1. Provide the title of your story or series and the names of the journalists involved.
Who Protects the Patients? By Jeremy Kohler and Blythe Bernhard, St. Louis Post-Dispatch
2. List date(s) this work was published or aired.
May 16, August 1, November 7, December 12, 13, 14, & 15
3. Provide a brief synopsis of the story or stories, including any significant findings.
– Patients are kept in the dark about problems with doctors and hospitals. – Hospitals either don't sanction dangerous or incompetent doctors, or find ways to avoid federal reporting rules. – The health care system does more to protect doctors' livelihoods than patients. – Missouri's regulation of doctors is among the most lax and secretive in the nation.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
We reviewed about 200 medical board cases, more than 100 state and federal court cases, hundreds of hospital inspection reports, dozens of reports from health department investigations, law enforcement and nursing home inspectors, Medicaid billing data, and several FDA warning letters. We used state and federal FOI laws extensively. We requested documents from at least 20 different states, and sent a survey to all 50 states' medical boards. When a report from a CMS (Medicare) investigator failed to answer our questions about a wrong-site surgery, we used the federal FOIA to obtain the investigator's handwritten notes. We were not successful with all of our record requests, but when we were blocked from reviewing records, we were able to show readers to what extent the government was keeping us from viewing public records. In one extreme case, the Missouri healing arts board planned to charge us more than $60,000 to produce about 6,000 pages of records (about one box full) which would take 18 months to produce. It all went to prove our point — the system is closed to patients.
5. Explain types of human sources used.
We interviewed dozens of patients, family members, doctors, politicians, state regulators, retired board members and experts in health care.
6. Results (if any).
Hearings will be held in early 2011 to investigate the state's weak physician disciplinary record. The head of the department that oversees the state medical board has called on the legislature to draft new laws that will make it easier to discipline doctors, strengthen patient protections and improve transparency for consumers. The president of the medical board congratulated the Post-Dispatch reporters for their investigation, crediting the work for inspiring improvements to their governance. Missouri Gov. Jay Nixon said he would work with state legislators in the coming year to strengthen the state board responsible for protecting patients from dangerous doctors. Republican and Democrat legislators told reporters that their top priority would be fixing the state's lax, secretive system of disciplining doctors. The state nursing board filed a complaint against one of the nurses referenced in a story. The nurse failed to start CPR on a teenage patient who was suffocated. The president of a St. Louis-area medical society commended the Post-Dispatch investigation, saying doctors were amenable to a more transparent system that roots out unsafe doctors. Dozens of readers have sent notes of encouragement and support, citing a desperate lack of information on doctors and hospitals.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
After the August 1 story published, a nurse's lawyer came forward with an update on the state investigation of hospital negligence in the death of a teenage patient. The lawyer said the state's case against one nurse had recently been resolved. The state would not confirm the information. We published a clarification based on a letter provided by the lawyer. Also after the August 1 story, the company that owns the hospital where the death occurred wrote a letter to the editor saying the story "grossly misrepresented the safety and quality of care our patients receive day in and day out."
8. Advice to other journalists planning a similar story or project.
If you are investigating your medical board, take the time to build your own database of its actions. Those cases are usually published in newsletters and can easily be entered by hand. We developed a system for quickly formatting the entries into an Excel spreadsheet. Get to know how to use the National Practitioner Data Bank, which contains nearly 700,000 records of malpractice judgments and adverse actions against health providers. The database identifies doctors only by unique number — not by name — but if you know enough about a particular physician you can often use that information to identify his unique number in the data bank. Then you know his whole story.