How I Did It

Learn from these journalists how they have covered various aspects of patient safety. They provide valuable tips and sources and explain how they got past the challenges to better inform their audiences.

Lessons learned while tracking a UCSD anesthesiologist’s drug abuse and diversion case 

March 2020
When patients undergo surgery, the anesthesiologist usually administers more than one type of drug. Some tackle pain, so you don’t feel the incisions. Some tackle memory, so you don’t recall the experience.

But what if someone stole some of your pain meds? Would you have felt pain during the operation, but not remember it? Or what if someone stole the drugs that induce amnesia and substituted saline for some of your medications? Would you remember whirring noises from drills or surgical team conversations after you woke up? Would they haunt your subconscious? What if they substituted some of the drugs in the syringe with saline?

Those are some of the questions that emerged as Cheryl Clark worked on a story for MedPage Today about Dr. Bradley Glenn Hay, an attending anesthesiologist at the University of California San Diego Medical Center who admitted an addiction to sedative drugs he took from UCSD and its patients since his anesthesiology residency in 2003.

Reporter uncovers ‘painful mistakes’ in one state’s handling of dentist errors

January 2020
Over five months, Arthur Kane, an investigative reporter for the Las Vegas Review-Journal, immersed himself in the workings of the Nevada State Board of Dental Examiners. Kane combed through state audits and internal documents and delved into the stories of patients who were left suffering by dentists who were allowed to keep practicing. He weighed troubling allegations raised by a local dental society. In October, he emerged with a six-part series, "Painful Mistakes."

In the wake of the project’s publication, more than half of the board’s members left or lost their seats and two professional staffers were terminated. Gov. Steve Sisolak has pledged reforms.

In this Q&A, Kane describes how he tackled the reporting for the series and worked with newsroom colleagues to bring the story to life. He also offers advice to journalists who may want to take a closer look at a professional board in their state.

In patient safety, compelling stories are waiting to be told

January 2020
Prominent stories about medical error played a central role in the political impact of the landmark Institute of Medicine (IOM) report, "To Err is Human," which came out in late November 1999. The IOM estimated that up to 98,000 Americans die from preventable harm in hospitals each year and another 1 million are injured.

Yet, physicians did virtually nothing about patient safety for decades, despite repeated warnings about treatment-caused deaths and injuries. 

The good news is that today every hospital is doing something to improve safety. The bad news is that a commitment to reducing harm to the greatest possible extent ­­– so-called “zero preventable harm” – is still uncommon, partly because too many clinicians still wear blinders about error prevalence and preventability. Patient safety stories remain relevant and important. Patient safety expert and former reporter Michael L. Millenson offers an overview of some opportunities.

December 1994: Medical error meets journalism

January 2020
When Dr. George Lundberg, then editor of JAMA, printed two articles on medical error, he hoped that no reporter would notice. Fortunately, news people don’t all take off for their winter homes at the end of December. The frank talk about medical error in a prestigious journal was first picked up by a Boston public radio reporter and later by The Washington Post.

Investigating climate change and the military heat crisis

November 2019
David Hasemyer reported an InsideClimate News/NBC investigative story showing more U.S. troops are falling to heatstroke and heat exhaustion as the military struggles to balance training with rising temperatures.

The story behind case No. 20160614001 was that of Sgt. Sylvester Cline, an Iraq veteran and father of five who collapsed and later died after enduring hours under a scorching sun during a field exercise at Fort Chaffee in Arkansas. Case No. 20160614001 was among the decade’s worth of data the military had gathered that showed a steady increase in the number of military personnel harmed by heat.

Here, Hasemyer lays out the background and shares his sources for similar reporting that could be done all around the country.

66 Garage: Reporter talks about finding a patients' identity, humanity 

November 2019
Award-wining journalist Joanne Faryon has been writing a series of stories and produced a six-part podcast on her two-year pursuit of the identity of 66 Garage, a man kept on life support for nearly two decades and whose consciousness was questionable.

She found him in a San Diego skilled nursing facility, or “vent farm.”

So moved by the anonymity of his plight, she vowed to learn his name, find out how he got there and contact his relatives who, as it turned out, thought he had died long ago.

