Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.
A well-known, prominent California physician. Allegations of a suspicious death. Family feuds. A recovering addict and possible affair. Elder abuse. A controversial investigation by the coroner.
While it may sound like a made-for-TV movie or the latest John Grisham novel, this life-and-death true story took journalist Charles Piller more than 10 months to investigate. Not only did Piller track and verify conflicting accounts of Jerome Lackner’s final months, but he also had to somehow navigate privacy roadblocks thrown up by hospitals, providers, the hospice facility and lawyers.
In this fascinating “How I did it,” Piller describes his five-part Sacramento Beeinvestigative series that may raise as many questions as it answers. He explains his efforts to answer basic questions about the roles and responsibilities of caregivers, hospitals, and hospices, and how he had to unravel a web of finger pointing by family, ex-spouses, friends and health professionals.
Without seeming to take sides, how does a reporter sift through mounds of conflicting evidence to create an engaging and coherent narrative? How can you track down reluctant key players in such a saga? How do you separate fact from fiction when family members accuse caregivers of indifference, neglect – or worse? Read about how Piller did it when investigating the death of Dr. Jerome Lackner.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ’s social media efforts and edits and manages production of association guides, programs and newsletters.
Issued by leading medical associations and government institutions, treatment guidelines are supposed to be based on rigorous science. But the committees that write them have been dominated by doctors who have worked as paid speakers, consultants or advisers for companies selling the recommended drugs.
In their investigation, the duo found:
Nine guidelines were written by panels where more than 80 percent of doctors had financial ties to drug companies.
Four panels did not require members to disclose any conflicts of interest. Of the 16 that did, 66 percent of doctors on the panels had ties to drug companies.
Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing. Medical experts have raised such questions about guidelines for anemia, chronic pain and asthma.
A while back, Sen. Charles Grassley wrote to state health officials, asking for lists of top Medicaid prescribers of certain drugs. When her state released its, Lisa Chedekel of the Connecticut Health Investigative Team took it and ran with it, using all manner of public data to assemble a portrait of Connecticut’s prolific prescribers and the conflicts of interest that may drive them.
Speaking of conflicts of interest, Chedekel found that 43 of the 108 high prescribers (some broke into the top 10 for multiple drugs) earned money, meals or other benefits from the very companies whose drugs they were subscribing in such large quantities. She profiles a number of these physicians, but my personal favorite is one whose records show a curious correlation:
Dr. Kathleen Degen of Norwich was not among the top prescribers of Eli Lilly’s Zyprexa in 2008, but was the seventh-highest prescriber in 2009 (with 255 prescriptions), when Eli Lilly paid her $24,950 in speaking fees. Her prescribing fell off slightly in 2010, and she received $5,291 from Eli Lilly for speaking and travel. She disappeared from the high prescriber list in 2011 and received just $16 in meals from Eli Lilly, records show.
To better understand the problems that could arise from situations like these, Chedekel talked with academics, as well as a number of physicians named in the story. She also took a look at the drugs themselves, many of which Grassley had selected due to their controversial nature. The piece is a blueprint for reporting state-by-state on similar lists. The story also aired on Fox Connecticut.
Armstrong talked with 20 current and former patients and their families, examined criminal and civil cases, and went through “over 2,000 pages of court and medical records, police reports, state investigations and autopsies.”
Patients’ families or state agencies have alleged abuse or care lapses in at least five residents’ deaths since 1998, two of them in the last 18 months. Three former employees face criminal charges of abusing FINR patients – one of whom was allegedly hit repeatedly for two hours in a TV room last September.
But before you get lost deep in the details of Armstrong’s report, take a minute to appreciate his deft aggregation of scores of disparate resources through convenient hyperlinks and attachments. His entire work is truly integrated with the Web in way that, even today, few investigations are. Just as importantly, it’s tied to the bigger picture and what this scandal shows about extended care for Americans with brain injuries.
The complaints underscore the problems that 5.3 million brain-injured Americans are having finding adequate care. Their numbers are growing, according to the U.S. Centers for Disease Control and Prevention, as better emergency medicine and vehicle safety mean that fewer die from traffic accidents, bullet wounds and other causes of traumatic brain injuries.
The long-term ills range from memory loss and physical handicaps to the inability to control violent anger or sexual aggression. Yet because insurance benefits for rehabilitation are scarce, less than half of those who need it receive it, according to the Brain Injury Association of America.