Facebook
Fark
Digg
Reddit
Stumble
Sunday, June 27, 2010 | 2 a.m.
Do No Harm: Hospital Care in Las Vegas
- Prologue: A breakthrough in transparency
- Reporting is the first of its kind in Nevada
- Health care can hurt you
- Accident took her life, his heart
- Fall proves fatal for elderly patient
- Inadequate care, unspeakable pain
- Scarred for life by mistake in surgery
- Where I Stand: Fascination and frustration in reporting on Las Vegas hospital care
- Editorial: Preventing harm
- Health care leaders discuss Sun report’s findings
- St. Rose Dominican Hospitals to post data on quality
- State presses hospitals for full accounting of preventable injuries
See the results
Share your stories
There’s a running joke about hospitals here:
“Where do you go for great health care in Las Vegas?”
“The airport.”
The implication is everyone knows hospital care in Southern Nevada is substandard.
The reality, however, is that almost no one has had access to meaningful information about the quality of Las Vegas-area hospitals.
Until now.
The Sun on June 27 launched an ongoing report about hospital care in Las Vegas.
As part of a two-year investigation, Sun reporters Marshall Allen and Alex Richards have obtained a record of every Nevada hospital inpatient visit going back a decade — 2.9 million in all. The information, coupled with interviews with more than 150 patients and health care insiders, has yielded a sweeping and detailed portrait of hospital care in Las Vegas.
Revealed are the dangers patients have unknowingly encountered as they enter delivery rooms, surgical suites and intensive care units, including thousands of cases of injury, death and deadly infection associated with stays in Las Vegas hospitals.
There have been previous red flags about hospital safety. A suicidal patient, for instance, recently hanged himself while under observation at MountainView Hospital, and a woman in labor was ignored at University Medical Center, leading to a miscarriage.
A recent study found that Nevada hospitals have the worst rate in the nation of readmissions, meaning discharged patients needed to return within 30 days to the hospitals for additional care.
But the public has not known the scope of the problems, even though the state has been gathering inpatient data since 1986. The data, gathered primarily for cost-control purposes, are based on individual hospital billing records that state law mandates be collected for the purpose of analysis.
The state contracts with UNLV to maintain the records, which do not contain identifying names, birth dates or addresses, nor the dates patients were hospitalized. The data also leave out clinical details, so they’re not the same as medical records. Rather, they signal trends and warning signs that warrant further investigation.
Until now, Nevada hospitals have succeeded in controlling the release of this information to the public. The result: In a state where gamblers can easily access the odds on any video poker machine, hospital patients have had no way of knowing how frequently harmful outcomes occur where they receive their most sensitive health care.
But now, with tables and interactive online charts, much of that information is available in the Sun.
Dr. John Santa, director of the Health Ratings Center for Consumer Reports, a national nonprofit organization, said he has not heard of another organization, in journalism or otherwise, analyzing inpatient hospital data in a way that’s transparent to the public.
“This is the first step in getting to a new and different and better relationship between hospitals and physicians, and patients and the public,” Santa said.
Helen Haskell, director of the national advocacy group the Empowered Patient Coalition, said the Sun’s analysis will allow patients to make better-informed decisions about where to seek care, exerting financial pressure on low-performing health care providers to improve.
Because most states have similar databases, the Sun’s investigation can be replicated, imposing a new era of transparency within the hospital industry.
“This is the Holy Grail,” Haskell said. “What every patient wants is provider-specific information about outcomes.”
Assembly Speaker Barbara Buckley, a longtime legislative advocate for improving health care, lamented it was a newspaper that has brought this information to light instead of state regulators who have had the data for years.
“Do you have the right to know about the quality of care you’re receiving? I think you do,” she said. “When you buy a car, you can go to Consumer Reports. Isn’t someone’s life worth more than his car? I would think so.”
Thank you Las Vegas Sun for recognizing the elephant in the room. This type of investigative reporting is what makes The Sun a real awarding-winning newspaper that continues to make Hank and Barbara very proud. Kudos!!
bravo!!!
Thank you for shining some light on poor hospital care here in Southern Nevada. Our hospitals understaff their care units, making it impossible for RNs to perform needed surveillance. Failure to rescue occurs when nurses have to watch over 9 or even 10 patients at a time. If you are going to be admitted, make sure you have someone at your side to advocate for and obtain needed assistance (and to make sure you don't fall!).
ANOTHER Pulitzer for the Sun?
