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April 20, 2014

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Do No Harm: Hospital Care in Las Vegas:

Why we suffer

Substandard hospital care has roots in a culture of seeking profits, shunning best practices, turning away from problems

Image

Leila Navidi

Nearly two years ago, Sern Englestead of Henderson had heart surgery at Sunrise Hospital Medical Center. Although the surgery was successful, he developed a bedsore the size of a grapefruit on his buttocks while recovering. He was forced to move to an assisted-care facility, where nurses regularly tend to the wound.

Do No Harm: Part Four

Michelle Butts, center, and her children Stephanie Hilaman, 21, from left, Lisa Butts, 12, and Dennis Butts, 15, pose in their home in Mountain Grove, Mo. July 4, 2010. Michelle's husband David Butts died at Spring Valley Hospital in 2003 from an overdose of narcotic painkillers. The nurse who administered the drugs did not observe him after the injection. Launch slideshow »

Mediocre hospital care in the Las Vegas Valley, evidenced by thousands of preventable injuries, infections and deaths, can be traced to a few fundamental causes.

Based on a two-year examination of 2.9 million hospital billing records and interviews with more than 170 health care insiders and scores of harmed patients, the Sun found:

• The corporate push for profits sometimes trumps patient care and can create an environment where best practices give way to risky shortcuts. Nevada and Clark County have the highest concentration of for-profit hospitals of any state or urban county in the nation.

• Academic medical centers elevate a city’s health care because of their focus on excellence, innovation and research. Las Vegas is the only U.S. city of its size or larger with no such center.

• Hospitals suffer from staffing problems, both in numbers and quality. At one hospital, each nursing assistant was required to care for up to 26 patients at a time, an unmanageable number, and administrators were unresponsive to complaints by employees for months.

• Oversight agencies are either controlled by the hospital industry or inconsistent in their findings. One accrediting agency, for instance, praised a hospital for its transplant program even though the federal government disciplined the same program for an excessive number of deaths.

• Hospitals are required to report unexpected harmful events and to then learn from those mistakes. But hospitals sometimes cover up harmful incidents, in part because of fear of lawsuits.

The blame can be shared among hospital leadership, elected officials, regulators, doctors and nurses — all of whom, combined, have created a health care system that too often has turned patients into victims.

The most common complaint by patients is that they feel dismissed, disrespected or ignored. Too often hospital care lacks, of all things, the caring they expect.

The shortcomings help explain the findings in the Sun’s two-year investigation, which identified 3,689 cases in 2008 and 2009 where patients suffered preventable harm while under a hospital’s care.

The mishaps included patients being infected with lethal bacteria, falling and breaking bones, acquiring gaping bedsores and being injured during surgery, including one patient who suffered serious burns after catching on fire on the operating table.

In 356 of the incidents, patients died in the facilities.

FOR-PROFIT MEDICINE

In Nevada’s frontier mining days, the abundance of single men and high transiency contributed to a cultural ethic of independence, where people looked out for themselves, not the larger community.

A century and a half later, Nevada’s demographics have changed but not its libertarian foundation. As Las Vegas became the fastest-growing metropolitan area in the country, little philanthropic or public investment in health care occurred, and no one agency or organization assumed responsibility for developing a coordinated system of health care.

As a result, patient services are provided by a fragmented collection of special interests — doctors, nurses, competing hospitals, insurance companies and government payers. There is no overarching assessment of community needs and no integrated planning.

Instead, hospital care in Nevada is shaped by market forces — entrepreneurship, cutthroat competition and what’s best for the bottom line — says Larry Matheis, executive director of the Nevada State Medical Association and a former health division administrator. There is no real hospital system here, but rather an industry.

The hospitals were developed during the rise of corporate medicine in the United States. Out-of-state for-profit hospital chains entered Nevada, proliferated and reaped enormous profits. Twelve of the 13 acute-care hospitals in the Las Vegas Valley are privately owned, and nine are for profit.

According to federal records, 52 percent of admission days in Nevada in 2008 were at investor-owned hospitals, compared with a national average of 13 percent. State records show that for-profit corporations control 70 percent of acute-care beds in Las Vegas hospitals.

The out-of-state for-profit chains are responsible to shareholders, and their profits have been the stuff of legend. Former administrators, requesting anonymity for professional reasons, told the Sun that profit margins were as high as 25 percent at Sunrise and Valley hospitals in the 1980s.

In 1987, legislation required hospitals with profit margins exceeding 17 percent — Desert Springs, Valley and Sunrise at the time — to reduce billed charges. (These cost-containment efforts led the state to collect hospital billing data used by the Sun for its analysis.)

The legislation expired after several years and, a Sun analysis of state records has found, some Las Vegas hospitals have reaped robust profits in the past decade — 16 percent profit at Desert Springs and 11 percent at St. Rose Dominican Hospitals – Siena Campus in 2008 — although all the chains have struggled during the recession.

