” Ms. Hutton said. “The treatment chairs that they gave people to relax in had someone else’s dried blood on them.”

Ms. Hutton said that the clinic was ordered to begin sending its patients to other clinics immediately while the Health Department began testing patients for signs of infection.
She said that when one patient was found to have been infected by hepatitis C, a liver disease, because of contaminated equipment, the clinic shut down voluntarily.

Richard F. Daines, the state’s health commissioner, sent letters on Monday to 657 patients of the clinic going back to January 2004, the last time infection-control violations had been found, urging them to be tested for possible exposure to hepatitis C, hepatitis B and H.I.V. The clinic, which had 171 patients at the time of the inspection, agreed to pay for the testing, even if it is done by private doctors, officials said.

Ms. Hutton said there was no evidence that other patients had been infected.

Dr. Walter Wasser, the clinic’s operator and medical director, was fined $300,000 and surrendered his operating certificate, Ms. Hutton said. He could face the loss of his medical license after an investigation by the State Office of Professional Medical Conduct, Ms. Hutton said. She declined to say whether such an investigation had begun.

Dr. Wasser did not return a call for comment left with his answering service.

Ms. Hutton said that the Health Department visited the clinic in August to follow up on previous violations, not because of any specific new complaints from patients. She said the department tried to inspect clinics once a year, but was sometimes not able to do so that often because of manpower shortages and the volume of complaints.

She said the department was particularly concerned about dialysis clinics because their patients have compromised immune systems that make them vulnerable.

http://www.nytimes.com/2008/09/17/nyregion/17dialysis.html?_r=2&ref=nyregion&oref=slogin&oref=slogin

Special Dyes and Lighting Kill MRSA, Research Shows

2008-09-10T20:54:00.000-07:00

But new technologies don't replace basic infection control procedures, expert says

By Steven Reinberg, HealthDay Reporter

WEDNESDAY, Sept. 10 (HealthDay News) -- A new kind of paint that releases titanium dioxide when exposed to fluorescent light and a green dye for wounds that gives off toxic molecules when activated by near-infrared light could both kill the deadly superbug known as MRSA, two new studies claim.

MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to many antibiotics commonly used to treat it, and it can be fatal. Both reports were presented Tuesday at the Society for General Microbiology Autumn meeting at Trinity College in Dublin.

In the first study, British researcher Lucia Caballero, from Manchester Metropolitan University, found that paint that contained particles of titanium dioxide killed bacteria when it absorbed ultraviolet light.

"If this turns out, the impact is sure to be positive in the area of health," Caballero said.

The same reaction occurs when paints containing titanium dioxide are exposed to infrared light. The researchers found that the paint containing titanium dioxide successfully killed bacteria when the concentration of these nanoparticles was stronger than the normal paint. In fact, they found that all E. coli were killed with fluorescent lights.

"There are many circumstances where it is necessary or desirable to remove or to kill microorganisms found in a biological host or on surfaces," Caballero said. "Maintenance of hygienic standards is essential in hospitals, pharma and the food industry. Surface hygiene could be improved by the action of fluorescent light on catalytic surfaces, such as paints containing nanotitanium, for retarding contamination and saving on cost of cleaning maintenance."

In the second report, Dr. Ghada Omar, from University College London, found that 99 percent of the MRSA bacteria in infected wounds could be killed using a green dye that gives off toxic molecules when activated by infrared light.

"The chemicals produced when the dye is activated harm the bacteria in such a wide variety of ways that it is unlikely bacteria could ever develop resistance to the treatment," Omar said in a statement. "This makes it ideal, and possibly the only option, for treating infections with multiple drug-resistant bacteria, including MRSA."

Infected wounds are a major problem for thousands of hospital patients. Up to 9 percent of hospital-acquired infections occur during surgery and contribute to 77 percent of deaths from operations. These infections increase the length of time patients remain in hospital and increase costs, Omar noted.

Dr. Pascal James Imperato, Dean and Distinguished Service Professor of the Graduate Program in Public Health at SUNY Downstate Medical Center in Brooklyn, said a lot more work needs to be done before these technologies become practical.

"It's very much in the experimental stage at this point," Imperato said. "It's an interesting new development, but one is going to have to see many more studies to determine whether or not this is really going to work."

Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine, thinks that basic cleanliness can do more to remove the threat of hospital infections than these new technologies.

"This technology is very promising, but it gets us away from the real issue, which is that we have a problem with cleanliness and sterility in hospitals," Siegel said. "The real issue is that doctors don't change their coats, change their gloves enough. We are not using hand wipes."

Siegel noted that soap and water, when used properly, gets rid of most of this bacteria.

"MRSA has been around for 20 years and is a symptom of our inability to properly clean and sterilize facilities, while, at the same time, we are overusing antibiotics," Siegel said.

For more on MRSA, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Lucia Caballero, Manchester Metropolitan University, U.K.; Marc Siegel, M.D., associate professor, medicine, New York University School of Medicine, New York City, and author, Bird Flu: Everything You Need to Know About the Next Pandemic; Pascal James Imperato, M.D., M.P.H., dean and distinguished service professor, Graduate Program in Public Health, SUNY Downstate Medical Center, Brooklyn, New York; Sept, 9, 2008, presentations, Society for General Microbiology Autumn meeting, Trinity College, Dublin

A Real Look at the Joint Commission

2008-09-08T13:05:00.000-07:00

Value of hospital accreditations under review

By YAMIL BERARD yberard@star-telegram.com

Christine Cahill, a government inspector, walked in to the operating room of a Los Angeles county hospital and found a technician cleaning a surgical instrument. He told her that he had just washed it, but she noticed no water in the sink, so she questioned how he had cleaned it, and he said he had used a cleaner that was in a bottle on the shelf.

"Give me a Q-Tip," she said. She shoved it into the hollow bore of the instrument.

"Out came this crud," she recalled. It was dried-up fragments of bone and blood.

At one out of every three hospitals Cahill surveyed for the federal government in California from 2004-06, she said she found egregious deficiencies that put patients’ lives at risk. Yet these same hospitals, within a year before her review, had received passing grades from the Joint Commission, America’s top healthcare evaluator.

It gave its most prestigious honor — its trademark Gold Seal of Approval — to Martin Luther King Jr./Drew Medical Center, where Cahill found the filthy surgical instrument.

And the commission also awarded that top honor, symbolizing that a hospital has met the most rigorous standards for patient care and safety, to John Peter Smith Hospital in Fort Worth in spring 2006 — the year before an independent consultant documented pervasive problems that put patients at risk.

Now, the Joint Commission itself is under review. For the first time in three decades, Congress is requiring the commission to reapply for authority to certify that hospitals meet federal standards. The commission has a virtual monopoly on hospital accreditation; 88 percent of the nation’s hospitals now choose it over a state agency.

The commission isn’t flinching over the new requirement. It posted a statement on its Web site saying it "is confident that it will receive deeming authority."

But Congress’ rare move opens up the application process to other organizations — including one in Houston that is drawing the interest of a number of Texas hospitals. Some member hospitals are griping that commission reviews often depart from Medicare standards, creating more compliance work.

For critics who characterize the relationship between the commission and client hospitals as too cozy, there couldn’t be a better time to shake up the status quo.

The situation resembles a "country-club-like setting," said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group in Washington, D.C., a consumers group. "What’s the point of having a regulator that’s a cheerleader over the institution they are supposed to be regulating?"
Scandals also fired up congressional debate last year involving the value of the commission’s accreditation. At issue were cases of accredited hospitals where patients got grossly inadequate treatment. One was a 14-bed West Texas facility where a patient died and federal officials reported that numerous staff members did not have adequate training for the medical procedures they were performing.

As a response to critics, the commission has been working in recent years to beef up its reviews. So-called unannounced visits — in which hospitals are given 48 hours’ warning — began a few years ago. Surveyors now track patients in the operating room and question doctors about diagnoses. What’s more, the agency responds not only to patient concerns, but to news reports of problems, as they did with JPS.

Commission surveyors arrived unannounced at JPS in June following Star-Telegram reports describing the JPS trauma center as a war zone, operating rooms as chaotic, instruments broken, rooms dirty, linens threadbare. Patients were put at risk when doctors couldn’t locate lab results or get crucial reports from specialists.

"We take all complaints seriously," commission spokeswoman Elizabeth Zhani said.
The inspectors cited a list of deficiencies, including intrusions into patient privacy, use of outdated drugs, filth and a system that could not keep track of narcotics, hospital officials said.
Such disturbing findings don’t mean the accreditation process is flawed, Zhani said.

"Accreditation is just not a [survey] visit," she said. "A lot of people tend to focus on that. We don’t know everything else that goes on."

"We cannot be there 365 days of the year," Zhani said.

But critics say the commission will be hard-pressed to identify a hazard so serious that it will shut down a hospital. It didn’t pull the accreditation from Martin Luther King Jr./Drew Medical Center until a year after Cahill conducted her survey — and the news media highlighted patient deaths tied to staff errors.

The Joint Commission process "in itself is, to say the least, superficial," Cahill said. "It doesn’t tell you what the hospital is doing."

Survey problems

The Joint Commission’s plan of attack has always been to "peer-review" or educate hospitals about quality standards, not regulate them, Zhani said.

"Organizations who contract with the Joint Commission are voluntarily saying: 'We want you to come in and survey us and inspect us to see if we’re following your standards for patient care,’ " Zhani said. "They are making a commitment that they want to focus on quality improvement."

But even supporters say the survey process has weaknesses.

Hospitals, no matter the size, are surveyed at least every three years. And the inspectors — usually independent contractors, not commission employees — spend about three days, often in back-to-back interviews with hospital administrators. Some say that doesn’t allow sufficient time for investigation.

At times, medical records are reviewed to make sure the proper documentation is there, not that patients received the proper medication, critics say. The focus of the surveys is on process rather than outcome, said Emily Moreno, a San Antonio registered nurse, now retired, who spent 30 years doing quality assurance at hospitals.

Even at that, though, a surveyor might have found what the JPS consultant did — that up to 20 percent of all medical records were missing.

It also isn’t clear to what degree hospital officials direct surveyors to departments or whether surveyors can — or have time to — wander around and just freely observe. That could explain why troubling problems were apparently overlooked at JPS.

Because the Joint Commission doesn’t make its reports available to the public, patients can’t be assured that surveyors visited some of the less conspicuous areas of the hospital, such as the unit that houses Tarrant County Jail inmates.

An independent consultant in 2007 noted a "dungeon like feel" to the unit and said that infectious patients were housed with noninfectious ones, with the potential of exposing patients, staff and sheriff’s deputies to such diseases as tuberculosis. Staff members told the consultant that the toilets were usually dirty and smelly, garbage cans regularly overflowed. Furniture was broken, and workspaces put doctors and nurses at risk of attack.

The Star-Telegram was not able to interview commission inspectors, despite repeated attempts.
When the survey turns up deficiencies, the commission works with hospitals to help them meet standards. And the commission continues to unveil better methods of identifying patient safety risks. One is a new practice in which surveyors "trace" or follow patients in surgery and other critical services in order to look for vulnerabilities in a hospital’s management of their care.
But critics say that the Joint Commission has other interests that may trump patient safety and lead the commission to stymie efforts that would strengthen compliance and public awareness of hospital problems.

For one, it relies on hospitals for the lion’s share of its $108 million in revenue. Hospitals pay tens of thousands of dollars for their survey evaluations. What’s more, the commission sells its consulting services to help hospitals meet accreditation standards. That boosts sales and creates the potential for conflicts of interest.

"It’s basically run by the [hospital] industry," said Julia Greene, a healthcare professional in Chicago with the Service Employees International Union, which has 2 million members, including the nation’s largest healthcare union.