Once again the smaller newspaper in town shows those clumsy oafs at the RJ what real reporting is all about. There's more to serving a community than selling ads and regurgitating GOP talking points.
This is where national health care and a complete computerized patient record system will allow one to compare hospitals and doctors and clearly show which facilities and people and delivering poor health care.
Why does it take a newspaper to get good health care in Las Vegas?
Sick patients are more profitable. That is why this stuff happens.
I dont see where stating the obvious makes this news.
Why should health care be any different than education and public safety? Both Nevada and Clark County are at the bottom of almost every measure in education and public safety, is there any reasonable expectation that health care would be different?
As long as the Southern Nevada economy is built around "the fast buck" we will have bottom of the barrel in education, public safety and health care. All of those people that live for today will suffer tomorrow.
Journey,
Be careful how you interpret the chart data. If you are looking at the total number of incidents in the far-right column for each hospital, that is a raw number and does not reflect the rate of incidents given the number of inpatients. The individual columns do show those rates.
It is all but impossible to give an overall rating for hospitals in terms of patient safety and to declare which is the "best" or "worst."
But experts do make the point: any number greater than zero is bad because the incidents involving patients being harmed are preventable and avoidable and shouldn't be happening at all.
Comment removed by moderator. Off-focus, gets into national politics.
Sun staff,
Obviously all these hospitals have been in business for different lengths of time meaning the older ones will naturally have more chances to commit errors. How does that figure into these statistics?
LastThroes,
The data that the Sun specifically examined for today's main story, "Health care can hurt you," is a snapshot of the number of inpatients harmed during their hospital stays during 2008-2009, not going back to the opening of each hospital. IE, the data reflects the number of patient-harmed incidents at each hospital for the same amount of time.
Any way to factor in average age of patient into this study? Or just disclaim it on the results pages?
Kudos to the LV Sun for an article addressing in part why many choose an airline ticket as part of their health care needs.
Our local hospitals and providers are knee deep in self-interest and greed and both feed each other. I would think that a surgeon performing a case should be fully engaged on the patient he is operating on. Not so in the world of spine surgery within Southern Nevada!
A practice as disgusting as "the touch" (an second doctor entering the operating room long enough to "touch" the patient and charge an assistant fee)is done here every day.
Many of our community's most prominent spine surgeons repeatedly schedule cases with two separate OR teams and anesthiologist. The surgeon runs back and forth between the rooms in an effort to get as many cases done in as little time as possible with great risk. While this may not be the most efficient nor safe practice for the anesthiologist, they are forced to agree, or the surgeon will merely seek another provider who will compromise safety for business. For both the surgeon and hospital, it is a way to keep their OR rooms filled and their profits high.
But what happens when their timing is off, or something goes wrong? What happens when an emergency arises and not one but two patients are under anesthesia at the same time, many times one of them not even having an incision made?
How can "any" facility allow this to happen, especially when many of the surgeons are also covering ERs or Trauma Centers, even outside of the facility they are working in?
In one reported case that happened at UMC and the surgeon (Smith) had three rooms committed at once. The stress was so unbearable that he even assaulted one of the nursing staff as reported by the RJ. Are you listening DD, JA, JG, and all of the other guilty parties?
Some patients have been under anesthesia for over an hour, just waiting for their surgeon to finish up with the previous patient. Who pays for this unnecessary expense? In one case a non-spine surgeon was noted to perform part of a procedure outside his expertise, while the spine surgeon was finishing up in another room. This is a time bomb waiting to explode.
How about some accountability from the surgeons, anesthiologists and hospital administrators who put profits before patient care?
Our community welcomes this investigation and hopefully National attention will be earned by the Sun for exposure to the true medical mafia.
Bear in mind that hospitals like Sunrise are part of a huge corporation with other hospitals. It has to do with their managerial culture that in the end affects the quality of patient care.
Now, the bigger question is: Why can't Las Vegas have its own Mayo, Scripps or worldclass healthcare facility? Is it politics and money that is keeping them out? Wouldn't surprise me. Has our dear economic development leaders tried to lure them to Nevada with some really worthwhile incentives?
If the answer to this question is revealed, it will speak volumes about the leadership in Nevada!
Mamabear,
Remember that the world-renowned Cleveland Clinic has partnered with the Lou Ruvo Center for Brain Health in Las Vegas and is considering expanding here.