Although for-profit hospitals are criticized for prizing profit above patient care, others argue that the community should be thankful for their presence.

“There would be almost no hospitals here if not for the for-profit hospitals,” said Mike Walsh, a former administrator at Valley Hospital Medical Center as well as the county’s public hospital, University Medical Center. “They’ve invested a great deal of money to provide service for the community, and the taxpayers didn’t have to pay for the hospitals.”

The reliance on for-profit hospitals has, by some accounting, undermined any initiative to build academic medical centers in Las Vegas. (Some teaching occurs at UMC, but there is little research — a hallmark of academic medicine.)

The underfunded University of Nevada School of Medicine’s academic center is in Reno. Promises to develop a health sciences center in Las Vegas, pitched in 2006, have faded with the recession. There are not enough residency and fellowship programs to keep locally trained doctors in Nevada, and the best doctors in the country are not attracted to Las Vegas, in part because it lacks a reputation for cutting-edge health care.

Kathy Silver, CEO of UMC, said private hospitals are not “mission driven as it relates to research and academics. There is no room for that in the for-profit world.”

Most U.S. medical communities are more mature and have a deeper mix of public and private teaching facilities, Silver said, adding that such facilities exert peer pressure.

“It steps up the pace for everybody,” said Silver, the only Las Vegas hospital CEO who agreed to be interviewed by the Sun. “We seem to lack that here. In part that’s because there’s been a lot of dedication to building infrastructure that generates money.”

INADEQUATE STAFFING

Ron Serino suffers with a bedsore he acquired in April at a Las Vegas hospital. Serino, 60, a retired Army captain, said there were not enough nurses and aides to shift his body to prevent the bedsore.

“I would ring the buzzer, and they wouldn’t answer it, up to hours at a time,” he said.

Ronald Serino

Ron Serino, a retired Army Captain with a Master's degree in hospital administration, still suffers from a bedsore he acquired in April 2010 at a local hospital. Serino was photographed inside his Las Vegas home October 26, 2010. Launch slideshow »

Although patients claim they were neglected, nurses say the problem is poor staffing, and they point the finger at budget-conscious administrators.

As is the case in most states, there are no specific nurse-to-patient ratios in Nevada. Staffing is flexible, depending on the number of patients and the severity of their conditions. Hospitals, however, are required by law to provide the individual attention that each patient needs.

But that doesn’t always happen. In 2008, state regulators cited Valley Hospital managers for having no system to staff nurses based on individual patient needs.

Indeed, when UNLV surveyed recent nursing graduates about what it was like on the job, at least three in four respondents said staffing levels were inadequate and they had no time to spend with patients. And 65 percent said the conditions were not conducive to safe patient care.

Thirty percent quit their jobs in the first year and 57 percent quit within two years, many complaining that administrators did not staff enough nurses to care for patients. Patient safety issues were cited in the UNLV study as the most negative aspect of the job and the most common reason for leaving.

A nurse who cared for up to eight patients at a time said on the survey: “The outcome for patient care was poor. I witnessed so many frightening events that I decided to quit after one year and transfer to another hospital.”

Another nurse noted, “The patients were wonderful, but I had so many I felt I wasn’t giving them the care they deserved.”

Academic studies cite poor nurse-to-patient ratios as a contributing factor in patient deaths and nursing burnout. A 2007 study published in the journal Medical Care linked insufficient staffing levels to patient bedsores, infections and deaths.

In 2009, eight of the 13 Las Vegas hospitals had high rates of postoperative blood clots, ranging from 40 percent higher than expected at Spring Valley to 95 percent higher than expected at UMC, the Sun found.

Nurses told the Sun that helping patients get out of bed to move around — which helps prevent blood clots and bedsores — is usually the first task lost when they are overworked.

Staffing problems prompted a state investigation of a January 2009 incident involving a patient on a ventilator at Centennial Hills Hospital. When a relative found the woman sitting in diarrhea, her feeding tube leaking onto the bed, she hit the call button to no avail. After waiting more than 20 minutes, the relative walked down the hallway, yelling into each room that she needed a nurse.

In the ensuing investigation, Centennial Hills employees said staffing levels were unsafe, with certified nursing assistants — who take vital signs, feed patients and take care of basic hygiene — responsible for up to 26 patients.

The chief nursing officer told the state inspector that employees had complained for three months about unsafe staffing levels, and a group of nurses met with administrators in March 2009 to discuss the problem. They were told the current staffing would continue, the state investigation found.

FLAWED OVERSIGHT

Clark County Commissioner Lawrence Weekly was the chairman of the UMC board of trustees when he told the Sun that he was uncertain if it was illegal for a hospital employee to leak private patient information to outsiders.

It is illegal.

Silver acknowledged that it’s difficult for lay people to understand the complexities of hospital care.