Among those seeking change is the American Nurses Association, which blames the U.S. Department of Health and Human Services for failing to adequately supervise the commission’s role in the accreditation of hospitals.

Pressure is also coming from some groups concerned about rising healthcare costs. Business groups and insurers want to know if they are getting effective care for their money.

The Office of the Inspector General of DHHS is also expected to add fuel to the fire to revamp the commission. By winter, it is expected to release an examination of the commission’s accreditation process. The inspector general last reviewed the nonprofit in a scathing 1999 report that said its inspections were superficial and left little time for real scrutiny of a hospital’s errant practitioners — the ones most apt to do harm to patients.

Checks and balances

The government does provide some checks and balances to the commission in the form of federal validation surveys, such as Cahill’s at Martin Luther King Jr./Drew, which closed in August 2007 because of substandard conditions.

The surveys are conducted to validate the processes of the commission — "to make sure they’re doing what they’re supposed to be doing," Cahill said.

At most, only 5 percent of the nation’s hospitals undergo the federal scrutiny each year, she said.

But they always involve a team of specialists who spend a longer period studying a hospital, relying on a set of 19 health quality "conditions" required under Medicare regulations. For the MLK Jr./Drew Medical Center survey, Cahill was teamed with pharmacists, nutritionists, nurses and physicians. The surveys can last up to five days, and surveyors can visit the hospital four or five times to check to see that the hospital has corrected problems.

"When [government inspectors] do a validation survey based on the federal regulations, they are very, very thorough and the survey process is a much better process at finding problems than the Joint Commission would ever be," Cahill said.

While inspectors will suggest ways to improve, the survey is intended to root out bad practices, Cahill said.

If a medical record is reviewed, for example, government inspectors observe the patient’s care to see if the practice matches the hospital’s policy and federal standards, she said.

"We probe it further until we are convinced that it’s not an issue or it is an issue," she said.
That’s how inspectors found the case of a meningitis patient who had mistakenly received a potent anticancer drug for four days at the Los Angeles hospital.

Patients may also get some protection from state enforcement agencies. In June, Texas health inspectors were quick to arrive at JPS after news reports drew the commission back for a closer look. State inspectors are closer to the action and can add more layers of protection, the DHHS inspector general reported in 2000.

And next year, there may be a new face or two arriving to accredit hospitals in Texas. A Houston-based accreditation company — DNV Healthcare — is drawing the interest of a number of hospitals who say the commission’s standards deviate too far from Medicare rules.

The commission may have to reckon with the idea that, over time, it could lose its virtual monopoly on accreditation.

That’s all right with the Texas Hospital Association.

Competition "is a good thing . . .," says Starr West, senior director of policy analysis for the association.

"This sort of levels the playing field. We’ve been very supportive of having competition . . . it kind of keeps everybody in line."

Changes in hospitals sought Consumer advocates and other critics are pressing the Joint Commission to strengthen public accountability of hospitals. These are some of the changes being sought.

1 Disclose more information, including life-threatening medical errors and hospital deficiencies.

A commission manual states that hospitals are "encouraged" to report sentinel events, including patient suicide, abduction of newborns, foreign objects left in patients’ bodies during surgery and other major events. But hospitals are not required to do so. When a hospital does report, the commission usually does not identify it to the public. A national snapshot of reported sentinel events on the Joint Commission Web site shows just a map of the number of incidents by state.

Releasing the names of hospitals where sentinel events occurred would be a small step in protecting the public, said Lisa McGiffert, senior policy analyst at Consumers Union in Austin, which publishes Consumer Reports. But even that wouldn’t provide the public with information it needs, she said. For example, the Centers for Disease Control and Prevention estimates that almost 100,000 people die of hospital-acquired infections each year, yet in the past 13 years, the Joint Commission has classified only 105 cases as sentinel events, she said.

"If these sentinel events weren’t so misleading to the public, it’d be laughable," McGiffert said.
"The public has this belief that someone else is watching and making sure that hospitals are safe, and they are mistaken. Nobody is watching."

2 Make survey reports available to the public.

On its Web site, the commission publishes "Quality Reports" that compare a hospital’s performance in a handful of areas to that of other hospitals. For example, John Peter Smith Hospital’s report shows that in 2007 it rated below most accredited hospitals in the country when it comes to heart attack care. ( www.qualitycheck.org/qualityreport.aspx?hcoid=9048#)

But it’s left up to hospitals to decide whether to disclose deficiencies noted by surveyors. After commission inspectors paid a surprise visit to JPS this summer, the hospital made public some findings but did not release the report and specific deficiencies.

"If the organization wants to release the report, they can release it," Joint Commission spokeswoman Elizabeth Zhani said.

3 Pay more heed to patient complaints.

Emily Moreno of San Antonio, who focused on hospital quality during her 30 years as a registered nurse, filed a complaint with the commission after she developed an infection at the site of a breast biopsy at an Oklahoma City hospital. The commission had accredited the hospital seven months earlier.

It took no action on her complaint, she said. It only told her, in response, that it gives "serious consideration" to all complaints.

Susan Sheridan, an Idaho mother of a child with cerebral palsy, did get the commission’s attention. Her son, now 13, suffered brain damage because of the failure of hospitals to test newborns for jaundice. She and other mothers of children with cerebral palsy co-founded Parents of Infants of Children with Kernicterus. Thanks to her advocacy, hospitals now test for excessive bilirubin levels in newborns.

4 Place more patient representatives on the commission board.

Sheridan would also like to see the commission open up more hospital data to the public, but doesn’t believe that will happen soon.

"Their very structure stifles that," she said. Most of its board members are doctors or health practitioners.

"What ties their hands basically is that its members and their clients are hospitals," she said.

Public Pressure Is Working

2008-08-19T13:57:00.000-07:00

7 SoCal Hospitals Fined For Medical Errors

KTLA News August 18, 2008, 8:58 PM PDT

LOS ANGELES -- Seven hospitals in L.A. and Orange counties were fined today by the state for mistakes that included leaving surgical tools in patients and over-medicating a patient.

"Ensuring all Californians receive quality patient care is our top priority," said Kathleen Billingsley, deputy director of the Center for Health Care Quality with the California Department of Public Health.

Statewide, fines were levied against a total of 18 hospitals -- some of which had multiple violations -- for "incidents that caused, or were likely to cause, serious injury or death to patients."

Harbor-UCLA Medical Center in Torrance was fined $25,000 for failing to accurately label tissue specimens, which led to unnecessary surgery for one patient and delayed treatment for another, according to DPH. The hospital received a second $25,000 penalty for failing to provide screening examinations and stabilizing medical care in a timely manner for two patients, according to the state healthcare agency.

Los Angeles County-USC Medical Center was fined $25,000 for not providing adequate nursing staff for a suicide watch to meet the needs of a patient, DPH found.

Five hospitals in Orange County were fined $25,000 per violation cited by the state.

Anaheim General Hospital received two violations for failing to ensure medical devices were electronically safe and for failing to maintain the pharmacy's refrigerated temperatures.

Coastal Communities Hospital in Santa Ana was fined for over-medicating a patient, resulting in death.

At Fountain Valley Regional Hospital, doctors left a sponge in a patient following surgery.

At Hoag Memorial Hospital Presbyterian in Newport Beach, hospital staff left a surgical instrument in a patient.

At Los Alamitos Medical Center, a patient died after falling out of a wheelchair. State regulators found hospital staff failed to buckle the person into the chair.

The hospitals may appeal the penalties by requesting a hearing within 10 days of notification.

How to stop Hospital Infections

2008-08-15T18:55:00.001-07:00

Fox11 News in Los Angeles reports on the very disturbing trend of more and more patients picking up stubborn, dangerous infections while in the hospital. Such was the case with necrotizing fasciitis Survivor Alicia Cole. Now Dr. Alfonso Torres Cook is fighting back against infections using a common-sense plan of attack, and drugs have nothing to do with it. More hospitals should follow his lead.

Anonymous Protection?

2008-07-09T22:53:00.000-07:00

No hospitals named in tales of infection
Report on diseases acquired during medical procedures keeps institutions anonymous

By CATHLEEN F. CROWLEY, Staff writer First published: Wednesday, July 9, 2008

ALBANY -- Three years after a law requiring hospitals to report their infection rates to the state passed, the numbers have been released -- sort of.

The hospital-by-hospital rates for 2007 will not be fully disclosed. Instead, New Yorkers can see aggregate rates, an interim step negotiated by the hospital industry when the law was enacted in 2005.

"The promise that was made to (the hospital community) was we will do this right," said Assemblyman Richard Gottfried, chairman of the Assembly Health Committee, "to make sure it's running right before we take it public. That was an important promise and a smart promise."

The hospital-specific numbers will be revealed next year and every year thereafter. Meanwhile, the public can view the 2007 hospital-by-hospital rates on the state Department of Health's Web site, http://www.nyhealth.gov, but the names of the hospitals are masked.

According to the federal Centers for Disease Control and Prevention, there were an estimated 1.7 million health care-associated infections nationally and 99,000 deaths from those infections in 2002. Hospital-acquired infections are considered preventable with good hand-washing, equipment sterilization and proper procedures.

Capital Region hospitals refused a request from the Times Union to voluntarily release their infection rates on Tuesday, saying they will follow the state's timeline for unveiling the information.

"It allows us and all hospitals to take a look at the statewide data and compare it to make sure it's accurate and complete and we are all comparing apples to apples," said Brad Sexauer, Saratoga Hospital's vice president of strategy and marketing development.

Arthur Levin, director of the Center for Medical Consumers and a member of the state's advisory board for the reporting system, defended the anonymity granted to hospitals this year.

Levin said it will assure that the data is accurate, and next year, "hospitals will have no excuses."

According to the aggregate figures released Tuesday, New York's infection rates mirror the nation's. For every 100 people who undergo colon surgery, about six get an infection, according to the report. For people who have a coronary bypass graft, 3.6 out of every 100 get an infection. Fewer than 1 percent develop infections related to central lines, which are tubes that snake through a vein to the heart to deliver medicine and monitor heart function.

Of all reported infections, about 10 percent were caused by methicillin-resistant Staphylococcus aureus or MRSA. The rest were caused by organisms that respond more easily to antibiotics.

Betsy McCaughey, the former New York lieutenant governor who has since founded the Committee to Reduce Infection Deaths, said the report has many shortcomings -- most notably the comparison to national rates.

"The only infection rate that is acceptable is zero," McCaughey said.

McCaughey criticized the report for highlighting risk factors for infections, like gender and obesity, without exploring the most important contributors: unclean hospitals and lax procedures.

100 Mistakes A Month

2008-07-07T21:05:00.000-07:00

Serious patient errors at California hospitals disclosed in state filings

About 100 Californians a month are being harmed in adverse events considered preventable. A lawmaker proposes banning reimbursements to hospitals for some types of injuries.

By Jordan Rau, Los Angeles Times Staff Writer June 30, 2008

SACRAMENTO -- Last October, a technician at the children's hospital at Stanford University improperly connected a ventilator hose, accidentally pumping too little oxygen into a 9-day-old infant's lungs.

A month later, technicians at Dominican Hospital in Santa Cruz unintentionally placed a CT scan of one patient into the electronic file of another, leading physicians to remove the wrong person’s appendix.

Last March, Virginia Fahres, 76, died at Pomona Valley Hospital Medical Center in Pomona after a nurse gave her two drugs, neither of which her doctor had prescribed.

Those incidents were among 1,002 cases of serious medical harm disclosed by California hospitals between July 2007 and May of this year. The disclosures are the first under a state law that requires hospitals to inform health regulators of all substantial injuries to their patients.