Sun Staff: A while ago, maybe about 8 years ago, there was a "malpractice scandal" of sorts. There were news reports of doctors walking out, etc. I remember this time well because I was pregnant with my first child and right after he was born, my (awesome) doctor "retired". So out of curiosity, do you think that in the aftermath of that time, we (Vegas) attracted less than stellar medical professionals or the "under-staffing" we see today? One other quick question: when a comment is removed because it is "flaming", what exactly does that mean? Thanks.
Sassy,
Good question about the effects of the malpractice crisis... Stay tuned for more stories.
"Flaming" is the nickname for when writers attack one another. We don't tolerate that. Stick to the issues and don't make it personal.
thank goodness we have one paper in town that's willing to do actual reporting. great job, LV Sun. great material!
The split up of the once successful partnership of Western Regional in several days could seriously affect emergency coverage, since the big ticket partners hate calls, even though UMC and HCA fork over $1M per month to have Western Regional emergency coverage. Fortunately those constacts will need renegotiated, since the breakup is happening July 1, 2010.
The public can soon expect more attention and hopefully after admission receive emergency treatment immediately, rather that hours later, after someone at Western Regional is found. The UMC surgicial coverage can no longer pick and choose insured patients over street types or expect inflated bills to be paid because Clark County, who is now also broke will pay.
Your articles really lit up the contributions in a positive way and helps us all focus on healthcare, physicians and hospitals.
There are a vast majority of physicians who really care and try everything possible to be pleasant, knowledgeable and a comfort to patients and families.
The problems may be cured if good physicians felt comfortable in reporting bad ones or if RN's felt that their jobs were secure if they reported unethical practices.
Unfortunately neither group can believe that a watchdog agency exists other than the Medical Examiners, who appear to protect the guilty and punish any "whistleblowers"
The print media reporters at the RJ have done everything possible to tarnish the innocent for speaking up.
Nobody will speak. Look at the lack of witness in the Desai dilemma.
Until there is justice from the highest level of the State, where physicians can feel safe and report their peers without retribution nothing meaningful will happen.
The State Boards are clubs established for egos and not watchdogs for the public.
Kudos to the Sun, for brave and detailed reporting.
After having had bad family experiences at hospitals owned by the St. Rose chain, the Sunrise/Southern Hills chain, and UMC Pediatrics, I have instructed my family to let me die rather than check me in to a Las Vegas hospital.
God bless you, Las Vegas Sun, for doing this! Fifteen years ago I worked for the Medical Dental Screening Panel in Las Vegas, which screened medical malpractice cases, including hospital error. After seeing the horrors that went through that panel, it was obvious that Las Vegas hospitals needed intense scrutiny. The regular folks living in Las Vegas will be safer because of what you are doing, as those hospitals will not be able to hide what they've been doing!!!
Congratulations! We need transparency. As registered nurse in a very busy ED department I see management, medical associations, and politicians are indeed the medical mafia. I live in fear of retaliation from my employer because I speak up for patient and employee rights. I see and have seen travesties of justice before my very own eyes. If only the public could see what I see or hear what I have to say but if I speak out or the "outside" wants to "look in".....they slam the door shut in our face.
The saying in our department goes "to get promoted to management you have to kill a patient first to be qualified" No joke.
Major cover ups! Major!
Let's not hold the facility accountable without taking a look at the surgeons. We have some of the worst in the nation here, and they cover for each other in an obscene way. It's bad enough to receive poor care, but what is worse is you have to leave the state to get an accurate diagnosis. They watch out for each other and patient care is the least of their concerns.
Good, informative article. As a retired nurse, I would be a liar or a coward if I made the statements that puppy made. If I have "seen travesties of justice" in the hospitals I worked and did not speak up, then I have deserted my patients and my ethics as a nurse. Nurses and doctors have to be part of the solution and not sit back and point fingers. Leaving foreign objects in a patient or removing a healthy organ, that's on doctors. Bed sores, UTIs and other line infections, that's on nurses. Reporting these events, that's on administration.
Thank You for your article, My father went to Saint Rose, Sienna to have melanoma removed. He was back in the Hospital the next day with an infection. He was sent back home with antibiotics. He was back in the hospital the next day. Making a very long story short, he died in the hospital about 8 months later. He had too many mishaps from his hospital stays which included twice in two ICU. Also his stay included Sunrise and Desert Springs Hospital. Desert Springs was little better. Thank you again, for your work.