But that’s precisely where the Nevada Administrative Code places responsibility for providing quality care: with a hospital’s board. The boards are made up of physicians, administrators and community members who may sit on the board for political, philanthropic or business reasons, but have little knowledge of the intricacies of running a hospital.

A businessperson who sat on a hospital board in Las Vegas told the Sun that the boards provide the appearance of oversight but fall short. Community board members understand little about medicine, and the information they receive is carefully controlled by the CEO, the director of nursing and the chief of staff, the former board member said.

“The boards are soft, just soft,” the former board member said. “They’re just community people who don’t challenge the system, do their own homework or get immersed in the things they’re asked to decide on.”

Boards are just one part of the fragmented structure of hospital oversight. State, federal and accrediting agencies have jurisdiction over various aspects of patient care, but there is little coordination among them and no uniform standards or controls, sometimes resulting in conflicting findings.

Improving patient safety is also hampered by conflicts of interest. The federal government’s Centers for Medicare & Medicaid Services, for instance, contracts in Nevada with HealthInsight, a nonprofit consulting organization, to improve quality of care, transparency and other initiatives. But HealthInsight’s board is largely made up of hospital administrators and lobbyists. The board’s “consumer representative” is a physician, former assemblyman and newly elected state Sen. Joe Hardy, who favors limiting the amount of money patients can receive as the result of malpractice.

Thus, it’s no surprise that HealthInsight sometimes sounds more like a cheerleader for the medical industry than a watchdog.

Another quality-control organization, the Joint Commission, is paid by hospitals to provide inspections and accreditation, which creates an incentive for the organization to avoid harsh sanctions, especially considering the accreditation is optional.

Hospital lobbyists and officials tout the commission’s standards to assure patients they’re held to strict quality of care standards. But sometimes the commission’s findings contradict those of other agencies.

For example, Medicare threatened to stop paying UMC for kidney transplants in 2008 because its death rate was about twice what was expected. That same year the Joint Commission gave UMC its Medal of Honor for Organ Transplantation.

Also in 2008, the commission did not publicly report any infection-control problems at MountainView Hospital, awarding it its gold seal of quality. A month later, Medicare threatened to make MountainView ineligible for its payments because of its failure to adhere to infection-control standards.

Sometimes state legislators undermine oversight. It was known that the Nevada State Health Division, which licenses hospitals and investigates complaints made by patients, lacked enough inspectors to do the job effectively. In 2009, legislators addressed the problem by allowing fee increases to fund additional positions. But in October, the Legislative Commission’s Subcommittee to Review Regulations voted to not impose those fee increases, leaving the problem unresolved.

The health division has also been limited in assessing fines by Nevada law.

In California, health care facilities can be fined up to $100,000 if they put a patient in immediate jeopardy.

And then there’s Nevada.

When a woman wearing an oxygen mask was being prepared for surgery at Desert Springs Hospital in March 2009, technicians made two mistakes, according to a state investigation. They cleaned her chest with an alcohol-based solution but draped her before it dried, trapping the combustible vapors. The techs also failed to remove a pad under her body that had absorbed the flammable solution.

When the surgeon sparked the electric knife, the patient erupted in a fireball. She suffered second- and third-degree burns on her neck and chest.

The state fined the hospital the maximum allowed, $800.

Legislators increased fines in July 2009 but they have yet to go into effect. Future fines could be much higher for incidents where patients are harmed, said Richard Whitley, health division administrator.

NOT LEARNING THEIR LESSONS

The state tracks unexpected injuries in hospitals so lessons can be learned and mistakes won’t be repeated. Toward that goal, hospitals are required to conduct a “root cause analysis” to determine factors that led to an injury.

But Las Vegas hospitals have been reluctant to acknowledge shortcomings.

When the Desert Springs patient caught fire, the hospital violated its procedures by failing to call the fire department, a state investigation found. And the health division investigation was launched by the family’s complaint, not the hospital’s disclosure. The hospital has since submitted a plan to address the issues that caused the tragedy.

In 2008, a man received a call from Valley Hospital, saying his mother, who had Alzheimer’s, was ready to be discharged. As he walked through the hospital’s parking lot to pick her up, he saw her standing alone at the sidewalk as if she was going to cross the four-lane city street, a state investigation found.

The man took his mother back to her hospital room and reported her escape.

“Not again,” a nurse said.

The nurse told him that his mother had previously escaped, but he had not been informed, the state’s report said.

Valley Hospital’s records reported a different version of events, the state report said. Medical records said that when the son came to pick her up she was “in her room … reading the newspaper.”

The hospital’s risk management inquiry said the son had found his mother “downstairs” and that she “was OK and waiting for him.”

