A frightening story on the front page of The New York Times today is a reminder that the best medical advice is: Don't get sick.
The tepid headline–Hospital Chain Inquiry Cited Unnecessary Cardiac Work–does not do justice to a story that reveals not only that procedures were done when they shouldn't have been, but that the hospital chain has refused to answer questions, to reveal the results of its internal investigations, or to discipline or dismiss some doctors accused of doing unnecessary procedures.
The story, by Reed Abelson and Julie Creswell, is a nicely written and thoroughly reported look at the cardiac care provided by HCA, which they report is the largest for-profit hospital chain in the U.S. Evidence from as long ago as 2002 showed that some cardiologists could not justify the procedures they were performing, which included cardiac catheterizations and the insertion of stents.
The reporters tell several horror stories of patients being nearly killed by procedures they didn't need. But what I found most compelling–and which wasn't reflected in the headline or the lede–was that the company has largely been stonewalling requests for information.
A few examples:
In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary…
…HCA also declined to show that it had ever notified patients…
Details about the procedures and the company’s knowledge of them are contained in thousands of pages of confidential memos, e-mail correspondence among executives, transcripts from hearings and reports from outside consultants…A review of those communications reveals that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line.
The reviewer…concluded there were problems with 13 of the 17 cases performed by Dr. Shadani…Dr. Shadani continues to practice…
The story also involves Bain Capital, Mitt Romney's former buyout firm, and Gov. Rick Scott of Florida, the former CEO of HCA.
It's no surprise that the motivation behind all of this, as the story makes clear, is money. These procedures are lucrative. One can scarcely expect rules and regulations to prevent doctors or hospitals from straying over the line, under the pressure of home mortgage payments or quarterly reports. But one would hope that once such transgressions are discovered, the individuals and corporations involved would be clear about remedies and punishments.
The most frightening thing about this story is not the medical horror stories, but the corporate refusal to come clean. Who knows what other offenses might be hiding under the hospital bedsheets.
Kudos to the Times for this fine exposé.
– Paul Raeburn
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