Considering the ethics of producing podcast on 'vent farm' patient

November 2019
Joanne Faryon produced a podcast about “Sixty-Six Garage,” a man who went unidentified in a San Diego “vent farm,” aka skilled nursing facility, for 15 years. Her gripping oral recount of how she quit her job in 2015 and spent her own money and resources to find out who he was and how he ended up this way, attached to ventilators and unable to speak or move, is chilling.

She ultimately discovered his identity through sheer persistence, although she encountered some tricky ethical questions along the way about how she herself became part of the story. She also discovered how he got that name, “Sixty-six Garage,” which reveals a lot about how hospital providers grapple with the challenge of identifying patients when they themselves can’t tell their care givers who they are.

How a doctor’s tip and a Facebook algorithm led to an award-winning series

July 2019
This is the story of how a doctor’s tip, with help from a Facebook algorithm, led to an award-winning series about a nationwide network of diabetes clinics that some experts called a scam. The story does not end well for the network’s founder, G. Ford Gilbert, who goes to federal prison in August.

How I learned about Trina is probably what happens to a lot of journalists who stumble onto a great story. The path might be circuitous and require a lot of patience and curiosity.

Reporters find dire problems with Texas’ Medicaid system

June 2019
This year’s Goldsmith Prize for Investigative Reporting, awarded by the Shorenstein Center on Media, Politics and Public Policy at the Harvard Kennedy School, went to two reporters at the Dallas Morning News who investigated the Texas Medicaid system.

David McSwane and Andrew Chavez spoke to the Shorenstein’s Journalist’s Resource about their series, "Pain & Profit.”

We’re reprinting it, with their permission, as a “How I Did It” piece.

How one reporter accidentally stumbled on a state-wide prescribing investigation

November 2018
With “Death Certificate Project” and “opioids” in a headline, any story would — one would think — be a gold mine for page views. 

But it surprised Cheryl Clark that no media organization had published anything on this California effort when she found out about it, though it had been going on for more than three years.

Designed to identify excessive opioid prescribers, the ongoing project involves the Medical Board of California’s review of nearly 2,700 death certificates for patients with confirmed fatal overdoses in 2012 and 2013.

Patient safety expert Wachter discusses evolution of technology in health care

November 2018
Robert Wachter, M.D., chair of the Department of Medicine at the University of California, San Francisco, is considered the “father” of the hospitalist field and a leader in the patient safety field. He’s written six books, including “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age,” which took a detailed look at the role of technology in health care. Wachter was a keynote speaker at the 2018 Society to Improve Diagnosis in Medicine Conference in New Orleans – where he talked about medicine’s digital transformation and the upsides and the downsides that accompany progress. He sat with Liz Seegert for an interview prior to his presentation.

Award-winning journalist helps students dive deep into local elder abuse investigation

October 2018
Tracy Breton, a Pulitzer prize-winning investigative and legal affairs reporter at the Providence Journal for 40 years, and now professor of English and nonfiction writing at Brown University, finally got the opportunity to report out the elder abuse series she’s wanted to do for a decade. She oversaw a year-long investigation by a team of Brown University students into the issue of elder abuse in Rhode Island. The project blossomed into a nine-part-series for the Providence Journal thanks to a new, nonprofit community news initiative, the Community Tribune.

Breton, (along with two of her student reporters), discussed their experiences for the Providence Journal’s “From the Newsroom” podcast. In a follow-up interview with me, Breton further detailed aspects of this significant body of reporting. 

New data set helps reporter pinpoint critical staffing concerns in skilled nursing facilities

July 2018
In April, Medicare began using data to rate staffing for more than 14,000 skilled nursing facilities. Data from the Payroll-Based Journal provides a much better look at the how staffing relates to the quality of care than the less precise — and too easy to inflate — staffing data Medicare had been using since 2008, which was based on two-week snapshots of staffing homes provided to inspectors. The data shows staffing and occupancy on every day. It’s an unprecedented degree of granularity that allows for new levels of inquiry.

Jordan Rau of Kaiser Health News used the new data to focus on the wide fluctuations in nursing home staffing from day to day, with staffing consistently plummeting on weekends. Here he discusses some of his methodology and how he made some decisions about how to use the data.