Summerlin Hospital Medical Center waited more than two years to report the suspension of a surgeon to the Nevada Board of Medical Examiners in 2006. Nevada law requires such actions to be reported within 30 days. The medical board said the hospital’s CEO apparently entered into a “nonreporting agreement” with the surgeon, which the medical board deemed contrary to state law.

And a March 2009 state investigation found that when an 18-year-old woman was oversedated at MountainView Hospital during childbirth, the facility failed, as is required by state law, to analyze or report it to the state as a sentinel event — an unexpected injury or infection that takes place in a hospital. The hospital’s vice president of risk management acknowledged that the facility failed to follow its policies. The hospital was not fined; the woman recovered.

Valleywide, hospitals appear to be underreporting to the state sentinel events, the Sun analysis of hospital records has found.

A state investigation prompted by the Sun’s analysis found patients suffered 342 preventable injuries or infections during the second half of 2009, while facilities reported only 44 sentinel events. Each of the 342 cases seems to fit Nevada’s definition of a sentinel event.

Bill Welch, president and CEO of the Nevada Hospital Association, has said that the fear of malpractice lawsuits leads hospitals to fight public reporting of sentinel events.

The fear of malpractice lawsuits also plays a role in discouraging hospitals from admitting mistakes to patients. Internally, Silver said UMC uses accidents as teaching opportunities. But the hospital does not usually initiate a discussion with patients and family members when something goes wrong, she said, adding that when conversations occur, the process is patient driven.

“There is this fear in the back of everyone’s minds: ‘Is this going to result in a lawsuit if we talk about this?’ ” Silver said.

What’s too often lost in hospitals’ fear of lawsuits and pursuit of profits is their fundamental mission — placing the needs of the patient first.

Toward that end, the Institute for Healthcare Improvement, an independent not-for-profit organization based in Cambridge, Mass., has campaigned for hospitals to more candidly and proactively examine their shortcomings.

When something goes wrong, the hospital should respond immediately, with transparency, an apology and accountability — first to the patient and family and next to the staff, the institute says.

“The risks of not responding to ... adverse events in a timely and effective manner are significant, and include loss of trust, absence of healing, no learning and improvement, the sending of mixed messages about what is really important to the organization, increased likelihood of regulatory action or lawsuits, and challenges by the media,” the organization says.

Dr. Peter Pronovost, a medical director at Johns Hopkins University and national leader in the health care quality movement, said reform begins when patients become the focal point — the North Star that guides the way health care is delivered.

In Las Vegas, the Sun’s findings suggest that other interests eclipse patient care.

Alex Richards contributed to this story.

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  1. That is just SICK!!!

    As usual, GREED is the KILLER.

    A timely and important story from the Sun.

  2. Should be another Putlitzer for Public Service for the LV Sun. The Sun is starting to be the most relevant newspaper in the southwestern US. The LVRJ continues to be a non-entity. Perhaps the management shakeup at the LVRJ will change its direction--they were so focused on politics (i.e. Angle) that they forgot that reporters should report the news instead of trying to formulate and direct public opinion. Congratulations!!

  3. Soylent Green IS Privatization of medical care.

  4. All during my life, I had never really been ill and only needed doctors occasionally. Shortly after I was transferred to Las Vegas with my company, I became very seriously ill. That was in 2004. For five years I had many stays at Valley, UMC and Sunrise, saw many different physicians, and only seemed to get progressively worse. I wasn't happy with my care but I truly didn't know how bad it was. A friend convinced me to come to visit her in Phoenix and just see on doctor who specialized in my type of illness.

    I gathered my medical records and headed to Phoenix. I wasn't in the doctor's office for an hour before he bundled me off to a local hospital. The next day he sat with me for nearly 2 hours and discussed my previous care. The short of it is that I should have never suffered as I did for 5 years. The long of it is that the substandard care (even with top notch insurance) caused me greater harm.

    I now live in Phoenix and have great doctors, great facilities and am well on my way to regaining my quality of life. I'm not saying that what they have here is perfect, but it is night and day compared to Vegas. My first stay in the Phoenix hospital blew my mind - a nurse or an aide actually came to attend me when I rang for assistance. Doctors actually took the time to talk to me and answer questions. Nurses and staff didn't seem as harried and hurried. The word care actually comes before profit in the dictionaries here. I am an educated woman, but I don't have a medical degree. I did my research on my illness, but there is only so much a lay person can comprehend when it comes to medicine without that more specialized education.

    Not only is the care bad in Vegas, but it's also a lack of education on the part of the patient - part of which we can be faulted for, part of which we can't be expected to know or there would be no need for the doctors or facilities.

    I really have no suggestions on how to fix the problems in Vegas, and my story probably will do nothing to effect change. If anything, this series of articles helps me a bit to feel some validation about what I experienced. I wish I knew the answers but I always seem to come back to one - money. I can't seem to pinpoint what they do differently here, but whatever it is should be bottled or packaged and given to the medical facilities and practitioners in Vegas.

