January 7, 2019
New Year, Old Problems
By Michael D. Shaw
Not everyone made resolutions for 2019, but one thing is certain: Absent death, each of us will become one year older at some point during this new year. And with advancing age, come the virtually inevitable health issues. We Boomers love to pride ourselves on being more health-conscious than our parents. Perhaps this is true, but whether this makes a difference in our comparative quality of life will have to await the final accounting–when our generation literally dies out.
Part of this health consciousness involves obtaining the best possible healthcare we can find. Indeed, healthcare has been a major political issue for decades, rising to fever pitch during the endless debates that finally forged Medicare. Of course, this fever pitch has hardly subsided since Medicare was passed in 1965. However, such fervent interest in healthcare was not always the case.
Even though substantial scientific progress in medicine occurred in the first half of the 20th century, it took a while for these improvements to work their way into the system. It is worth noting that prior to World War II, neither physicians nor patients believed that medical care could do much to affect the course of disease. Thus, both the demand and the cost of care were relatively low.
Scholars point to the development of better surgical techniques and “miracle drugs,” including antibiotics, along with increasing incomes and economic growth to explain the jump in hospital admissions in the 1950s. Figures cited by the American Enterprise Institute contrast annual hospital admissions per thousand: 56.7 in the 1923-1943 period to 99.4 in 1957-58. Inpatient admissions for 2016 are 105 per thousand persons; and outpatient admissions for 2011 are 410 per thousand persons.
As you can imagine, reconciling such data over the years would be a significant research project in itself, given dissimilar periods of reporting, and the trend to outpatient services that has grown over the last 25 years. Yet, it is abundantly clear that utilization is up.
So, how good is the American hospital experience? Here again, data and methodology can be problematic. For one thing, adverse events are not always reported. Even if such events–especially in infection control–are publicized, details are not described consistently. Consider the recent high-profile infection control breach at the HealthPlus Surgery Center in Saddle Brook, NJ. The facility was shut down on September 7, 2018 by state inspectors. It reopened on September 28.
Sixteen citations were listed, including poor management of fentanyl, inadequate hand-washing by the staff, and an out-of-date infection-control plan. A sheet on a stretcher in the hallway had a red, wet stain on it, the inspectors wrote. The surgery center says that 3,778 people who underwent procedures between Jan. 1 and Sept. 7 of 2018 may have been exposed to HIV, hepatitis B, and hepatitis C and should be tested. However, media coverage indicates that “hundreds of patients” in New Jersey and New York received certified letters around Christmas informing them of the center’s “lapses in infection control in sterilization/cleaning instruments and the injection of medications.”
Was drug diversion involved? What occurred specifically with the instruments? So far, no one is saying.
Moreover, complaints are being raised about how the blood testing–paid for by HealthPlus–has been run. The test results are being sent first to the chief of cardiology at an affiliated hospital. Is that supposed to be a confidence builder? Patients who arrange their own blood testing, outside of the HealthPlus arrangements, will not be reimbursed. By the way, no one has yet commented on what triggered the Department of Health doing its inspection in the first place.
Another contemporary issue involves several hospitals operated by Johns Hopkins. Problems include:
- Drastic deficiencies at a St. Petersburg, FL pediatric cardiac care unit.
- Major safety issues at a Bethesda, MD hospital, with the whistle-blowing nurse being terminated.
- Inexplicable radiology mistakes at a Baltimore facility.
Fortunately, the horror stories comprise a thankfully small percentage of the patient experience. Still, we do know that eliminating flat-out mistakes and incompetency is not rocket science. Rather, dedication and constant attention to detail are required. True metrics cataloging outcomes wouldn’t hurt either.
Now that’s a New Year’s resolution that we can all support.