Reporters’ data analysis added credibility to anecdotal evidence of hospice neglect

February 2017
Kaiser Health News reporters JoNel Aleccia and Melissa Bailey analyzed government inspection records to reveal that although U.S. hospices promise to be on call around the clock, dying patients and their families often face terrifying delays, no-shows and unanswered calls.

Reporter turned on-deadline account of a dental death into more than a tragic story

March 2017
Sacramento Bee health reporter Sammy Caiola worked quickly to give her readers the story about the death of a young California father from complications of a dental infection.

Her reporting began at 10 a.m. on Jan. 31 when she found the kernel of the story in an email. By that afternoon, Caiola had tracked down and visited with the man's grieving widow, interviewed a knowledgeable local dentist on the causes of dental deaths and located peer-reviewed research that added depth and context to her piece. She managed to file a basic version of her story by 2:30 p.m. and turned in a longer version of the story by the 5 p.m. print deadline.

In this Q&A, Caiola walks us through that busy day of reporting and reflects on what surprised her most in her work on the story. She also offers tips to colleagues who might find themselves covering a dental death on deadline.

Uncovering the safety flaws in IBM's Watson supercomputer

September 2018
IBM enjoyed positive PR on its cancer treatment adviser, Watson for Oncology, until two reporters for Stat looked into whether the results matched the buzz.

Casey Ross and Ike Swetlitz describe that they initially got interested in IBM Watson because there were “a few chinks in the narrative“ the computing giant had been telling. Notably, one big cancer center had scrapped its project with IBM.

Ross and Swetlitz describe their reporting process, and how initial stories on Watson for Oncology generated more leads and additional sources coming forward.

Reporters’ data analysis added credibility to anecdotal evidence of hospice neglect

December 2017
Kaiser Health News reporters JoNel Aleccia and Melissa Bailey analyzed government inspection records to reveal that although U.S. hospices promise to be on call around the clock, dying patients and their families often face terrifying delays, no-shows and unanswered calls.

Reporter turned on-deadline account of a dental death into more than a tragic story

March 2017
Sacramento Bee health reporter Sammy Caiola worked quickly to give her readers the story about the death of a young California father from complications of a dental infection.

Her reporting began at 10 a.m. on Jan. 31 when she found the kernel of the story in an email. By that afternoon, Caiola had tracked down and visited with the man's grieving widow, interviewed a knowledgeable local dentist on the causes of dental deaths and located peer-reviewed research that added depth and context to her piece. She managed to file a basic version of her story by 2:30 p.m. and turned in a longer version of the story by the 5 p.m. print deadline.

In this Q&A, Caiola walks us through that busy day of reporting and reflects on what surprised her most in her work on the story. She also offers tips to colleagues who might find themselves covering a dental death on deadline.

How to break down a big topic into a reader-friendly multipart series

October 2016
Anna Gorman says the statistics were startling: About one-third of patients more than 70 years old, and more than half of patients over 85, leave the hospital more disabled than when they arrived.

She came across these numbers while researching a potential series of stories for Kaiser Health News about how elderly patients fare in hospitals. She was curious about the reasons for a high rate of disability. After extensive research, a common theme emerged and it was clear that this wasn't simply because the patients were old or sick.

Here, she describes how she researched the series, organized her reporting and the stories, and even shares what she thinks would have made the series even stronger.

State budget cuts had adverse effects on patient care, leading to hospital’s decertification

September 2016
Last December, Megan Hart was reading the local newspaper before heading to her first day of work at KHI News Service when she came across a few paragraphs about a public notice stating one of Kansas’ two state psychiatric hospitals would lose Medicare payments within a month.

Hart recognized that there was likely more to the story because it's rare for the Centers for Medicare & Medicaid Services to ‘decertify’ a facility or cut payments.

Here she tells us how she pursued the story, which became a project, and who her best sources were.

Unsafe anesthesia use in dental procedures for children continues to be an issue

September 2016
In the wake of the Dallas Morning News’ seven-part Deadly Dentistry series, Texas media outlets are now following the story of yet another child left dead after a dental visit.

Daisy Lynn Torres suffered complications from anesthesia while undergoing a procedure in an Austin dental office last spring, a medical examiner recently concluded, according to the Austin American-Stateman.