  5. nednougat, if you can get into Mass General, do it now.

  6. Thank you, Las Vegas Sun.

  7. It's really scary being a senior in Southern Nevada. I really hope that these articles change the quality of care available here. Whatever happened to the Hippocratic oath???

  8. This is just one more example of why the new public health care plan is a house of cards. Factor the Medicare fraud and billing fraud (oops, sorry we charged you $3,000 for a procedure that was never performed) -- Tort mayhem (John Edwards) and you have a system that is a train wreck. Our congress should have been working on FIXING the system before ever dreaming of expanding it.

    No more H1B Visas for substandard doctors and no more nurses from SE Asia who cheat on their exams might be a place to start -

  9. And Nevada's republicans want to REDUCE medical coverage? Regulatory action with teeth is the answer. It is wrong to financialy reward medical practice by allowing cutting costs that reduce our quality of care. A few doctors are bad but most doctors are good, it's the same with all medical staff. We must create a system that rewards good and punishes bad.

  10. Thank you, Las Vegas Sun. As a sidebar, you might want to do a story on what happens when a legislator tries to stand up to the medical community. It isn't pretty - and the idiot voters here believe the lies that come from the medical community.

  11. Our Hospital events in the time we lived in Vegas:

    2006: My wife was given the wrong baby to breast feed at Summerlin Hospital during the time she was there for the birth of our first child.

    2009: My wife gave birth to our second child, and things went *okay*.

    2009: My wife had a kidney stone, she checked into the hospital, they kept her for 36 hours, administered pain killers, and discharged her before the stones passed.

    Glad I don't have to deal with this anymore - for those of you still there, I hope this story (Thanks Sun) helps to drive some changes that will benefit LV residents.

  12. Living in LV for close to 20 years, my family and I have had occasions to be patients at 3 different hospitls here. Several years ago I was a patient at least twice at UMC and once at Desert Springs. These times were unremarkable other than feeling that the nursing staffs were overworked. Over the last few years we have had several occasions to be admitted to St. Rose Dominican (Siena) and must say that the care at this facility has been wonderful. My husband was a cancer inpatient several times and at all times was treated wonderfully. Most recently I had life threatening emergency surgery at St. Rose and my only "complaint" is that while waiting in the ER no one (nurse or ER doc) explained what was going on. I finally called my PCP on my cell phone and was advised by him that I would be admitted for emergency surgery and was only being "on hold" until an Operating Room became available. My subsequent procedure and stay was not horrible as depicted in the article, but rather very effective. I realize that there are problems with the medical field here in LV, but also realize that as a patient or family member, you must also take responsibility for what is going on. Personally I love St. Rose and their staff.

  13. The Patient is the Loser. I am a patient, and I am a loser. Why am I a loser? Because what voice I do have, when I use it, cause people to get defensive rather than use the information constructively, and they will then retaliate and cause me further loss, pain, and suffering. I truly appreciate the Las Vegas Sun having the courage to put a platform of reliable information for citizens to glean, and offer an avenue for them to voice what is actually going on in their community relating to their health care.

    Here is part of my story, and trust me, I have the best people in the world in charge of my medical life. But what was to be only a brief 3 day hospital stay turned 4, at a newer northwest side local hospital, and no matter how urgently I rang the nurse's desk telling them I needed help to the restroom (10 minute intervals-mind you), the fact that not once, but several times, I ended up disconnecting myself and walking myself after 50 minutes of waiting (although they said they were, "On their way," or "Coming now.") The bottom line was that staffing is stretched as thin as possible. The nursing staff sincerely apologized, but there definitely was a cover up happening, even to the last day of my stay.

    I now worry about having another operation done and going through the same experience. My doctors are the world's best, but judging from the voices I heard in the patient rooms next to mine, other patients (same doctor) at this same hospital are having similar problems (they are saying during their post-operative check ups). Thumbs up for the doctor, thumbs down for the hospital experience. What's a patient to do?

  14. This series on health care (or sometimes, the lack thereof) in Nevada is investigative reporting as it is supposed to be. The Sun has done a great public service by publishing these articles. I cringed in disgust as I read some of these heart wrenching stories of patients who have been victimized by the system. I'm no socialist but I am a believer in a single payer system like they have up in Canada. Sure we have great health care here in the US if you can afford it and go to some of our better hospitals. Here, at the hospitals mentioned patient care is just another cost to be minimized, to maximize the bottom line so as to pay the executives that run these operations their muliti-million dollar salaries and bonuses. The goal becomes reduce costs, deny claims, provide as little service as possible. I am sure that these hospitals have some dedicated and capable health care professionals working in them. It is the system that has and continues to fail these patients. There will be mistakes made because even the best medical professionals are human, but when corners are cut and that becomes systemic then the number of mistakes and human tragedy goes way up.