Officially called “adverse events,” those accidents are also known as "never events" because they are considered preventable, and many safety experts say they should never happen. California patients are being injured at a rate of about 100 a month, according to data compiled by the state Department of Public Health.

"I think the never events are a wake-up call to everyone about the safety of California hospitals," said Beth Capell, a lobbyist for Health Access California, a consumer group.

Revelations of such errors have led lawmakers and hospital associations in at least seven states to protect patients from having to pay for the cost of care that went awry. In Sacramento, an assemblyman proposed a ban on reimbursing hospitals for the types of injuries tracked by the state. But when lobbyists for doctors and hospitals objected, he scaled it back to cover far fewer errors.

Four million people were admitted to California hospitals last year. State investigators found some errors occurred because hospitals failed to follow safeguards designed specifically to prevent harm.

Last July at UC San Diego Medical Center, a patient died after a nurse incorrectly programmed a medicine pump that then delivered more than twice the appropriate dose of a specialized blood pressure drug. Regulators found that the hospital's administration had been warned earlier by its own safety committee that "errors continue to occur" with that type of pump but had not taken sufficient corrective action, according to a state probe.

UC San Diego officials said they have since held repeat drills with staffers who treat patients with Flolan and examined every step in the process.

Dr. Angela Scioscia, the center's senior medical director, said the public reporting requirement is "a great opportunity to make rapid improvements" because hospitals can learn from one another's problems. "We don't want people to be afraid when they come into hospitals, because they are becoming safer and safer all the time," Scioscia said.

Under the 2006 disclosure law by state Sen. Elaine Alquist (D-Santa Clara), hospitals must inform state regulators of every occurrence of 28 different types of dangerous mistakes. Those include deaths during labor, medication errors, suicide attempts and sexual assaults.

The public health department has until 2015 to begin posting the information on the Internet, although officials said they hope to begin publishing it earlier. The most recent figures available cover the 10 months since July 2007. In that time, 466 patients developed bedsores so severe that the dead skin formed a crater or rotted through to the muscle or bone.

Another 145 patients had foreign objects such as surgical equipment left in their bodies. Thirty-four died while under anesthesia. In 41 surgeries, doctors performed the wrong procedure or operated on the wrong body part or on the wrong patient.

So far, the state Department of Public Health has levied $25,000 fines against 10 hospitals that reported adverse events. Officials said other investigations are still under way.

One hospital, Scripps Memorial in La Jolla, was fined twice for two errors that occurred last November with the same patient. First, as the patient was recovering from surgery, she was given a painkiller that is not supposed to be used after operations. When she went into respiratory arrest, the pharmacist provided a corrective medication at a dose 10 times too weak to be effective.

The patient survived. State investigators discovered that the hospital's pharmacists had not been properly instructed in the use of 10 medications, including the corrective drug, that the hospital stocked for emergencies.

The ventilator error at Stanford's Lucile Packard Children's Hospital occurred because a therapist had assembled the machine by following a diagram that had been drawn backward. Dr. Christy Sandborg, the hospital's chief of staff, said the medical team quickly noticed that the ventilator wasn't working correctly and stopped using it. The child recovered, she said, and the hospital has made changes to prevent future occurrences.

Overcrowded emergency rooms are another factor behind patient injuries. A 2006 study found that California had fewer emergency rooms per resident than any other state.

At Kaiser Foundation Hospital San Jose in March, staffers left a patient waiting in the emergency room for more than an hour after a test showed that his blood sugar was higher than the maximum measurable with a glucometer. The medics determined that he needed immediate care, but all 25 treatment bays were full. He passed out in the waiting room and died from heart failure.

CA Hospital Infection Legislation

2008-06-18T00:02:00.000-07:00

There are two good hospital infection bills that are moving in the CA legislature.

In a great effort, these bills were passed by the Senate and are currently in the Assembly Health Committee.

SB158, sponsored by Sen. Dean Florez and SB 1058 sponsored by Sen. Elaine Alquist.

The Committee has scheduled a hearing on June 24 for both bills. I have been asked to speak at the hearing for SB158 and share my Survivor Story in the hopes that it will touch a legislator’s heart to vote “Yes” and help save lives.

Prior to this hearing we are asking people with personal infection stories to visit legislators in Sacramento and ask them to support these bills. We don’t want these bills to die in this committee after getting this far!

There are two things you can do to help these bills pass:

If you live in the area, travel to Sacramento for the hearing. We would like to have as many members of the public there as possible, especially Survivors and family members of victims of Hospital acquired infections.

Another thing you can do is determine if your assembly member serves on the Health Committee and contact him or her.

We support these bills because they include:

Public reporting of hospital acquired infection rates
Screening for MRSA or other effective prevention techniques
State oversight on hospital cleaning practices and policies
State agency oversight on infection issues

Links to the bills:

SB158 (Florez): http://info.sen.ca.gov/cgi-bin/postquery?bill_number=sb_158&sess=CUR&house=B&site=sen

SB1058 (Alquist): http://info.sen.ca.gov/cgi-bin/postquery?bill_number=sb_1058&sess=CUR&house=B&site=sen

Thanks for your support

Committee Members

Mervyn M. Dymally - Chair
Dem-52
(916) 319-2052
Assemblymember.dymally@assembly.ca.gov

Alan Nakanishi - Vice Chair
Rep-10
(916) 319-2010
Assemblymember.nakanishi@assembly.ca.gov

Patty Berg
Dem-1
(916) 319-2001
Assemblymember.berg@assembly.ca.gov

Wilmer Amina Carter
Dem-62
(916) 319-2062
Assemblymember.Carter@assembly.ca.gov

Hector De La Torre
Dem-50
(916) 319-2050
Assemblymember.DeLaTorre@assembly.ca.gov

Kevin de Leon
Dem-45
(916) 319-2045
Assemblymember.deLeon@assembly.ca.gov

Bill Emmerson
Rep-63
(916) 319-2063
Assemblymember.emmerson@assembly.ca.gov

Ted Gaines
Rep-4
(916) 319-2004
Assemblymember.Gaines@assembly.ca.gov

Loni Hancock
Dem-14
(916) 319-2014
Assemblymember.hancock@assembly.ca.gov

Mary Hayashi
Dem-18
(916) 319-2018
Assemblymember.Hayashi@assembly.ca.gov

Edward P. Hernandez
Dem-57
(916) 319-2057
Assemblymember.Hernandez@assembly.ca.gov

Bob Huff
Rep-60
(916) 319-2060
Assemblymember.huff@assembly.ca.gov

Dave Jones
Dem-9
(916) 319-2009
Assemblymember.jones@assembly.ca.gov

Sally J. Lieber
Dem-22
(916) 319-2022
Assemblywoman.lieber@assembly.ca.gov

Fiona Ma
Dem-12
(916) 319-2012
Assemblymember.Ma@assembly.ca.gov

Mary Salas
Dem-79
(916) 319-2079
Assemblymember.Salas@assembly.ca.gov

Audra Strickland
Rep-37
(916) 319-2037
Assemblymember.strickland@assembly.ca.gov

Time Out for Patient Safety

2008-06-12T17:52:00.000-07:00

LeapforPatientSafety.org encourages you to take the opportunity to recognize National Time Out Day on June 18th to remind every member of the surgical team how critical it is to take time out for patient safety.

Please visit our website: www.leapforpatientsafety.org for more information on how to prevent medical errors.

No Double Dipping on Wipes & Clothes

2008-06-11T21:18:00.000-07:00

Antibacterial wipes can spread superbugs
Cloths used in hospitals may transfer bacteria to other surfaces, study finds

updated 1:13 p.m. PT, Tues., June. 3, 2008

LONDON - Disinfectant wipes routinely used in hospitals may actually spread drug-resistant bacteria rather than kill the dangerous infections, British researchers said on Tuesday.

While the wipes killed some bacteria, a study of two hospitals showed they did not get them all and could transfer the so-called superbugs to other surfaces, Gareth Williams, a microbiologist at Cardiff University, said.

The findings presented at the American Society of Microbiology's General Meeting in Boston focused on bacteria that included methicillin-resistant Staphylococcus aureus, or MRSA.

"What we have found is there is a high risk," Williams, who led the study, said by telephone. "We need to give guidance to the staff on how to use the wipes because we found there is a possibility of cross transfer."

MRSA infections can range from boils to more severe infections of the bloodstream, lungs and surgical sites. Most cases are associated with hospitals, nursing homes or other health care facilities.

The superbug can cause life-threatening and disfiguring infections and can often only be treated with expensive, intravenous antibiotics.

Experts have been saying for years that poor hospital practices spread dangerous bacteria, and yet many studies have shown that health care workers, including doctors and nurses, often fail to even wash their hands as directed.

The findings from a study of intensive care units at two Welsh hospitals suggest that even cleaning with antimicrobial wipes may not be enough depending on how staff use them.

The researchers found that many health care workers cleaned multiple surfaces near patients, such as bed rails, monitors and tables with a single wipe and risked sweeping the infections around rather than cleaning them up.

"We found that the most effective way to prevent the risk of MRSA spread in hospital wards is to ensure the wipe is used only once on one surface," Williams said.

Copyright 2008 Reuters.

How do you say "There's been a mistake."

2008-06-04T23:15:00.000-07:00

From Academic Medicine

The Attitudes and Experiences of Trainees Regarding Disclosing Medical Errors to Patients
Original Post 05/29/2008
Andrew A. White, MD; Thomas H. Gallagher, MD; Melissa J. Krauss, MPH; Jane Garbutt, MB, ChB; Amy D. Waterman, PhD; W. Claiborne Dunagan, MD; Victoria J. Fraser, MD; Wendy Levinson, MD; Eric B. Larson, MD, MPH Author Information

Abstract and Introduction

Abstract

Purpose: To measure trainees' attitudes and experiences regarding medical error and error disclosure.

Method: In 2003, the authors carried out a cross-sectional survey of 629 medical students (320 in their second year, 309 in their fourth year), 226 interns (159 in medicine, 67 in surgery), and 283 residents (211 in medicine, 72 in surgery), a total 1,138 trainees at two U.S. academic health centers.

Results: The response rate was 78% (889/1,138).

Most trainees (74%; 652/881) agreed that medical error is among the most serious health care problems. Nearly all (99%; 875/884) agreed serious errors should be disclosed to patients, but 87% (774/889) acknowledged at least one possible barrier, including thinking that the patient would not understand the disclosure (59%; 525/889), the patient would not want to know about the error (42%; 376/889), and the patient might sue (33%; 297/889).

Personal involvement with medical errors was common among the fourth-year students (78%; 164/209) and the residents (98%; 182/185). Among residents, 45% (83/185) reported involvement in a serious error, 34% (62/183) reported experience disclosing a serious error, and 63% (115/183) had disclosed a minor error. Whereas only 33% (289/880) of trainees had received training in error disclosure, 92% (808/881) expressed interest in such training, particularly at the time of disclosure.

Conclusions: Although many trainees had disclosed errors to patients, only a minority had been formally prepared to do so. Formal disclosure curricula, coupled with supervised practice, are necessary to prepare trainees to independently disclose errors to patients by the end of their training.

Introduction

The rise of the patient-safety movement and the publication of the Institute of Medicine report To Err is Human[1] have drawn the attention of both the public and physicians to the problem of medical errors. Physicians are increasingly expected to recognize, prevent, and properly disclose medical errors. In particular, ethical standards and guidelines that have emerged from accrediting organizations[2] and professional bodies[3] reflect a movement toward greater transparency in communicating with patients about errors. Although a few schools provide formal instruction in disclosure, these skills are largely taught via the hidden curriculum and role modeling.[4,5] There is little known regarding trainees' attitudes about and experiences with medical errors or their experience in disclosing errors to patients.