Brooks Egerton, who left the Dallas Morning News in a newsroom buyout since the publication of Deadly Dentistry late last year has been following the coverage. He reflected on the death and offered advice on how reporters should approach these stories.

Reporter explains how he turned a troubling hospice death into an investigative series

September 2015
“An Unquiet Death,” Charles Piller's five-part investigative narrative that appeared in August in The Sacramento Bee, looked into the death of Jerome Lackner, former maverick leader of California’s Department of Health, one-time personal physician to Cesar Chavez, and a savior of countless addicts. Jerome passed away in 2010 during hospice care in his Davis, Calif., home. His primary caregivers had been his second wife, Rebecca, then 72, from whom he was legally separated; and Joseph Poirier, a 51-year-old recovering addict who friends and family would claim later was having a clandestine affair with Rebecca.

Making an investigative piece about ‘preventable harm’ accessible to readers 

August 2015
Sarah Kliff's story,“Do No Harm,” began with a simple question.

She is one of AHCJ's 2015 Reporting Fellows on Health Care Performance and, while writing a series on fatal medical errors, she wanted to understand why preventable harm happens. Why do errors that we know how to stop persist?

Her attempt to answer that question became one of the largest projects she's undertaken as a journalist. “Do No Harm,” published on Vox, took about four months to research, report, and write. Kliff learned a lot about how to manage big projects — and find good sources for long narratives. Here she shares few lessons she took away from the experience.

Using evidence, FDA reports and legal documents to explore robotic surgery’s risks and benefits

July 2015
A few years ago Laura Beil did a story for Men’s Health on proton beam radiation. If she learned one thing, it was that if you want to promote a new technology, sell it to men worried about bladder and sexual function after prostate surgery. So the first time she saw a billboard for robotic surgery making just those claims, she had to wonder whether she was seeing an advancement in marketing but not medicine.

Spotlighting sepsis: How one journalist reported on 'dirty little hospital horror'

July 2015
As senior quality editor for HealthLeaders Media, Cheryl Clark wrote more than 1,300 stories about hospitals' efforts to improve quality and safety and related issues. The story she wrote for the June 2014 issue of HealthLeaders, about how U.S. hospitals are improving recognition and treatment of sepsis — which is diagnosed in 750,000 patients a year and kills 40 percent — won the 2015 National Institute of Health Care Management prize in the trade print category.

Rates of sepsis seemed to be one more dirty little hospital horror to explore, one that the Joint Commission said cost hospitals about $16.7 billion annually. Yet hospitals' efforts to tackle it seemed hidden behind improvement initiatives attracting more attention, such as reducing hospital-acquired infections, and preventable readmissions, lowering emergency room wait times and raising patient experience scores.

Here, she explains how she did her reporting, despite a lack of data and sources who didn't want to talk.

How we did it: Uncovering mystery deaths in state mental hospitals

Alan Judd and Andy Miller of The Atlanta Journal-Constitution write about how they reported a series about deaths in Georgia's mental hospitals. They found that at least 115 patients had died under suspicious circumstances in Georgia's mental hospitals from 2002 to 2006, and that more than 190 patients over that time were victims of employee abuse.

Inspection reports reveal deficiencies in assisted-living care

August 2007
Ziva Branstetter of The Tulsa World reported a series of articles about assisted-living centers. She found that the public is remarkably uninformed about major issues such as what services to expect in assisted living, when to choose a higher level of care and what a center's inspection records reveal. In addition, "assisted living" can mean different things to different people and in different states, and there are no specific federal regulations governing assisted-living centers; each state has its own standards.

Medical misconnections: Patient-safety problems

July 2007
David Wahlberg of the Wisconsin State Journal reported on patient-safety problems, including tubing misconnections, incompatible defibrillator pads, nurse fatigue and more. In an article for AHCJ members, Wahlberg explains how he reported the series and offers tips for other reporters.

How we did it: Investigating organ transplant centers 

February 2007
Charles Ornstein and Tracy Weber of the Los Angeles Times describe how they went about reporting on problems in organ transplant centers. They describe the data and federal standards they used to document problems, as well as the types of sources they used to report the ongoing story.