Congratulations on pulling together a great deal of information. You could improve on it by converting the raw numbers to rates, i.e., rate of falls/trauma per admission or per patient day. The rates would be very low, as you noted, but that would make a better comparison between facilities.
Hi jhook, we've got the rates for the various incidents under "see the results" on this main page for the project: http://www.lasvegassun.com/news/health/h...
The kidney story is very tragic, but I read the court documents linked to this story and there are a few details the Sun left out in the body of the story. It was a healthy kidney, but it was also abnormally shaped, about the half the size of a normal kidney, and in an area it should not have been located. When you take this information into account it explains the circumstances a little better. The way the Sun tells the story it sounds like everything was normal and it was a textbook case. These three circumstances together are very unusual. Was it a mistake? Yes, and it should not have happened. Was it reported? Yes. Are the doctors incompetent? Probably not. It was just a very unusual situation and they thought they were doing the right thing based on their previous experience and the information they knew about the patient. Like many people have pointed out, doctors and patients are not perfect. I'm sure these very same doctors have saved and improved many lives during their careers. I think most of the stories in this article are the exception and not the rule. We have many excellent doctors and nurses in our valley. Let's not jump to conclusions without all the facts.
Tom Gorman..
Perhaps your well written investigative reporting caused the State Board of Medical Examiners to focus on their job.
They finally found some stones and filed a complaint on June 16th, 2010, [case # 10-11398-1] against the big money partner @ Western Regional, William Smith MD, just as their partnership is undergoing major disruptions with fractured egos.
Seems in the referenced complaint malpractice was alleged, based upon a failed operation September 30, 2004.
A records search could probably retrieve other and similar prior issues.
Case looks strong against Dr. Smith and worth reading.
The point is that until injured patients and honorable medical professionals step forward, perhaps because of your contributing valuable insight and a strong voice at the Sun, nothing will happen to correct these injustices against the public.
Thank you !
Well FredFlinstone R.N. must be blind or retired a hundred years ago. Come work in my shoes now Fred and you will see that nurses that advocate for their patient is not a wanted commodity! Reporting events is now back in my department. Administration has and will cover it up and has and will sweep it under the rug and you guessed it has and will hang many a nurses out to dry to shift the responsibility off of their incompetence. The Peter Principle is alive and well in Health Care and has been for way too long!
First, the comment about health care not being like a cell phone booklet and/or an insurance policy is quite a difference. Why do people enter the Emergency Rooms and PMD offices. Meaning, this can't be as one sided as it sounds; what about pt accountability. Don't get me wrong,there are PLENTY of unqualified and dangerous Docs and nurses out there but it is also the patients job to be as involved in their healthcare as the medical team. You probably wont find anyone interested in your health more than yourself, if you don't care why should the medical field? Ask questions, get answers; keep the Docs and Nurses on their toes. As an RN in the ED when you enter the Dept. I don't know what is going on with you and usually you don't know what is going on with you; if you can't breath or are unconscious, this make our job more difficult because you are no longer contributing to finding the solution to the problem. This is something we, as the medical team, work on together.
I am there as an advocate to my patients, as all nurses should be, and to protect them. Any nurse that is unwilling or afraid to do that is probably in the wrong profession.
The internet will only give you general outlines because 1) they are unable to give medical advice over the internet because 2) they could face litigation due to too little info...they will always tell you to contact your MD or go to the ED immediately if you have signs and symptoms of _*fill in the blank*_ ,because of so many diseases and/or life threatening processes mimic each other. I can't tell you how many times I have heard that a website told someone to come to the ED because of stroke symptoms.
If people want to know exactly what goes on in the health care system, join the health care force. Become a nurse, become admin., become a doctor, if you want it as simple as your phone instructions and insurance policy than go to school and learn about it. I'm in it and it still boggles my mind. To all the nurses out there: The hospitals you work in are seperate from the MD group; you have the ability to give anonymous incident reports w/out fear of repercussion (I've done it and I still work in the facility and the MD does not)you are here to protect your pts.SPEAK UP! You should be the reason a loved one gets sent home to their families. You should be the one who catches a deadly arrhythmia on the monitor. Don't wait for the on-call Doc to give orders when a pt c/o chest pain, get the EKG then call the Doc.
If there is anything that I would change in nursing; it's the name. We are more than order takers, we are pt protectors. If you don't love being a nurse you should think of another line of work.
I pray the families of the deceased can find peace in their hearts and those that are in pain can be relieved.
Some Medical personell do care and it is sad that so much negative is illustrated rather than the triumphs...what I like to call 'the good saves', it's what keeps me going.
