One of the themes in journalist Marshall Allen’s book is that few American leaders — neither politicians nor the chief executives of American companies — have been willing to fight back against high and rising health care costs. Therefore, the work of taking on the medical industry and health insurers falls to consumers, writes Allen, an award-winning investigative journalist for ProPublica.
The results of a yearlong joint investigation of the American autopsy system by ProPublica, Frontline and NPR show that problems in the death investigation system throughout the country have led to innocent people being sent to prison, “allowed the guilty to go free and left some cases so muddled that prosecutors could do nothing.” When autopsies aren’t done, diagnostic errors go undetected and opportunities to learn more about medicine are lost.
One story of patient rights and legal wrangling sports the remarkable headline “Why Can’t Linda Carswell Get Her Husband’s Heart Back?” It hinges, among other things, on the simple fact that “Even though the Institute of Medicine has reported that medication errors affect an estimated 1.5 million patients per year, it is not typical to conduct toxicology tests as part of clinical autopsies. They are routine in forensic autopsies.”
Hospitals aren’t required to perform autopsies – the Joint Commission hasn’t included autopsy rates in its accreditation process since 1971 – and neither Medicare nor private insurers reimburse hospitals for the procedures, which Allen found cost about $1,275 each. The implications of these financial disincentives, combined with related factors such as some physicians’ confidence that new diagnostic tools such as MRIs and CT scans provide such accurate results that they obviate the need for postmortem work, are far-reaching.
Diagnostic errors, which studies show are common, go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost to learn about the effectiveness of medical treatments and the progression of diseases. Inaccurate information winds up on death certificates, undermining the reliability of crucial health statistics.
A 2002 review of academic studies by the federal Agency for Healthcare Research and Quality found that when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of 10 cases, the error appeared severe enough to have led to the patient’s death.
In an investigation co-published with his old friends at the Las Vegas Sun, ProPublica’s Marshall Allen offers a revealing investigation into Heart Check America, a company whose high-pressure sales tactics and dubious quality record have earned it reams of consumer complaints and attention from state authorities.
Allen’s first-person anecdotal opener alone is enough to make the story worth reading, and the fact that he backs it up with thorough investigative work that appears to have already launched probes in two states is just the icing on the cake.
Heart Check America’s business model is eerily similar to that of the time-share industry, which is exactly where manager David Haddad earned his business stripes before being forced out by a state attorney general. Patients are lured in with the promise of free tests, then subjected to high-pressure sales tactics until they fork over thousands of dollars for long-term medical screening packages which they likely didn’t need in the first place.
It’s a classic investigation with evidence unearthed from a legion of sources; here’s just a sample of what Allen has assembled:
Colorado regulators checked Heart Check America’s Denver center. They found a litany of deficiencies, including no proof that staffers operating the scanner were qualified, no controls to ensure patients received as little radiation as possible, and that tests were being conducted without doctors’ orders.
Inspectors also found that the clinic was not supervised by a physician licensed in Colorado and that test results weren’t being read by a qualified radiologist or delivered to patients in a timely manner.
Allen’s work plays right into the debate over the efficacy of various screening procedures, especially those applied to low-risk patients, which makes one paragraph at the end of the story particularly ominous.
Haddad said he is continuing to look for opportunities in the imaging business. He has formed a new company, Cancer Check America, in Hilton Head, S.C, to focus on cancer screening.
This week’s Pulitzer announcements demonstrated just how far health journalism spread its wings in 2010, with health-related stories snagging wins and nominations for work related to everything from business to commentary to feature writing. Several AHCJ members were among the nominees, and Covering Health readers will recognize a significant number of the bylines and storylines. We’ve pulled the health-related award text below straight from Pulitzer.org and linked to related content when possible. Winning entries are in bold.
Awarded Mark Johnson, Kathleen Gallagher, Gary Porter, Lou Saldivar and Alison Sherwood of the Milwaukee Journal Sentinelfor their lucid examination of an epic effort to use genetic technology to save a 4-year-old boy imperiled by a mysterious disease, told with words, graphics, videos and other images.
Staff of The Wall Street Journal
For its penetration of the shadowy world of fraud and abuse in Medicare, probing previously concealed government databases to identify millions of dollars in waste and corrupt practices.
Sam Roe and Jared S. Hopkins of Chicago Tribune
For their investigation, in print and online, of 13 deaths at a home for severely disabled children and young adults, resulting in a state effort to close the facility.
The New York Times
For the work of Alan Schwarz in illuminating the peril of concussions in football and other sports, spurring a national discussion and a re-examination of helmets and of medical and coaching practices.
Writing for the Las Vegas Sun, reporter Marshall Allen put a fitting cap on an award-winning investigative run at the paper with a story rounding up the state’s first steps toward transparency in medical error reporting. Through the lens of former Beth Israel Deaconess chief, transparency pioneer and blogger Paul Levy, Allen demonstrates just how much transparency in Nevada could benefit both hospitals and their patients. It’s potential that was created, in no small part, through the reporting that Allen and Alex Richards have done.
Over the course of the Sun’s two-year investigation, most Las Vegas hospitals refused to discuss patient safety issues. The Nevada Hospital Association has since 2002 lobbied against mandated public reporting of patient harm. But since the Sun’s investigation, and with legislation pending, the association has said it will begin posting patient injury and infection data on its hospital quality website.
Throughout the piece, Allen paints a sunny picture of a more transparent future, and uses examples from Massachusetts to dissolve any reservations readers might have.
Dr. Tejal Gandhi, Partners’ director of patient safety, said at first there was panic over posting on the hospitals’ websites the infections and injuries suffered by patients. People worried there would be a media frenzy or a rise in malpractice lawsuits, she said.
When the information became public, in 2009, The Boston Globe published one story but there was little other reaction, she said.
The hospitals have seen no increase in malpractice lawsuits. But it has brought a new focus on reducing certain infections and injuries, including the formation of task forces and establishment of standardized safety protocols.