Sunday, July 26, 2009

Massive Fraud Uncovered at New York City Hospitals

I don't think I'm overstating matters in the headline. The City of New York operates 11 hospitals via the Health and Hospitals Corporation [ed: see the comments for clarification on relationship between NYC and the HHC]. They are: Bellevue, Coney Island, Elmhurst, Harlem, Jacobi, Kings County, Lincoln, Metropolitan, North Central Bronx, Queens and Woodhull.

Each and every one of those hospitals was found faking records, including coverups of medical malpractice and inadequate care.
A months-long probe found coverups at all 11 Health & Hospitals Corp. hospitals — the only option for millions of New Yorkers who cannot afford private medical centers.

From 2004 through September 2008, the state cited city hospitals 68 times for violating laws that require immediate reporting of "adverse events," records show.

Each hospital — Bellevue, Coney Island, Elmhurst, Harlem, Jacobi, Kings County, Lincoln, Metropolitan, North Central Bronx, Queens and Woodhull — had at least one citation.

The law requires all New York hospitals to quickly report all serious medical mishaps to the state.

"There's a tremendous lack of confidence in the reporting," said Arthur Levin, director of the Center for Medical Consumers. "It matters because it is a way to understand where the safety problems are. . . . This identifies what goes wrong and where."

Hidden incidents uncovered by The News — corroborated by dozens of interviews with doctors, patients, lawyers and families of victims — bordered on the Medieval.

Some incidents were simply not reported, while others were reported long after the fact, making investigation impossible. Some records were incomplete or even fictional.

* A stroke victim's leg had to be amputated after gangrene was left untreated. No report.
* An ill infant died after sitting, unexamined by a doctor in an ER for 24 hours. Confronted for not having enough doctors on duty, they produce a "corrected" report saying there was – a month after the fact.
* A mental patient hanged himself and, after several days, died. Though hospitals must report suicides, they report this one as an "unexpected death."
* Records were altered after medical students made mistakes and an infant died.
* Logs for a respirator were changed after staff failed to notice it wasn't turned on. The patient died.

The findings come a year after employees of Kings County Hospital tried to hide the death of 49-year-old Esmin Green. Hospital staff wrote in records that she was fine; a shocking video showed Green dead on the floor.

New York City has some of the best hospitals in the world, but these 11 aren't among them. The best hospitals are the private institutions such as Hospital for Special Surgery, Memorial Sloan Kettering, New York–Presbyterian Hospital, Weill Cornell, and Mount Sinai Medical Center.

This is the Obama health care in action. It's what the care will be in microcosm. Inadequate care, but access is provided.

Enforcement of existing regulations shows that several of the hospitals received no citations, despite racking up hundreds of violations. The oversight is completely lacking:
Since 1999, all New York hospitals have been required to self-report a long list of medical incidents to NYPORTS, which in turn analyzes the incidents and implements patient safety reform.

Sunday NYPORTS barely functions. The Statewide Council that oversees it hasn't met in more than two years. Though NYPORTS is supposed to release "annual" reports, the last one filed is dated 2004.

Levin, a consumer member of the NYPORTS Council, says he's watched the system "sort of gradually slide into total dysfunction."
While all hospitals have been underreporting bad outcomes for years on end, the HHC hospitals have underreported to a much greater degree: 34.8 incidents versus 45.5 for every 10,000 patients discharged.

The HHC will obfuscate that the HHC hospitals handle millions of admissions every year, 400,000 of which are uninsured, but that ignores the fundamental issue that they provide inadequate care to all those who come through their door. Insurance isn't the issue - the quality of care and the subsequent coverup of how inadequate that care is.

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