Despite the fact that patients uniformly endorse the disclosure of harmful errors,[6,7] such disclosure currently seems to be uncommon.[8,9] Emerging research is shedding new light on the disconnect between expectations that errors will be disclosed to patients and current clinical practice. Recent survey data from practicing physicians highlight their support for the general concept of disclosure and the difficulty they experience actually disclosing errors to patients.[10,11] Although less is known about trainees' attitudes and experiences regarding medical errors and their disclosure, the available literature suggests that most trainees have been personally involved with errors[9,12,13] and that discussing these events with patients presents substantial challenges for residents.[14,15] In one study, 76% of housestaff reported that they had made a serious medical error that they had not disclosed to the patient or a family member.[12]

Academic health centers can enhance transparency in health care by preparing new physicians for the challenges of recognizing and disclosing errors. Like all accredited organizations, they are also required by Joint Commission regulations to ensure patients are informed about unanticipated outcomes in their care.[2] Improving disclosure and meeting these regulatory goals require understanding how trainees perceive, experience, and disclose errors. Therefore, we undertook a multicenter cross-sectional survey of trainees to explore their attitudes and experiences regarding medical error and error disclosure.

Google Your Medical Records

2008-05-30T23:52:00.000-07:00

Google unveils medical records storage plan
Beth Israel, CVS part of new service
By Jeffrey Krasner
Globe Staff / May 20, 2008

Internet search giant Google Inc. yesterday rolled out its long-awaited Google Health product, which will enable users to upload and store medical records from many sources. Local healthcare companies working with Google on the project include Beth Israel Deaconess Medical Center in Boston and CVS Caremark of Woonsocket, R.I.

Google said users can enter their personal medical records on a site with individual password protection, giving them a way to view the information from any geographic location. The company said such access is especially useful if a patient becomes ill or is injured far from his or her primary care physician.

"We believe that patients should be the stewards of their own data," said Dr. John Halamka, chief information officer at Beth Israel Deaconess, in a statement.

"Our vision is that [Beth Israel] patients will be able to electronically upload their diagnosis lists, medication lists, and allergy lists in a Google Health account and share that information with healthcare providers who currently don't have access" to Beth Israel's proprietary site, Halamka said.

Many in the healthcare industry consider electronic medical records crucial to reducing the cost of providing healthcare and eliminating medical errors. But the start-up of electronic systems has been painfully slow because few physicians and hospitals can afford to make the investment. Meantime, there are no established standards that would allow data to be shared across different medical record systems.

For Google, the service is part of a plan to boost user loyalty by giving them more reasons to log on to Google sites.

"This really puts the users' records right in their hands," said Marissa Mayer, a Google vice president. "We realize this is just the beginning."

In addition to uploading patient records, patients can also search for medical information, similar to what is offered on the popular website WebMD.

Helena Foulkes, a senior vice president at CVS Caremark, said patients who use in-pharmacy clinics will be able to store the record of their visits on Google Health. That function will be offered first in Tennessee and eventually expand to 500 MinuteClinic locations, she said. The chain is planning to open dozens of such clinics in Massachusetts.

"In today's healthcare environment, information related to an individual's overall health is often fragmented, creating gaps in the availability of data and missed opportunities to coordinate care," said Foulkes in a statement.

Yesterday, Google disclosed a first round of partners in the electronic medical record service. In addition to Beth Israel and CVS Caremark, partners include the Cleveland Clinic, Longs Drug Stores, Medco, and Walgreens Pharmacy. Google will continue to sign up partners to ensure that its users have the broadest possible access to medical information, Mayer said.

Google Health also has a variety of features intended to help users manage their healthcare. They include a link to help users find doctors by location or specialization. Another feature, called a "virtual pillbox," notifies patients when they need to take medications, and it warns of possible drug interactions.

Patient advocates and privacy specialists have expressed concern that despite password protection, sensitive health records stored online could be compromised. In recent years, data breaches have become more common, especially in the retail industry.

Google's new site already faces competition. The Mountain View, Calif., firm's biggest rival, Microsoft Corp., has introduced HealthVault, a similar service that gives users control over who sees their information.

Revolution Health, a start-up backed by former AOL chairman Steve Case, is believed to be working on a service for electronic medical records.

Material from Globe wire services was used in this report. Jeffrey Krasner can be reached at krasner@globe.com.

A Patient's Point of View

2008-05-28T21:18:00.000-07:00

One of our own Advocate/Survivors Doreen Mulman has had 3 short articles published on Associated Content. Please check out her articles below!

Caring for Your Aging Parent? Please Read This
published on Wed, 28 May 2008 15:10:41 EDThttp://www.associatedcontent.com/article/783843/caring_for_your_aging_parent_please.html

Cleanliness is Next to Impossible published on Mon, 23 Jul 2007 08:41:00 EDThttp://www.associatedcontent.com/article/311453/cleanliness_is_next_to_impossible.html

Necrotizing Fasciitis A Survivors Story
published on Wed, 11 Apr 2007 09:08:00 EDThttp://www.associatedcontent.com/article/190560/necrotizing_fasciitis_a_survivors_story.html

MRSA Survivors Network

2008-05-27T00:07:00.000-07:00

MRSA Survivors Network launches their new web site (http://www.mrsasurvivors.org/) and blog. MSN is the first consumer organization in the U.S. to raise the alarm about MRSA and healthcare-acquired infections. MSN has been the catalyst for prevention of MRSA infections by initiating groundbreaking legislation mandating MRSA screening and reporting.

The new web site will cover the latest issues concerning MRSA and is both consumer and healthcare professional driven to change the course of this disease.

For more information contact Jeanine Thomas at: jthomas@mrsasurvivors.org

Doctors On The Take

2008-05-20T23:59:00.000-07:00

http://www.twincities.com/ci_9316658?IADID=Search-www.twincities.com-www.twincities.com

St. Paul Pioneer Press
Part III in our series

Critics say drug firms' payments to doctors are conflict of interest
What they spend: A look at drug company spending in Minnesota ― on top specialties and select psychiatrists.

By Jeremy Olson and Paul Tosto Pioneer Press
Article Last Updated: 05/20/2008 07:25:43 AM CDT

Drug companies have given $88 million in gifts, grants and fees to Minnesota doctors and caregivers since 2002, according to state payment records, including $782,000 to the two University of Minnesota psychiatrists who oversaw Dan Markingson's participation in a clinical drug trial.

A lawsuit over Markingson's suicide, which happened during the drug trial, accused Dr. Stephen Olson and Dr. S. Charles Schulz, chairman of the U's psychiatry department, of coercing the schizophrenic Markingson into the study.

The lawsuit, brought by Markingson's mother, Mary Weiss, charged that the doctors were under pressure to recruit patients such as Markingson to maximize payments from AstraZeneca and gain prestige by participating in the drug company's national study.

Both doctors said in court depositions that their roles were appropriate and that the money didn't influence their decisions over Markingson ― including when his mother argued that he wasn't getting better in the study and should be withdrawn.

Schulz was dismissed from the lawsuit in February; Olson settled this spring for an amount a university official described as little more than court costs. Federal reviews of the death didn't result in any penalties against the doctors or the university.

The case nonetheless offered an inside look at the kind of financial payments to doctors that some health policy experts and congressional representatives say should be restricted or at least fully disclosed to the public.

It also scrutinized the ethics of drug company funding of research ― something that has received less public attention and criticism than the free lunches, dinners and trips that drug companies have provided to doctors to promote their drugs.

Markingson, 27, killed himself May 8, 2004, in the bathroom of a West St. Paul halfway house. He had been enrolled for more than five months in the university's "CAFE" study, which compared three antipsychotic drugs.

Weiss sued the university and the psychiatrists. In an interview, she said doctors have a conflict of interest when they are financially benefiting from studies and caring for patients in those studies at the same time.

"I think they lose sight that these are people," she said, "not their own special little guinea pigs."
Minnesota is unique in requiring drug companies to report how much money they give to each doctor, but the reporting system has limitations. It doesn't always distinguish between money for a doctor's travel expenses and money for a research trial, nor does it distinguish money that was in a doctor's name but was passed directly to a research institution.

U.S. Sen. Chuck Grassley, R-Iowa, is urging a national reporting system. Grassley held a hearing last year in which two doctors said their colleagues have become trapped by the lures and pressures of drug company money.

"Physicians face a difficult choice," testified Dr. Greg Rosenthal, an Ohio eye specialist. "One path is to go along. With drug company money, you can increase your income, prestige, build your practice or fund a department, research or professorships. The middle ground is to simply look away. The hard choice is to fight back."

Olson received $220,000 from six companies since 2002, including $149,000 from AstraZeneca, according to the state records. Schulz received $562,000, including $112,000 as a researcher and consultant to AstraZeneca.

Olson said his AstraZeneca money went straight to the U but did support his salary. Markingson's full participation in the yearlong study meant up to $15,000 for the university.
The amounts aren't unusual, according to the payment records collected by the Minnesota Board of Pharmacy. The records, which were updated this month to include 2007 figures, show 167 Minnesota doctors who have received $100,000 or more since 2002. One in four psychiatrists has received funding from pharmaceutical companies, averaging about $50,000 over the six years.

Greater awareness of drug company payments has prompted tighter rules among some Minnesota health care organizations. The Mayo Clinic prohibits its doctors from being paid by drug companies to serve on their speaker's bureaus. Doctors in speaker's bureaus give lectures to other doctors about the company's medications.

The St. Mary's clinic system in Duluth recently banned pens, mugs or other freebies bearing drug company logos.

There have been fewer steps to restrict drug company funding of research, though most medical journals long ago required doctors to disclose the funding source of any research results they publish. Some health officials are now questioning the drug companies' use of "ghostwriters" to revise articles about research results to promote the drugs they sell.

Many universities view industry-sponsored research as a necessity amid tightening state and federal science budgets. Drug company funding makes up less than 7 percent of the psychiatry department budget at the University of Minnesota, but Schulz said it is needed as the U tries to move up the list of top-funded U.S. research institutions.

Since Olson was recruited in 2001 to boost the university's expertise in schizophrenia, he has led the U's efforts in three drug trials funded by AstraZeneca. He also took part in the federally funded "CATIE" trial, which suggested that older antipsychotic drugs were as effective as AstraZeneca's Seroquel and other newer drugs.

A growing body of research suggests that drug company money has an influence on study outcomes. One analysis found that industry-funded research was four to five times more likely to produce positive outcomes for a paying company's drug than federally funded research. A report last year found that drug company-funded studies of cholesterol medications were much more likely to produce results that favored their own drugs as well.

The CAFE results didn't show that AstraZeneca's Seroquel offered much benefit over two competitors ― Zyprexa and Risperdal. Patients gained control over schizophrenic symptoms and tended to stop taking the medications at the same rate, regardless of which drug they took. The level of unhealthy weight gain was comparable, too, albeit slightly higher among the Zyprexa patients.

Weiss sued AstraZeneca as well, though the company also was dismissed from the lawsuit. Her attorneys argued that AstraZeneca's goal with the CAFE study was to gain a marketing edge and that the company used selective information from the study to promote Seroquel.

The attorneys cited internal documents, which have been sealed under court order, in which AstraZeneca discussed its use of ghostwriters and strategies to present CAFE results in a way that "sells" Seroquel.

AstraZeneca declined to discuss documents from the case, but brand corporate affairs manager Abigail Baron said the company's financial arrangements with doctors are necessary to improve health through drug discovery.

"That mission cannot be fulfilled," she said, "without close partnership with those on the front lines of patient care and ... research."