  15. EVERYTHING in our society has its roots in a culture of seeking profits, shunning best practices, turning away from problems. God knows, none of us wants to grow old if this is our future. Those who think we don't need some kind of health care reform are either filthy rich or totally in la-la land. Maybe our current health care law is incorrect; but we'd better come up with something, and soon. Anyone want to guess how many baby boomers are about to become old, ill, and in need of care? No political party has even started to address that.

  16. The most common complaint by patients is that they feel dismissed, disrespected or ignored. Too often hospital care lacks, of all things, the caring they expect.

    The biggest problem in my opinion, lies with the insurance companies. Doctors refer to other Specialists for testing or physical therapy is ordered without a precise diagnosis. You have to pay a co-payment up front while the insurance companies are being billed inflated prices that they only pay a portion of, then the "For Profit" Doctor will write off the difference on what they bill and what was paid, thereby reducing thier tax liability. It seems that everyone get to drink from the Insurance fountain. I know, this is what I am involved with and still have no solid diagnosis or pain management plan. They keep referring, testing and billing. A cycle that repeats not just in Vegas but all over the country. God help us all.

  17. Great piece of journalism on this subject.
    You are to be congratulated - this is award winning stuff. The big question is - SO WHAT HAPPENS NOW? WHO IS GOING TO STEP AND MAKE THIS RIGHT?

  18. * there are for profit, non profit, and government hospitals. 2/3rds of hospitals across the nation are private non-profit.

  19. Patty,

    When would you ever find fault with for profit business related directly to profit over people? This is why people should ignore you as the shill you are.

  20. The Las Vegas Sun reaches a conclusion that is unsupported by the facts they've provided. I've looked up the facts at the U.S. Department of Health and Human services and found that southern Nevada's for profit hospitals are not any better or worse than the national average.

    http://prgibbons.blogspot.com/2010/11/so...

  21. Yeah, Canada has one of those Marxist single payer health care systems. Consistently, respected polling organizations find that Canadians overwhelmingly, usually in the 80+% range indicate their satisfaction with their "Marxist" health care system and by the same margins approve of their system over one similar to the United States. The notion that excessive wait times are pervasive are a myth. Furthermore, according to 2009 Organization of Economic Cooperation and Development (OECD) (not a Marxist organization) data, comparisons between Canada and the US were as follows-------life expectancy 81.5 vs 78.1, infant mortality 4.5 vs. 6.9, doctors per 1000 population 2.2 vs. 2.4, nurses per 1000 population 9.0 vs. 10.6, per capita expenditures 3895 vs. 7290, health care as a % of GDP 10.1 vs 16.0, % of govt. revenue spent on healthcare 16.7 vs 18.5, % of healthcare costs paid by the government 69.3 vs. 45.4. By almost every measure the "Marxists" up in Canada have us beat.

  22. I know how the nurses in these hospitals feel. I stopped nursing in the '90's.
    Hospitals will work Registered Nurses to death and have the nerve to tell you that you have a time management problem (too many patients, not enough time, was my complaint). I got tired of giving substandard care, worried about being sued (and I have no doubts that the hospital would have thrown me under the bus to save themselves), and they didn't care that you had a life outside of your work (yes, women have the nerve to have children).
    I let my license lapse, because I never intend to go back to nursing.
    Not to mention the stress of trying to give good patient care and not having the time or staffing to do so.

  23. Kasidie: Are you sure you're not talking about some eastern european country, like Albania, Bulgaria or Romania? The facts according to the OECD, are that Australia, Canada, France, Germany, Japan and Sweden have higher life expectancy and lower infant mortality than we do. Furthermore, those countries have comparable or in many cases more doctors and nurses per 1000 of population than we do. We have the best health care in the world, if you can afford to pay for it in our best hospitals, otherwise, not so good in many cases.

  24. There is no evidence that profits are being put before patients. Data from HHS suggests that Nevada's hospitals are not any different in patient outcomes and mortality rates than the national average.
    http://prgibbons.blogspot.com/2010/11/mo...

  25. Hi Patrick_R_Gibbons, thanks for your comment on my story, but please don't make presumptions about my supposed "agenda." Please call me at 259-2330 if you would like to know what I think about these subjects, rather than making baseless allegations about my reason for writing this series of stories.

    The Sun focused on PREVENTABLE injuries, infections and surgical accidents precisely because it eliminates the need to compare facilities to one another. The plumb line is ZERO: these are things that should not be happening to patients in hospitals.

    Unfortunately, the medical industry nationwide keeps the rates and number of these preventable injuries and infections secret from consumers. How is competition among facilities supposed to take place when relevant information is withheld?

    The withholding of this information that the public has a right to know was a large motivation for reporting this project the way we did. Yes, consumers can get limited information from HHS and Hospital Compare. I encourage people to go to the sites that are available. But it's ignorant to suggest that consumers don't have a right to know more than they are currently being told about quality and patient safety in health care facilities.

