Healthcare Purchasing News

July, 2003

Only a few industries kill their customers

By  Michael D. Shaw

There are three giant bureaucratic industries that touch nearly everyone’s life these days-education, entertainment, and health care. These three titans share several characteristics.

While they employ huge numbers of people, only a relatively few actually make any real money. In general, they don’t care very much about their customers, beyond mechanically delivering the product or service. And, significantly, big government has changed, perhaps ruined them in such a manner that they might never be repaired. But, for the most part, education and entertainment don’t kill their customers, which brings us to the nasty topic of nosocomial infections, said to be fatal to about 100,000 Americans every year.

You want horror stories? Here are a few:

How about “top-ranked” Manhasset, NY cardiac surgeon Dr. Michael Hall, who has Hepatitis C, and has already infected at least three patients. Numerous studies have indicated that the transmission of this disease to the patient occurs during the sternal closure. Back in 1988, an article in The Lancet  said that an astounding 40 percent of cardiac surgeons punctured their gloves during the sternal closure. But, egos being what they are, Hall wouldn’t defer closure to an assistant, or close via an alternative method until he was required to notify all prospective patients of his condition.

The good news is that he was finally persuaded to wear double layers of latex gloves. Still, this took months since, in the words of Duke University Medical Center professor of surgery Dr. Robert H. Jones, who serves on the New York State Cardiac Advisory Committee, “it would be inappropriate for him to tell another surgeon how to run his team.”

That’s right, Robert, we wouldn’t want to damage his self-esteem. What are a few cases of Hepatitis C among friends?

Then there’s the ongoing crisis in Scotland’s hospitals, over a virtually uncontrolled outbreak of MRSA (Methicillin Resistant Staphylococcus Aureus), affecting numerous facilities and hundreds of patients. Incredibly, according to Professor Hugh Pennington, leading British infectious disease authority, “In Scotland, MRSA [infections are] now accepted as part of the scene and attempts to get rid of them have been virtually abandoned.”

The case of Mary Antczack, a 50-year-old heart patient, is typical. What should have been a simple procedure of replacing her pacemaker turned into a nightmare of three heart operations, since the unit was infected with MRSA. Ironically, the UK’s National Health Service, famous for its penny-pinching, and no doubt largely to blame for the situation by cutting back on basic cleanliness, ended up spending the equivalent of $72,000, for a procedure that should have cost about $8,000.

For sheer numbers, as well as mind-numbing bureaucratic inefficiency, to say nothing of criminal disregard for his patients, the prize would seem to go to Scarborough, Ontario, Canada neurologist Dr. Ronald Wilson, who single-handedly caused the worst outbreak of Hepatitis B in Ontario history.

Under the “guidance” of Wilson, more than 14,000 patients were exposed to the potentially fatal liver disease when they received electroencephalography (EEG) testing from 1990-1996. One man died, and about 1,000 were actually infected. Somehow, even though the College of Physician and Surgeons of Ontario had been warned about the poor sterilization techniques at Wilson’s six clinics as early as 1991, nothing was done until 1996.

Cold comfort that this one man wrecking crew was finally punished with revocation of his license—at age 65. Would it surprise you that despite Wilson’s egregious record, he was still able to marshal more than 100 letters attesting to his medical skills and good character? Not content with setting the standard for mere malfeasance, he was also able to achieve the highest malpractice settlement for a single physician in Canadian history—a staggering CDN$ 27.5 million.

But, you say, we have the Joint Commission looking over our shoulder. That’s true, as far as it goes, but since less than 1 percent of hospitals have failed to receive accreditation from the Commission in the last 17 years, one might argue that the process isn’t exactly thorough. This is the same Commission, after all, that gave high marks to Palm Beach Gardens (FL) Medical Center last year, even after federal investigators had just raided the place, finding that patients were in “immediate jeopardy” of harm because of infection control deficiencies.

In 1997, Bridgeport (CT) Medical Center was undergoing a terrible situation with antibiotic-resistant nosocomial infections. In fact, the Joint Commission was aware of the outbreak, but did not interview patients or doctors. Instead, it chose to review certain patient files selected by hospital officials. As such, its inquiry was closed, and the facility retained its high ranking even though it had recently settled four lawsuits with patients who developed infections.

At about this time, state public health officials conducted a surprise investigation, and found dozens of patient care and infection control violations. Compare this to the advance notice given by the Commission, allowing facilities ample time to temporarily clean up their acts and garner a passing grade.

To be sure, hospitals are under all sorts of pressure to cut corners, but then, so is every other business. Imagine the outcry if airlines were found to eliminate certain maintenance procedures, as a cost saving measure. What if your local supermarket cut back on refrigerating perishable items, to save a few bucks?

Perhaps it all comes back to that little problem touched upon in the second paragraph of this essay, the bit regarding caring about your patients. For the foreseeable future, the quality of education will drop and drop, even as funding increases. The entertainment industry will continue to release mostly junk. But, in your chosen field of health care, the stakes are simply too high. You have no alternative but to care. Try it, it’s infectious (in a good way!).

As the Romans used to say:   tuum est  [it’s up to you].