Jeremy Olson can be reached at 651-228-5583 or jolson@pioneerpress.com. Paul Tosto can be reached at 651-228-2119 or ptosto@pioneerpress.com.

How Much?
Visit our database of drug company payments to Minnesota doctors Related to This series
Patient's suicide raises questions
Dan Markingson had delusions. His mother feared that the worst would happen. Then it did.

Let's Set Our Standards High!

2008-05-19T01:21:00.000-07:00

Zero Tolerance for Infections: A Winning Strategy
Kelly M. Pyrek01/24/2008

“Zero tolerance” is quickly becoming the new watchword in infection prevention, as the concept of striving for zero infiltrates U.S. hospital staffs as they strive to meet new pay-for-performance mandates from the Centers for Medicare and Medicaid Services (CMS), this fall and to address healthcare-associated infections (HAIs) as “never-events.”

How did we get here? The data tell the clearest story. Approximately 2 million healthcare-associated infections (HAIs) occur annually in U.S. healthcare facilities, lead to 60,000-90,000 deaths and cost anywhere from $17 billion to $29 billion. Five percent to 15 percent of all hospitalized patients in developing countries develop an HAI; more than three-quarters of these infections are urinary tract infections, bloodstream infections (BSIs), pneumonia or surgical site infections (SSIs).1 Not only are patients sicker, pathogens are becoming stronger in their ability to shrug off microbicides, making for a potential train wreck of epic proportions unless our course is diverted.

At no time in history have healthcare institution infection prevention and control programs been more critical than they are today, and they are being supplemented by collaboratives and initiatives from public- and private-sector groups agitating for change and a recognition that something must be done to address increasing prevalence of hospital- and community-acquired infections. The Joint Commission has long required its accredited facilities to observe its patient safety goals, including preventing infections. It has been joined in recent years by a number of other agencies hoping to curb infections, including the Institute for Healthcare Improvement (IHI) and the Surgical Care Improvement Project (SCIP), as well as consumer watchdog groups such as Consumers Union and the Committee to Reduce Infection Deaths (RID). The call for public disclosure of infection rates is sweeping the country, and the MRSA scare several months ago has capitulated the angst Americans are feeling over opportunistic infections.

Infections are now on the radar of hospital administrators thanks to the aforementioned pay-for-performance mandates issued by CMS which is clamping down Oct. 1 on hospital reimbursement for complications relating to infections. Infection control practitioners (ICPs), who have long been the front-line defenders against infections and adverse events, find themselves needing to bone up on risk management principles and fiscal concepts as they attempt to tally up the high costs of infections and make the business case for infection prevention.

In the midst of this turning tide are the other healthcare workers (HCWs) responsible for providing medical and surgical care to patients and who have been blamed as the guilty party for ignoring infection prevention principles and best practices — all in a daily rush to do their jobs amidst staffing and resource shortages triggered by razor-thin hospital budgets that keep getting thinner. Although healthcare workers know what to do, they don’t always do it.
Behavior modification and cultural change is the answer, as is a call for a transition from benchmarking to zero tolerance. But there are degrees of behavior modification initiatives, from the warm and fuzzy, to the punitive and everything in between. Denise M. Murphy, MPH, BSN, RN, CIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC) and the chief patient safety and quality officer at Barnes-Jewish Hospital in St. Louis, alludes to a recent meeting of public health groups that discussed zero tolerance and concerns regarding the potential for a punitive response if hospitals set the goal at zero. “This could come from healthcare executives, or even the public, when an infection occurred despite compliance with known prevention measures and where no breakdown in safe practice was found,” Murphy says. “So we settled on language stating that we’re ‘targeting zero.’ One means of eliminating as many HAIs as possible will be zero tolerance for not adhering to infection prevention measures and broken systems that lead to harm.”2

Without a national standard or model, institutions are left to decide a course of action on their own. Either way, zero tolerance is taking on new urgency as healthcare institutions decide to take a stronger stance against the number of infections previously thought to be preventable. In a 2006 story on hospital infections, Washington Post reporter Christopher Lee quotes David B. Nash, chairman of the Department of Health Policy at Thomas Jefferson University in Philadelphia, as remarking, “The new wave of research is showing that our previous expectations around what was preventable underestimated what we could actually achieve. We can prevent more infections than we thought before. Lots of hospitals are striving to get to zero.”3

Noted infection prevention expert William Jarvis, MD, of Jarvis and Associates based in Hilton Head, S.C., alludes to the struggle over just how many infections are preventable. “There has been much debate over the years,” says Jarvis, who spent 23 years at the Centers for Disease Control and Prevention (CDC). “When I was at the CDC and I would say one-third of infections are preventable, a number of people would argue, ‘that’s way too high, you can’t do that.’ But with various collaboratives and other interventions in the last five to eight years, what we have seen is that a much higher proportion of infections is preventable, whether we are talking about surgical site infections, ventilator-associated pneumonia (VAP), central line-associated bloodstream infections, or even methicillin-resistant Staphylococcus aureus (MRSA) infections. Interventions have prevented well over 50 percent and in some cases even 80 percent and 90 percent of infections, so now if we can get clinicians to implement the evidence-based recommendations that we know work, we will be very successful at preventing many infections.”

Jarvis continues, “Will we reach zero? No, but the attitude that I think we are moving toward, is one where clinicians don’t see these infections as inevitable. There are very sick patients who need a lot of invasive devices and procedures, so they are going to get infections. We need the attitude of trying to preventing all infections, and if one occurs, investigating to see what went wrong.”

Getting to zero is the basis of the “zero tolerance” of infections movement that has arisen in the last several years, promulgated by APIC. Murphy notes, “Why is the phrase ‘zero tolerance’ getting so much hype, and why should we be shaping what zero tolerance means in terms of infection prevention? Because too many people are still dying or being harmed by HAIs. We know the numbers because we compile them, but every number is someone’s loved one. Keeping people safe is the reason we do what we do — not rates. But rates and numbers measure our success so the goal must be elimination of HAIs, the metric or target must be zero. Zero is often possible. Many APIC members and their teams have set zero as the target and achieved that goal. They are truly saving lives.”2

Murphy says at that meeting among public health groups where zero tolerance was discussed, the concept was formally defined as “a culture, a goal, an attitude, and a commitment.” Murphy adds, “Infection prevention is no longer getting to a benchmark and stopping there. Zero tolerance means we must keep going, targeting zero. John Jernigan from CDC said, ‘In public health we talk about elimination all the time, about eliminating TB and other infectious diseases. So why wouldn’t we set a theoretical goal of zero even if we can’t prevent every infection because we cannot control all risk factors?’ Zero tolerance means treating every infection as if it should never happen, but when it does, we investigate the root cause. Finally, it means holding everyone accountable for HAIs, not just the ICPs.”2

Zero tolerance is creating a new infrastructure for infection prevention that includes other effective tools such as evidence-based interventions in the form of bundles. Jarvis writes, “… no single intervention prevents any HAI; rather a ‘bundle’ approach, using a package of multiple interventions based on evidence provided by the infection control community and implemented by a multidisciplinary team is the model for successful HAI prevention.” But an increasing number of researchers are acknowledging that addressing the behavioral aspects of infection prevention compliance is essential to fighting infections.1

Aboelela and colleagues4 note that attempts to address the growing problem of HAIs and their impact on healthcare systems have historically relied on infection control policies that recommend good hygiene through Standard Precautions. But they emphasize, “In order for infection control strategies to be effective, however, HCWs’ behavior must be congruent with these policies.” Aboelela and colleagues conducted a systematic review to evaluate studies testing the effectiveness of interventions aimed at changing HCWs’ behavior in reducing HAIs. Of 33 published studies, four studies reported significant reductions in HAI or colonization rates. Behavioral interventions used in these studies included an educational program, the formation of a multi-disciplinary quality improvement team, compliance monitoring and feedback, and a mandate to sign a hand hygiene requirement statement. In all 33 studies, bundles of two to five interventions were employed, making it difficult to determine the effectiveness of individual interventions. The researchers noted, “The usefulness of ‘care bundling’ has recently been recognized and recommended by the Institute for Healthcare Improvement. Considering the multifactorial nature of the HAI problem and the logistical and ethical difficulties of applying the randomized clinical trial approach to infection control research, it may be necessary to study interventions as sets of practices.”4

These practices — and their payoffs in fighting infections — have traditionally been evaluated through benchmarking activities. The one challenge with infection prevention is that much of it has been based on benchmarking among U.S. hospitals; Jarvis says that national benchmarking can be a less-than-ideal representation of infection rates across the country because it can be skewed toward large academic or teaching hospitals. “There has been this benchmarking mentality where people would look at their infection rate and then look at the CDC’s surveillance rates within the National Nosocomial Infections Surveillance System (NNIS), without realizing that they only really account for a small minority of hospitals in that system,” Jarvis explains. “Secondly, hospitals having less than 100 beds are not even allowed in that system, even though the average U.S. hospital is less than 100 beds. That means the majority of U.S. hospitals weren’t represented in that system — it was mostly academic centers that were providing the benchmarks. Everybody would look at that and say, ‘Well, if my infection rate is at or below the median of the NNIS system then I am fine, I don’t need to do anything.’”

Jarvis explains further, “The debate goes back to the mid-1970s, when the CDC conducted its landmark SENIC Project, the study of the efficacy of nosocomial infection control programs, which was a retrospective medical record chart review, and it was the first time that infection control was documented in a valid, scientific way to be cost effective and to prevent infections.” The SENIC Project was designed with three primary objectives: to determine whether (and, if so, to what degree) the implementation of infection surveillance and control programs (ISCPs) has lowered the rate of nosocomial infection, to describe the current status of ISCPs and infection rates, and to demonstrate the relationships among characteristics of hospitals and patients, components of ISCPs, and changes in the infection rate.

“At the time, no one really had a sense of what percent of infections were preventable,” Jarvis says. “Researchers conducted chart reviews and interviews about infection control programs and then they made estimates based upon the data they collected. They looked at which hospitals had epidemiologists and which had infection control professionals, how many did they have, what did they do, and then looked at programs in hospitals with lower infection rates compared to those who had higher infection rates and then made an estimate that in general, about one-third of HAIs were preventable. So it really was more of a guesstimate.”

In a 2007 white paper1 Jarvis underscored that benchmarking is inadequate and a culture of zero tolerance is required, as is a culture of accountability and administrative support. “In order to reach the goal of zero infections, hospitals need accountability,” Jarvis says. “In many U.S. hospitals, infection control programs are not well supported by administrators because they are not revenue-generating departments. Imagine a CEO at a hospital; two people from his facility offer him an option for the future; the first is the facility’s ICP. She says, ‘We can prevent many of these infections but we need more personnel. I’d like to hire one or two additional infection control personnel.’ She’s probably talking about less than $150,000 a year in salary costs, and you can prevent five infections. The next person who comes in is the chief of cardiovascular surgery who says, ‘I’d like to build a new operating room because I can do two or three coronary artery bypass procedures at $200,000 to $500,000 a pop.’ For the CEO, the decision is kind of a ‘duh!’ as to which decision he is going to make — she is always going to build the operating room.”

Jarvis continues, “Hospital CEOs and administrators must understand the importance of infection prevention and its impact on patient safety. They must realize it’s not about lip service, it’s about taking action and spending money to get to zero. There are a number of things happening that are getting the attention of hospital administrators, including CMS mandates, public reporting and other legislation at the state level. These things are bringing infections into the open, so hospital administrators are starting to see the light.”

If administrators are to see improvements in their facilities and not lose revenue from CMS, they are going to have to resolve the aforementioned issue of behavioral modification among clinicians. There are several classical battles being waged between ICPs and clinicians regarding compliance issues. One of the most enduring examples is that of hand hygiene compliance, which notoriously hovers around 30 percent to 40 percent. Studies indicate that HCWs wash their hands just one-third to one-half as often as they should.