    I look forward to your phone call!

  26. Keep in mind a "public hospital" is generally taking poor, homeless, substance abusers, manual labor workers, people without routine access to medical care, etc. unlike a lot of private hospitals that even ask for $1000 up front from people on medicare.

    So they are getting more "problem" patients to begin with.

    If you want "competition" in the private sector, then you do need the facts to make your choices to strengthen the market place. You can get more data on cars, than hospitals.

    People like Gibbons, John Stossel, ET AL want to make excuses for business and don't really want competition based on facts.

  27. Bush, Cheney, McCain...where did they go for medical care? government or private?

  28. I don't think there is any reason to show an old man's bare buttocks on the front page except for the sole puropse of trying to be sensational and Pulitzer hunting. I think the Sun editorial staff feels like they have to be more dramatic and "edgy" in order to icrease their chances to get another Pulitzer award, as well as any other awards they can grab along the way. I think the "Do No Harm" series is an over the top effort from people who aren't sure exactly how they got the Pulitzer last year, but they sure are going to try too hard this year.
    The Sun has been outstanding recently because it has had ownership with the financial ability to allow smart people to do excellent work on a daily basis. Very subtly, that can become rich people trying to buy "significance".

  29. Patrick, Patrick, Patrick...

    You know what the problem is with 99 percent of your incessant whining?

    There is NO HUMAN ELEMENT to ANY OF IT.

    Your arguments lack any semblance of HUMANITY.

    Facks & figgurs, usually skewed to fit your positions.

    Please, join us in the real world!!!

  30. "A century and a half later, Nevada's demographics have changed, but not its libertarian foundation."

    The demographics changed, and people moving here changed everything. Think about it. A million people move to Las Vegas from 1993-2006 to chase an economic and lifestyle dream fostered by our libertarian, frontier roots, and yet once they get here, they start placing demands upon the system that, if implemented, up-end those very libertarian roots that enabled the lifestyle they came chasing.

    You cannot move to a place whose riches rest primarily upon the idea of the freedom to fail or succeed as an individual, and then set about immediately complaining about what the city lacks. Before you know it, Las Vegas is just like the last place you abandoned (to move here), and what's the point of that?

    Those libertarian roots are what make Las Vegas (and Nevada) so appealing to some. There are plenty of places to live in the United States where demands upon "the system" are welcomed and fed by high taxes and over-reaching bureaucracy. There are plenty of people who like to live that way, and there is nothing stopping them from moving to one of those places and enjoying that lifestyle. Why force Las Vegas to become like them? I just don't get it.

  31. I hope after reading this the Suns' own Harry Reid will work with the city of Las Vegas to buy up these for profit hospitals and run them publicly. With Obama free health care paying the expenses it should all work out fine. Sounds easy, no?
    Is it better to shut down all these hospitals and have no service at all? Maybe more regulation like they have in casinos with control boards being? hard choices here.

  32. Gmag,

    There is a difference between anecdotal evidence and empirical evidence. Anecdotal evidence does not paint the big picture -- it does not give us enough information to draw informed conclusions. The problems highlighted in this, and other, article could be happening at other non-profit and government hospitals (which is actually the case). This article - especially with the headline and conclusion - are suggesting that the anecdotal evidence is caused by profits over people. No attempt was made to prove that government hospitals and non-profit hospitals are better, which is absolutely necessary in order to reach the conclusion that profits are the problem.

    Despite what Marshall Allen may say above, this is wrong. There is no evidence to suggest that the problems we see are caused or encouraged by profits. More research is needed there is not enough evidence presented to reach any conclusion. I do agree that information disclosure is a good thing, but jumping to conclusions about the reasons is just flat wrong.

    Marshall Allen,

    I have no idea what your motivations are but I do know Greenspun media group has the apperance of one. The Sun is a money losing paper that is subsidiized by a profit making empire, there is nothing wrong with this but, allegedly, the Sun runs a blacklist on LTE authors, columnists and who his reporters can interview and cite (according to one former Sun employee).

    The Sun pushes a left-of-center message and is far more likely to cite left-of-center sources than the RJ is likely to cite right-of-center sources (I counted over a 6 month period awhile back and sent it to Erin Neff after she criticized the RJ for this problem). This is fine, it's a business and he's trying to wrangle left-of-center Nevadans to his paper. But I'm free to criticize the paper jumping to conclusions (much like the paper royally screwed up the budget shortfall story (the shortfall was $3.5 billion out of a $6.5 billion budget was just wrong) and royally screwed up the housing crisis -- a year ago the paper declared we hit rock bottom"I don't know if that had something to do with the fact that the Greenspun's own a real estate business or just bad information).