Why don't hospitals have something called a Morbidity and Mortality Conference? Every other state has it, and it is where any untoward event is discussed in a closed door meeting with all the surgeons and any interested medical staff member of the hospital. The reason we don't have it in Nevada is the Hospital is afraid that if they institute this, surgeons will go to a more compliant hospital. Thus $$$ creates the problem.
Why do health insurance companies pay the lowest reimbursements to doctors in the country here in Las Vegas? Because a few doctors created medical fiefdoms for themselves, using backdoor deals with insurance companies and their corrupt buddies on the medical board (who bought their board positions with donations to the governor etc) to harass/investigate/accuse anybody who complained or fought the system. Do you think getting paid doggy doodo makes a doctor happy? Do you think he/she may increase the volume of patients or procedures that they do to compensate? Do you think maybe even a good/great doctor gets disgusted with everything going on unchecked and loses that idealism? Do you think that unhappy overworked doctors in a corrupt system where there is no accountability make mistakes?
Welcome, Welcome to The Machine.
I knew this already. Hospitals are only out for money, they dont care what happens to you. My mom was at Mountain View hospital after her surgery which was when they removed her colon tumor and her ovary she was screaming in pain. Her nurse was yelling her to shut up, I know this because my mom still remembers the story. I did report it but the mental abuse is horrible.
Great Job SUN. Thank you.
Staff: In my experience as a healthcare provider and political activist...not to mention a native Las Vegan...I believe the main reason we have had a problem attracting quality healthcare providers, is this: We have no comprehensive medical internship or residency programs here in Las Vegas or up north. The great majority of physicians, nurses, and ancillary personnel stay where they do their residency.
Another reason is the lack of quality education in our state. Without the combination of quality education and healthcare, we cannot attract major corporations to relocate to our communities. In addition, without the tax/jobs support of major corporations, we cannot produce quality education or heathcare...this is the ultimate conundrum.
What do we do about this?? Unfortunately (if past experience has not convinced you) this dilemma lies in the hands of our legislators.
I applaud the Sun for taking on this gargantuan issue and bringing to light what we, in the healthcare field, have been pondering for many decades here in Nevada.
I am looking forward to your revelations!
Citizens force your government to do their job and protect us from hospital operators who have cut their staff to the bone in search of more profit. 20 years ago we had a state Public Health officer who had the "nerve" to criticize the poor quality of health care and the rubber stamp do nothing state boards in front of a AMA convention audience. He quickly lost his job. Why do you think nurses are unionizing and these corporations refuse to negotiate staffing issues or recognize the bargaining unit? Think back to the day when the community owned a hospital who served us, not profit.
You only need to read...HMO's, Making a Killing, or Physicians Against HMO's to know what has been going on in healthcare for many years.
For 32 years I have been fighting to change this...with a group of friends...it is sad to say, the fight has almost gone out of me.
No-one wants to believe the sad state our healthcare is in until they are faced with making a life and death decision, that they shouldn't have to make in the first place
I am not really surprised. In 2006, when I first came here as a tourist, I developed a severe case of gastro-enteritis which resulted in me becoming severely dehydrated. I was taken by ambulance to hospital in Summerlin where I was given an intraveinous drip consisting of potassium-rich saline and antibiotics. I was placed under observation on a gurney in a corridor for half a day and discharged with a prescription and referral advice. A couple of months after I had returned home to the UK I was surprised to get a notice of account from the insurance company with whom I had taken private travel insurance cover for the anount of $9,000 for this short visit. All I can say is, thank Heaven I had the foresight to ensure that I was armed with travel health insurance. But even so, it still left a bad taste in the mouth.
People always have to find someone else to blame...this article just makes me sick. Have you ever thought about investigating other cities hospitals to see just how bad they are and just how many accidents happen around the world?
I personally know a few nurses that work at one of the Valley ER Rooms. They were just inspected last week and they recieved 0 remarks - let me repeat ZERO.
The fact is...we are all born into this world to die and unfortunatley we don't always live through every ailment we encounter so GET OVER IT and stop criticizing everything everyone does
I couldn't find a doctor here in town that could fill out my FMLA form.
Ok, I'm reading all over the article and am unable to find the magic answer ! It's as if the newspaper is in cahoots with the hospitals. There is no single answer! What ARE THE RANKINGS of care and WHAT ARE the hospitals one would want to go to ? !!!