Whitby and colleagues5 observe, “Although HCW compliance with handwashing guidelines is a cornerstone of ideal infection control practice, the rate of such compliance has proved to be abysmal.” For years, researchers have studied various interventions to discover how to improve HCWs’ knowledge of and compliance with handwashing guidelines and then reinforcing these practices. Whitby and colleagues note that “until recently, none have engendered evidence of sustained improvement during a protracted period.”

In 2000, two studies provided hope that handwashing practice could be improved. Pittet and colleagues.6 demonstrated that handwashing compliance among nurses at the University of Geneva hospitals increased to 66 percent during a 48-month period thanks to a number of interventions likely to affect HCW behavior including the provision of an alcohol-based hand rub designed to reduce the time taken and the inconvenience associated with handwashing. Larson and colleagues.7 described a significant increase in handwashing compliance that was sustained for 14 months in a Washington, D.C. teaching hospital. Their program attempted to induce organizational cultural change toward optimal hand hygiene, with senior administrative and clinical staff overtly promoting the handwashing program. Whitby and colleagues write, “Handwashing as a practice is a globally recognized phenomenon; however, the inability to motivate HCW compliance with handwashing guidelines suggests that handwashing behavior is complex. Human behavior is the result of multiple influences from our biological characteristics, environment, education, and culture.”5

For their study, Whitby and colleagues used the Theory of Planned Behavior (TPB), explaining that with regard to handwashing, TPB is “predicated on a person’s acceptance that the immediate cause of handwashing is their antecedent intention to wash their hands. The intention to perform a given behavior is predicted directly, although to differing degrees, by three variables: attitude (a feeling that the behavior is associated with certain attributes or outcomes that may or may not be beneficial to the individual), subjective norms (a person’s perception of pressure from peers and other social groups), and perceived behavioral control (a person’s perception of the ease or difficulty in performing the behavior). These variables are predicted by the strength of the person’s beliefs about the outcomes of the behavior, normative beliefs (which are based on a person’s evaluation of the expectations of peers and other social groups), and control beliefs (which are based on a person’s perception of their ability to overcome obstacles or to enhance resources that facilitate or obstruct their undertaking of the behavior).

Whitby and colleagues’ investigations focused on elucidating and determining the origin of the behavioral determinants of handwashing in nurses in the healthcare setting. According to the researchers, handwashing was perceived by the study subjects foremost as a mechanism of self protection against harmful organisms. Handwashing behavior was also influenced by the appearance of their hands. Nurses recognized that handwashing played an integral role in the removal of microbes and the prevention of their transfer, and described the practice as unconscious and habitual, rather than as a thoughtful action associated with particular occasions.
Whitby and colleagues reported that although nurses appeared to believe that they habitually washed their hands without thinking about it, a number of factors appeared to affect the importance that they placed on handwashing in the healthcare setting, including the condition of their patients, the extent of patient contact, their assessment of the task involving a patient, and workload. They write, “Nurses believed that patients are a potential reservoir of infection because patients have little understanding of infection transmission. Nurses assessed the risk of infection due to contact with individual patients on the basis of several criteria, including the patient’s diagnosis, physical appearance, and perceived general cleanliness; visibility of the patient’s body fluids; and the patient’s age. An assessment was made in terms of the degree of ‘dirtiness’ or the lack of ‘cleanliness’ of a patient. Handwashing was not always considered to be essential for certain types of physical contact with patients. Tasks that require non-intimate touching of a patient or use of inanimate objects were less likely to be considered important motivating factors for handwashing, compared with tasks involving more-prolonged physical contact. In parallel with the nurse’s assessment of the task involving a patient, nurses judged the level of ‘dirtiness’ of the actual task. This assessment resulted in nursing staff feeling compelled to wash their hands if their hands were visibly contaminated, moist or gritty, or touched axillae, genitals or the groin. Nurses reported that, when under time constraints, they used physical and task assessments to determine the necessity of handwashing. However, nurses always felt compelled to wash hands after performing tasks they considered to be ‘dirty.’”5

Whitby and colleagues point out that attitudes toward physical contamination, such as fecal material, is consistent with a hypothesis developed by Curtis and Biran, who argue that the human emotion of “disgust” is an evolutionary protective response to environmental factors that may pose a risk of infection.8 Whitby and colleagues note, “This response may be mirrored in the way that nurses make judgments about the potential risk for infection that contact with a patient may pose. Their assessment of the need to wash hands was strongly influenced by the emotional concepts of ‘dirtiness’ and ‘cleanliness.’”5 Whitby and colleagues say their data suggest that an individual’s handwashing behavior is not a homogenous practice but falls into two broad categories. The first category, “inherent handwashing practice,” occurs when hands are visibly soiled or feel sticky or gritty and requires hand cleansing with water. The second category is “elective handwashing behavior,” which does not trigger an intrinsic response with an immediate desire to wash one’s hands; it represents to the nurse an elective opportunity for handwashing. Whitby and colleagues also indicate that because of perceived time constraints, nurses appear to act through a self-developed “hierarchy of risk” to determine when handwashing was necessary, thus ranking their opportunities for handwashing. When pressed for time, nurses assign lower priority to washing their hands than they do to other more urgent tasks.5

“A major component of zero tolerance is accountability,” Jarvis emphasizes. “In general, healthcare professionals are not taught about infection prevention in medical school or nursing school. We are not reaching them at a time when we could tell them this is critical to saving lives, so as a result many of them come out of training not thinking this is very important. Also, many clinicians think infection control is the infection control department’s job, not theirs. The fact is, infection control personnel should be the hospital’s consultants — they have the knowledge of what can and should be done to prevent infections, but they are not the people putting in IV lines or putting people on ventilators, they’re not the ones not doing hand hygiene, and that’s where accountability comes in. A number of large healthcare systems are taking a very aggressive approach against MRSA because the data show we can prevent many HAIs including MRSA. I was intrigued by a very large healthcare system whose CEO contacted the CEOs of each of the hospitals and told them in 2008 their yearend bonuses would be dependent upon how well they prevented MRSA infections. If you don’t think that’s going to make clinicians have some accountability, you’re nuts. The CEOs at each of those hospitals are going to ensure their clinicians are accountable for infections because it will impact the CEOs’ pockets.”

Jarvis continues, “Behavioral changes are key. One of the biggest challenges we have had in infection control is getting clinicians to do proper hand hygiene, and we have to admit that those of us in healthcare are absolutely atrocious at achieving behavioral change. If you look at changes in behavior, whether it’s wearing seatbelts or helmets or not smoking, we don’t change our behavior because of any kind of educational program, it’s because we have to obey the law — a law is passed and you have to wear a seatbelt or you get fined. We are very poor in our understanding of the capability to change HCW behavior. It’s why hospital CEOs and administrators must move that accountability down to unit directors. A good example of this is a surgical intensive care unit. We commonly see surgeons do a tremendous job of hand hygiene before they go into the OR; they gown and glove and mask and cap, and then they scream at anyone who violates infection control in the OR. Then they finish surgery, walk out of the OR, walk into the ICU and go from patient to patient to patient and don’t do hand hygiene. That kind of behavior must become a violation in the eyes of the unit director, who warns you one time and the second time you are out of there.

“It requires a tremendous change in our culture,” Jarvis says. “For example, there are no data to show that gowning and gloving and masking in the OR actually reduces infections — there has never been a randomized controlled trial. Yet if I went into any U.S. hospital wearing the clothes I have on right now and said I want to do surgery, there would be at least four people who would tackle me before I got to the OR — even though there are no data to suggest there would be a negative impact on patients if I did that. But it’s a cultural expectation in healthcare, and I think we have to change that culture throughout our hospitals with respect to infection prevention, where everyone is expected to do the right thing. And when they’re not, others tell them they must.”

APIC provided a startling insight late last year when it released findings from a non-scientific poll of ICPs asking them about changes made in their hospitals to better address MRSA infection rates.9 This poll came on the heels of APIC’s MRSA prevalence study, written by Jarvis. “APIC’s follow-survey showed that approximately 50 percent of the ICPs who responded to the poll said they had not done more to fight MRSA because they were not given the resources they needed by their hospital administration,” Jarvis says. “I think that will continue to be an issue and it’s only through public reporting and increasing state legislation that infection control program resourcing issues will be acknowledged. With CMS penalizing hospitals on one side and legislation on the other, the two of them are going to start squeezing, and hopefully this pressure will yield results in improved resourcing, reduced infections and the kind of healthcare all of us should expect.”

Murphy provides a 10-point plan10 for getting to zero:

1. Educate all healthcare providers about infection prevention

2. Educate hospital administration about infection prevention

3. Challenge HCWs to lead the charge against HAIs

4. Influence and educate stakeholders

5. Educate the community about infection prevention

6. Use and share meaningful infection data

7. Automate more tasks in infection prevention so more time is spent on education efforts

8. Learn how to make the business case for infection prevention

9. Develop strategic partnerships

10. Keep the patient at the center of all infection prevention efforts Murphy notes,
“What else do we need to do to get to zero? We need each other. ICPs worldwide need to persist, and together we can eliminate HAIs. We can broaden the range of what’s preventable. By partnering with patients and their families and healthcare teams, with researchers, educators, standards and law makers, industry, and innovators, we can work to establish a reliable system that prevents harm from infection. We must continue to negotiate effectively to get resources needed to prevent HAIs, and then we can ‘pay it forward’ to our patients and their families.2

APIC recently announced the launch of its “Targeting Zero” Initiative. For more details, go to: http://www.infectioncontroltoday.com/hotnews/targeting-zero-initiative-launched.html

References
1. Jarvis W. The United States approach to strategies in the battle against healthcare-associated infections, 2006: transitioning from benchmarking to zero tolerance and clinician accountability. Journal of Hospital Infection. Vol. 65. Pages 3-9.
2. Murphy DM. Go for zero then pay it forward. APIC News. Fall 2007.
3. Lee C. Studies: Hospitals Could do More to Avoid Infections. The Washington Post. Nov. 21, 2006.
4. Aboelela SW, Stone PW and Larson EL. Effectiveness of bundled behavioral interventions to control healthcare-associated infections: a systematic review of the literature. Journal of Hospital Infection. Vol. 66, No. 2. Pages 101-108 June 2007.
5. Whitby M, McLaws ML, Ross MW. Why healthcare workers don’t wash their hands: A behavioral explanation. Infection Control and Hospital Epidemiology. Vol. 27, No. 5. May 2006.
6. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide program to improve compliance with hand hygiene. Lancet 2000; 356: 1307-1312.
7. Larson EL, Early E, Cloonan P, Sugrue S, Perides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infection. Behav Med 2000; 26:14-22.
8. Curtis V, Biran A. Dirt, disgust, and disease: is hygiene in our genes? Perspect Biol Med 2001; 44:17-31.
9. APIC. Survey Finds U.S. Healthcare Facilities Not Doing Enough to Curb MRSA. Accessed at: http://www.infectioncontroltoday.com/hotnews/curbing-mrsa.html
10. Time to come clean. Hospital Management. March 2007. Accessed at: http://www.hospitalmanagement.net/features/feature977/
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Can You Guess?

2008-05-13T23:01:00.000-07:00

The Official SAT Question of the Day™
Tuesday, May 13

Choose the word or set of words that, when inserted in the sentence, best fits the meaning of the sentence as a whole.