    That said, your article jumped to conclusions. I don't know if you wrote the headline or the conclusion or that was added by your editor. I don't care, all I care about was that the headline and the conclusion appear wrong and are not supported by the evidence presented.

  33. Patrick - You possess ignorance in abundance and seem proud to put it on display. I would dismiss your wild allegations, but you're questioning my integrity.

    You accuse me of jumping to conclusions, but do so yourself. Let me assure you that I am the one who has been driving this project, based entirely on more than 170 interviews with health care experts and insiders and years of in-depth reporting about health care in Nevada. The health care sources have been directing this work, not my higher-ups. I do not get any type of mandates from above.

    I write about health care from a patient-centered perspective, and that's been the foundation of this entire series. Hospital care in Las Vegas has become a joke -- "Where do you go for good health care in Las Vegas?" "The airport." -- and that's not acceptable to anyone with a conscience. So I've been exploring the reasons for this.

    The story does not say that nonprofit medicine is better than for-profit medicine. But the quest for profits does relate to short-staffing of nurses and non-academic medicine, which has a direct effect on patient care. The story also points out that Las Vegas is missing an academic medical center, there is not effective oversight, and that hospitals often do not learn from their own mistakes. Those issues combine to help explain our substandard hospital care here.

    If you really care to understand these issues, including how the Sun operates, then please call me at 259-2330. I enjoy being informed by by people with all types of points of view. I would be interested in hearing what you've been doing to improve the quality of health care here.

  34. It seems Mr Allen's presenting a compelling argument, and Patrick's response is... mortality rates?

    Patrick, I'm sure you're aware that you can receive terrible, life-threatening care in medical facilities without dying. Further, mortality rates do not take into account bad/dangerous medicine or practices that contribute to patient harm that, you know, do not lead to death.

    Your citing mortality rates does nothing to disprove or even critique Mr. Allen's article. It's irrelevant. Patient care can and is compromised on a daily basis without the patient succumbing to death.

    Take, for example, the incidents of wrong site surgery. This is extremely harmful and dangerous to the patient, yet according to your statistics, since no one died, it's not a problem.

    Or is your argument that, so long as the patient doesn't die, why complain?

  35. Marshall Allen,

    Anecdotal evidence about preventable problems are not sufficient to conclude that profits are being put in front of patients. No amount of interviews will sufficient prove that -- you need solid empirical evidence; which you don't have.

    Lets look at one of your unsupported statements,
    "The corporate push for profits sometimes trumps patient care and can create an environment where best practices give way to risky shortcuts. Nevada and Clark County have the highest concentration of for-profit hospitals of any state or urban county in the nation."

    How did you reach this conclusion? Based on available facts from a cursory search there is nothing to lead me to believe profits are the problem. Did you take your own journalistic shortcut? Did you just add in your own preconceived notions (bias) about health care? Did you not bother taking a look at the empirical data? Did you know it even existed?

    How did you justify making this claim?

    Lets take a look at the data from Health and Human Services. http://www.hospitalcompare.hhs.gov/
    1) There is not a statistically significant difference in mortality or readmission rates for the problems tracked by HHS between southern Nevada's hospitals and the national average. http://prgibbons.blogspot.com/2010/11/mo...
    2) There is no evidence to suggest that for-profits are statistically different than the non profit and government hospitals in southern Nevada
    3) Patient satisfaction surveys conduced by HHS at southern Nevada hospitals suggest people are actually more happy with the for-profit Hospital service than UMC. http://prgibbons.blogspot.com/2010/11/so...

    Furthermore, your most damning evidence was against UMC, not the for profits. I'm seriously confused as to how or why you'd even suggest profits are the problem.

    Now I'm not questioning your integrity (but suggesting someone is ignorant after they provide evidence that you are wrong does say something about you) I do question the intentions of the Las Vegas Sun's management.

  36. Kevin,

    The HHS data also looks at practices of administering appropriate medicines and medical techniques and even that doesn't prove profits are the problem. There is also no data in HHS I've found so far that suggest that Nevada's hospitals are statistically worse than the national average or that our for-profits are worse than the government run UMC.
    The only reason why Allen's argument is compelling is because anecdotal evidence itself is compelling. Anecdotal evidence itself is not sufficient to prove a point. The reason anecdotal evidence even works is because its human interest, it puts a face to a problem and the majority of people (journalists included) aren't trained in empirical research and methods. It's the same reason why people believe the end of the world is 2012 or believe in ghosts or that you can find water with a dowsing rod.

  37. Gibbons is a joke. He distorts facts on tax rates, private verses public sector, etc.

    Should the government stop inspecting restaurants? and giving them ratings?

    Why is it wrong for the public to get data on hospitals? Don't the "libertarians" want competition based on value and performance?

  38. Where did the guy from the "profit making newspaper empire" go for his medical care?

    Arizona

    If they are such profit makers, why did they put the "AD MAN" in at the top? Profit problems??