The ------- of drug-resistant strains of bacteria and viruses has ------- researchers’ hopes that permanent victories against many diseases have been achieved.

vigor . . corroborated
feebleness . . dashed
proliferation . . blighted
destruction . . disputed
disappearance . . frustrated

Hint

© 2008 The College Board. The College Board, 45 Columbus Avenue, New York, NY, 10023-6992. College Board, SAT, and the acorn logo are registered trademarks of the College Board. The Official SAT Question of the Day, The Official SAT Online Course, and The Official SAT Study Guide are trademarks owned by the College Board.

Having Insurance Won't Save You

2008-05-12T21:33:00.000-07:00

Hospital infection is a far deadlier problem than the number of uninsured.

The Institute of Medicine estimates that as many as 18,000 people a year die prematurely because they don't have health insurance. That's tragic. But five times as many people die each year from hospital infections, and most of them are insured.

The Public has a right to know!

2008-05-11T12:58:00.000-07:00

Hospital infections might be disclosed
Rates at institutions would be available for public to review
Saturday, May 10, 2008 3:13 AM
By Misti Crane
THE COLUMBUS DISPATCH

As Nancy Oliver spoke of her father's stay in an intensive-care unit, and of the infection that eventually killed him, her voice was calm, her delivery direct.

She wanted the people who are to tell Ohioans more about what goes on in hospitals to understand what it's like to love someone and watch him suffer, she said.

"I'd like you to understand the heavy burden placed on consumers of health care when these infections do strike," Oliver said.

Her father, Robert Totsch, was 75 when he died in November 2006 at Riverside Methodist Hospital, according to an obituary that ran in The Coshocton Tribune.

After heart surgery, Totsch developed a drug-resistant staph infection that started at his surgery site and spread to his blood, she told the Hospital Measures Advisory Council, a group created by state law and charged with recommending public reporting of various measurements of hospitals, including infection rates.

He also ended up infected with the sometimes-deadly intestinal bacteria Clostridium difficile, also known as C. diff, she said.

"My dad suffered greatly as he tried to beat these infections," Oliver said before hearing the panel members agree to recommend reporting of a list of hospital data, including rates of staph and C. diff infections.

After the vote, she wept.

The panel has to make its recommendations to Dr. Alvin Jackson, the director of the Ohio Department of Health. Public hearings and approval of the final rules are to follow.

Based on the current schedule, data should be available for public perusal as soon as October 2009.

A second phase of reporting requirements is to follow in 2011, said Madelyn Dile, the panel's facilitator and assistant chief of the state Health Department's quality-assurance division.
C. diff and methicillin-resistant Staphylococcus aureus, or MRSA, have been a particular concern for both infectious-disease specialists and the public as severe, sometimes-deadly, infections have been diagnosed in increasing numbers of hospital and nursing-home patients.

C. diff used to be a relatively minor problem, but it has grown increasingly menacing, with the bacteria producing toxins that can cause severe bowel infections, said Dr. Forrest Smith, medical director of the state Health Department's prevention division. He was part of a committee that recommended measures to the panel.

In a first-of-its-kind effort to quantify the reach of C. diff, the state found more than 15,000 cases in hospitals and nursing homes in 2006.

Staph infections "tend to ride in on instruments of medical progress," said Dr. Steve Schmitt, an infectious-disease expert from the Cleveland Clinic.

"It colonizes 46 of every 1,000 patients, so it's a big problem."

The Ohio Hospital Association is in favor of reporting information that can help consumers, said spokeswoman Tiffany Himmelreich.

But the group will closely watch and argue for reporting requirements that meet several standards, she said. The benefit to consumers should exceed the cost to hospitals, the state should use widely accepted definitions of C. diff and drug-resistant staph infection, and the rules should be careful to distinguish hospital-acquired infections from those brought in from elsewhere, she said.

mcrane@dispatch.com

A Patient's Point of View

2008-05-07T20:09:00.000-07:00

Actress Raises Awareness of Hospital Acquired Infections
By Megan M. Krischke, contributor

When Alicia Cole, whose only experience with hospitals was playing the role of a nurse on the popular TV show, Beverly Hills 90210, entered the hospital on August 15, 2006, for a routine abdominal surgery, she was expecting a two-day stay and was, by her description, “as healthy as a horse.”

(Actress Alicia Cole poses with her parents shortly before her release from the hospital, where she contracted a life-threatening infection.)

But, it would be two months before Cole was able to leave the hospital and, even then, she was greatly debilitated and faced a long road to recovery.

Soon after her surgery Cole contracted Necrotizing Fasciitis (NF), also known as Man-Eating Flesh Disease, which is as bad as it sounds. NF is an infection, often hospital acquired, that causes rapid destruction of soft tissue and muscle. The condition is rare and deadly, with a reported mortality rate of 70 to 80 percent.

During the most acute phase of the disease, despite aggressive treatment, Cole’s condition was so fragile that her life was in jeopardy for several weeks. She promised herself that if she left the hospital alive she would make it her personal mission to increase awareness among both medical professionals and the public about hospital-acquired infections.

A year and a half has passed since she first entered the hospital and Cole is still recovering from the wounds caused by NF and the six surgeries that were required to stop its spread throughout her body.

Cole has created several Web sites, including a MySpace.com page that tell her story and assist with networking and sharing information. She has also met with California Governor Arnold Schwarzenegger’s Committee on Hospital Associated Infections to push for awareness and safeguards.

“I also try to help my fellow NF survivors by counseling with them. We help each other mentally and emotionally,” said Cole, a 15-year member of the Screen Actors Guild who co-starred on General Hospital and The Young and the Restless, and appeared on many prime time shows, including Veronica Mars and Beverly Hills 90210.

“It is a difficult adjustment to have your life completely altered in an instant and to realize your health will never be the same,” said Cole, who has had to put her acting career completely on hold. “There is a close fellowship among survivors. Family and friends can be a huge support, but no one besides a fellow survivor truly knows what you are going through.

“My wounds were so massive that about a third of my body was affected. It has been the longest, longest process; it is a very surreal experience,” Cole said of her illness. “I’ve always been an athlete and I’ve never gone this long without exercising. I try to keep my spirits up because it can be depressing.”

Cole doesn’t condemn the medical profession but feels there is always room for improvement and that in-service education is a must to reinforce skills and introduce cutting edge treatments for NF.

In her effort to increase awareness about hospital acquired infections and to lessen their occurrence, there are several areas Cole would like to see hospitals address:

Sanitation and hygiene

“Just like in every other job, nurses get busy and start to cut corners. Sanitation simply isn’t a corner you can cut if you work in the medical field,” said Cole.

Often this is just a matter of following standard procedures, such as always washing hands before working with a patient. Cole would also recommend nurses keep long hair tied back, fingernails short, and because she was so sensitive to odors during her illness, she thinks nurses should forgo perfume while at work.

Teamwork

Cole would like to see medical staff, patients and caregivers work more as a team and for everyone’s input and opinion to be valued. Cole’s mother was the first to find the telltale sign of NF, a black dot, near her daughter’s incision. The nurse on duty passed if off as nothing, but Cole’s mother insisted on calling in the doctor—a decision that saved Cole’s life.

“Whistle Blower” Protection

“I think it is extremely important that nurses be able to report things and answer patients’ questions without fear of reprisal,” Cole commented. “There were several instances in my case where nurses gave us valuable information, but prefaced it by saying, ‘Please don’t say anything because I could lose my job.’"

Wound Care

“Outside of wound care centers, it seems that many doctors and nurses aren’t informed on the advances in wound care,” Cole said. “They send you home with basic wet to dry dressings when there are so many more advanced healing techniques and so many medications that promote healing and regranulation of tissue,” Cole said. “I think a lot of secondary infections, bed sores and breakdown of wounds and skin tissue could be prevented or better treated if doctors and nurses were kept up-to-date on the latest innovations in wound care.”

Finally, Cole wants nurses to know that patients appreciate them.

“Sometimes patients are in pain and not getting good sleep. It may not always sound like we are happy to see you. And it is true, when I see you coming with a needle, I’m not happy to see you, but I appreciate the care you are giving me,” Cole explained.

© 2008. AMN Healthcare, Inc. All Rights Reserved

Slap on the wrists in South Carolina

2008-04-28T23:47:00.000-07:00

S.C. lowest in doctor discipline
Study finds decline in serious penalties

By Jill Coley (Contact)
The Post and Courier
Wednesday, April 23, 2008

Ten years ago, the S.C. Board of Medical Examiners fined a Charleston orthopedic surgeon $3,000 for using an amputated foot as bait in a crab trap.

The paltry fine amounted to a slap on the wrist, said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen, a national consumer advocacy nonprofit.

Little has changed in South Carolina in the last decade, Wolfe said. In an annual report issued by Public Citizen, South Carolina slipped to the final rung in 2007, falling dead last in the ranking for serious doctor discipline.

Dr. Louis Costa, president of the state Board of Medical Examiners for the last two years and a Charleston surgeon, called the report's model flawed. Costa compared the premise to saying that the safest state in the country has the most prisoners incarcerated.

Further, the report failed to distinguish among states' criteria for licensure and different procedures for revocation, Costa said.

The rankings were calculated by averaging the disciplinary rates over the three-year period from 2005-2007.

South Carolina had 11,590 physicians and nine serious actions taken, amounting to a rate of 1.18 serious actions per 1,000 physicians. The state's rank hovered between 43 and 45 from 2003 to 2005, before dropping to 51 in 2006.

Nationally, since 2004, the number of serious disciplinary actions against doctors decreased 17 percent, resulting in 553 fewer actions.

Alaska fared the best, with a rate about seven times higher at 8.33. Kentucky ranked second with a rate of 6.55 and has a comparable number of physicians to South Carolina. Among 11,251 physicians in Kentucky, 83 actions were taken.

Wolfe and Costa see different meanings in the low rate of meting out serious disciplinary action.
Wolfe said, "The lack of doctor discipline in many states equates with a lack of patient protection for those patients whose physicians would have been disciplined in states with better enforcement of their state medical practice acts."

Costa countered that South Carolina has higher standard of licensure than many states and therefore has a higher quality corps of physicians. "We routinely turn away doctors licensed in other states for substandard training or previous disciplinary records," he said.

Wolfe has heard boards say before that they have better doctors than other states. "In every state, most doctors are practicing very good medicine," he said. "We're talking about the worst offenders in every state. There's not a shred of evidence that tiny fraction is smaller or larger than any state."

The study defined serious action as revocations, surrenders, suspensions and probations.
Revocation has different meanings in each state, Costa said. It is noteworthy that in the top three states, the process is not necessarily permanent, he said. In Kentucky, physicians can petition the board to practice again within two years.

In South Carolina, revocation is permanent and therefore not given so lightly, Costa said. A physician may undergo public exposure, fines and rigorous demands for retraining and rehabilitation before being able to practice again and still not make the definition of "serious action" used by the report.

"According to Dr. Wolfe's analysis, a perfect score would be the state that revoked all of its doctors," Costa said.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.

http://www.charleston.net/news/2008/apr/23/s_c_lowest_doctor_discipline38249/

Patient Safety Advocate needs your help!

2008-03-13T23:44:00.000-07:00

On Wed, Mar 12, 2008 at 12:23 AM, Hugh M. Robert <hugh.robert@gmail.com> wrote:

The senate recently voted against a bill that would have mandated health insurance companies to cover medically necessary procedures. While this bill has been politicized, there are some serious procedures that are being denied which are important to the insured’s health.

We are currently looking for examples where an insurance company has denied a claim for a breast reconstruction after chemo and mastectomy surgery, or a case where perhaps a burn victim was denied a claim to have facial reconstruction surgery.

If you could please pass this along to your lists and if you know of someone who has one of these circumstances, please have them contact me as soon as possible.

On Wed, Mar 12, 2008 at 10:06 PM, Hugh M. Robert <hugh.robert@gmail.com> wrote:

We will be having a press conference on Tuesday March 18th at 10:30 AM in the capital press room on the fourth floor to call attention to the problem of nursing homes operating without insurance.

We have one family who will be telling their story of a loved one who was seriously injured and not able to pursue a case due to the nursing home being in receivership.

We would love to have a couple more families or stories to tell at our press conference. If you know someone or could pass this along to your list to ask for families who have had a loved one injured but not able to hold them responsible due to their not carrying insurance, please have them contact me ASAP.

Hugh M. Robert
Executive Director
OK Center for Consumer and Patient Safety
PO Box 4481
Tulsa, OK 74159
office: 800-994-6025
mobile: 918-850-0293
facsimile 918-512-4208
hugh@okccps.org

'Dr. Death' arrested in Oregon

2008-03-13T22:37:00.000-07:00

FBI arrests doctor wanted in Australia

By WILLIAM McCALL
Wed., March. 12, 2008

PORTLAND, Ore. - First New York, then Oregon, and now Australia. Dr. Jayant Patel is accused of leaving a bloody trail of mistakes as a surgeon, now resulting in manslaughter charges.

His arrest at his Portland home Tuesday morning started the legal clock ticking on an extradition request by Australia, where he was director of surgery at Bundaberg Base Hospital in Queensland from 2003 to 2005.

Patel made a brief appearance Tuesday afternoon in U.S. District Court, where a judge scheduled a hearing for Thursday afternoon. His extradition hearing was set for April 10.

The extradition complaint charges Patel under Australian law with three counts of manslaughter, three counts of grievous bodily harm, two counts of negligent acts or omissions causing harm, seven counts of fraud and one count of attempted fraud.

If convicted on all counts, Patel could face up to three life terms in prison plus 100 years.

The complaint also said Patel "actively hid his history of professional misconduct and lied repeatedly on forms required for registration in Australia."

In a separate memo filed by the U.S. Attorney's office in Portland, prosecutors said that once he was hired in Australia, "Patel bungled surgeries with tragic results."

The list included: failure to stop internal bleeding in one patient who later died; removing a healthy gland from one patient and leaving behind a cancerous gland; tearing one patient's esophagus; and performing unnecessary surgery on patients in poor health when there were less risky alternatives.

Patel told U.S. Magistrate Judge Dennis Hubel "most likely not" when asked whether he could afford an attorney, so he was represented by a federal public defender, Susan Russell.

A family friend, Dr. Vijay Mehta, a Texas surgeon, compared a trial for Patel in Australia to Osama bin Laden going on trial in the United States.

"His wife has told me the best chance he has got is to fight extradition because they are not sure that they can even expect a fair trial in Australia with all the publicity and the demonizing," Mehta told Australian Broadcasting Corp. Radio.

Russell told the judge that Patel, who was born in India, came to the United States in 1977 and became a naturalized citizen in 1982.

News of the arrest was welcomed in Australia, where an organizer of a Bundaberg Hospital patient support group immediately phoned former Patel patients to inform them after first hearing the news in the middle of the night.

"We made a pact that they were to be told and they were very excited and relieved," Beryl Crosby said.

Patel was welcomed at first at the hospital in Bundaberg, a town of about 50,000 on the east coast of Australia known for sugar cane and as the tourism gateway to the Great Barrier Reef.

But then things began to go wrong for the American-trained surgeon.

Despite glowing references from fellow doctors in Oregon, complaints were emerging in Australia about his professionalism, his standard of patient care and even his personal hygiene. At one point, some nurses at Bundaberg claimed they hid patients from him.

Toni Hoffman, a nurse who worked with Patel at Bundaberg, said he regularly failed to wash his hands between patients, and another nurse, Gail Aylmer, an infection control specialist at the hospital, said he once claimed "doctors' hands don't have germs."

He treated more than 1,200 patients during two years in Australia. He was charged with manslaughter and grievous bodily harm after a government inquiry concluded in 2006 that he may have contributed directly to 13 deaths due to an "unacceptable level of care."

Patel trained in New York state at the University of Rochester School of Medicine in the 1980s, where he was cited for failure to examine some patients before operating on them _ a failure that "clearly evidenced his moral unfitness to practice medicine," according to the New York Commissioner of Health at the time.

However, after a three-year disciplinary probation, Patel was hired in 1989 by Kaiser Permanente Hospital in Portland.

By 1998, he had been sued several times and the Portland hospital had severely restricted his practice after reviewing 79 complaints. Patel left the hospital in 2001 after the Oregon Board of Medical Examiners cited him for "gross or repeated acts of negligence" and extended the restrictions on his practice statewide.

It's a start but the list is incomplete...

2008-03-13T21:30:00.000-07:00

I really wish this Medicare ruling had included Hospital Acquired Infections (HAIs) such as in my case Necrotizing Fasciitis or Man-eating flesh disease. In a case where a patient is in above average health with no prexisting conditions and gets a nosocomial infection following a routine procedure, there should be no charge as well. My hospital made a fabulous profit from the two months I was fighting for my life in their facility.

MSN Money The Basics March 7, 2008
Hospitals won't get to bill for errors

As of October, Medicare will no longer cover treatment resulting from eight types of mistakes, and patients won't have to pay. States and private insurers are also pushing for change.

By Melinda Fulmer

Under pressure from large private insurers, state governments and Medicare, hospitals around the country are now agreeing not to charge when they make medical mistakes, also called "never events" because they shouldn't happen.

Though it may sound like a no-brainer not to charge patients who had surgery on the wrong body part or were disabled from the wrong medication, in the hospital world it is a revolution.
"Asking hospitals to commit to normal customer-service principles should not be radical, but it is," said Rachel Weissburg of The Leapfrog Group, a nonprofit organization that pushed for the move. "We have a very strange system in the U.S., where you don't pay for quality, you pay for service."

That's beginning to change, experts say. Starting in October, Medicare, which covers 44 million elderly and disabled people, won't pay for treatment resulting from eight types of hospital errors, including surgical objects left in a patient during surgery, patient falls, catheter-caused urinary-tract infections and pressure sores, the most common preventable medical error.

Nor will hospitals be able to bill injured patients for these conditions. So a patient who in the course of treatment for a heart attack incurred pressure sores -- bedsores -- would be billed only for the cardiac treatment.

Next year, several more preventable errors will likely be added to the list, including drug-resistant staph infections and ventilator-associated pneumonia, a Medicare spokesperson said. The move is expected to save the government $190 million over five years.

The heat is on The movement to get hospitals to clean up their acts has been building since 2005, when pioneering insurance provider HealthPartners of Minnesota first said it would not pay for hospital errors, Weissburg said.

The next year, The Leapfrog Group took it a step further, pressing hospitals to tear up bills for medical mistakes, report them, apologize to the patients affected and launch investigations into their causes. So far, a little more than half of the 1,300 hospitals it surveys for quality and safety have agreed to this policy.

Under this kind of pressure, state hospital associations and the American Hospital Association are now urging their members to voluntarily agree not to charge for a list of 28 so-called never events published by the National Quality Forum.

Washington Gov. Christine Gregoire recently announced that three state medical groups, including the Washington State Hospital Association, had agreed not to charge for serious medical errors. That came on the heels of action in Vermont and Minnesota, Weissburg said.

This 13-inch-long surgical retractor was left in the body of Donald Church, of Lynnwood, Wash., by a University of Washington Medical Center surgeon during an operation to remove a tumor in June 2000.

Reinforcing these voluntary arrangements is a new resolve among the insurers and agencies that pay the bills. Medicare isn't the only one putting away the checkbook.

Pennsylvania's Department of Public Welfare said last month that it, too, would stop Medicaid payments for errors, following similar moves by Minnesota and Massachusetts. And large insurers such as Aetna, Blue Cross and Blue Shield are modifying contracts to make hospitals absorb the costs of their own mistakes.

"Fortunately, these events are quite rare," said Dr. Troyen Brennan, Aetna's chief medical officer. "However, it is important to take steps that will increase hospitals' focus on why never events happen, promote shared information and facilitate improved processes that will prevent future events."

There's no nationwide system for tallying medical errors. Only about half of the states require any kind of reporting of medical mistakes, Weissburg said.

In Washington state, for example, 193 never events were reported out of 630,000 admissions.
Mistakes must be acknowledged This move has been slow in coming, analysts say, because it forces hospitals to admit fault, a move that could aid malpractice lawsuits. Los Angeles tort attorney Peter K. Levine said that might be true.

"It's just one more arrow in our quiver," he said. But, he adds, with expert witnesses, serious mistakes generally aren't that difficult to prove in court. And, he said, it may cut down on the number of lawsuits, as more angry patients are mollified.

"Treating the customer right goes a long way to preventing litigation," Levine said.
But will withholding pay really improve care? Hospital groups say it will because it provides an incentive for people to point out imminent mistakes.

Under Washington State Hospital Association guidelines, many of the people in an operating room will not be paid if a mistake happens. So anesthesiologists, nurses and others have more reason to speak up if they see a physician about to make an error, said Cassie Sauer, a spokeswoman for the Washington association.

Of course, these hospital guidelines are voluntary, so there's no guarantee that everyone will follow them.

But, Weissburg said, with insurers, medical groups and Medicare turning up the pressure, hospitals have no choice but to improve their game. "The culture is changing -- it's being forced to change."

What Medicare won't pay for:

An object mistakenly left in a patient during surgery.

A preventable air embolism.

Complications from being given incompatible blood.

Catheter-associated urinary-tract infections.

Pressure ulcers (bedsores).

A vascular catheter-associated infection.

A surgery-site infection after coronary-artery-bypass graft surgery.

Patient falls.

Some hospitals won't charge for these never events:

Surgery on the wrong body part.

Surgery on the wrong patient.

The wrong surgical procedure.

Unintentionally leaving a foreign object inside a patient during surgery.

A postoperative death of a normal, healthy patient.

An infant discharged to the wrong person.

A patient suicide or attempted suicide resulting in serious disability.

A maternal death or serious disability in a low-risk pregnancy.

A death or serious disability (brain damage) associated with jaundice in infants.

Stage 3/4 pressure ulcers (bedsores).

Artificial insemination with the wrong donor sperm or wrong egg.

Any incident in which a line designated for oxygen or other gas to be delivered contains the
wrong gas or toxic substances.

Care ordered by someone impersonating a physician, a nurse, a pharmacist or other licensed health-care provider.

Abduction of a patient.

Sexual assault of a patient.

A death or significant injury of patient or staff from physical assault.

The same hospitals won't charge for a patient death or serious disability:

Caused by contaminated drugs, devices or biologics.

Linked to the use or function of a device other than as intended.

Associated with an intravascular air embolism.

Associated with a patient escaping or leaving without permission.

From a medication error.

Linked to a reaction to incompatible blood or blood products.

Associated with hypoglycemia.

Due to spinal manipulative therapy.

Associated with electric shock.

Associated with a burn incurred while hospitalized.

Associated with a fall.

Linked to the use of restraints.

Breaking the Error Chain

2008-01-28T12:49:00.000-08:00

'It's never just one thing' that leads to serious error
By Susan Brink
Los Angeles Times Staff Writer

January 28 2008

A technician mistakes an "a" for an "o" in a drug name. A doctor misplaces a decimal point in a prescription order. A nurse reaches for a vial in a cabinet as she's done hundreds of times before, only this time the light is dim and she fails to notice that the powder-blue label is more of a sky blue. The slip-ups are often simple, and always human, and all have happened in U.S. hospitals.

The complete article can be viewed at:
http://www.latimes.com/features/health/la-he-errors28jan28,1,185313.story