To stop hospital negligence, use the law

When you read the report "Call to Action: Safeguarding the Integrity of Healthcare Quality and Safety Systems," it soon becomes apparent there are far too many thugs running the nation's hospitals, men and women in white coats and expensive suits who pledge allegiance to hypocrisy rather than the Hippocratic oath.

The report, released last month by the National Association for Healthcare Quality, discusses behavior in hospitals that smacks more of intimidating mob goons breaking kneecaps than practitioners tirelessly trying to save lives.

Consider: "As attention to creating a culture of safety in health care organizations has increased, so have concomitant reports of retaliation and intimidation targeting staff who voice concern about safety and quality deficiencies."

No, the report doesn't reveal that a doctor had his legs broken after complaining that a surgeon on staff really was a butcher. But it does offer many nauseating insights into how too many hospitals really work, including this from a hospital staffer:

"The hospital's most profitable surgeon had complication and mortality rates two to three times the national average. I was asked to resign after repeated attempts to get administration to address the issue."

That kind of retaliation for expressed safety concerns makes it easy to understand why the carnage in hospitals continues since the 1999 landmark Institute of Medicine report, which estimated that as many as 100,000 people die each year in the nation's hospitals as a result of preventable errors. Some experts now believe the number is much higher.

A January report from the Department of Health and Human Services' Office of Inspector General makes it clear intimidation works ---- nearly 90 percent of harmful inpatient adverse events, including those dealing with death and permanent disability, were not captured by hospital reporting systems in the study of 780 randomly sampled Medicare patients' hospital stays.

Results of a federal survey released in February revealed that 54 percent of 600,000 hospital staff members at 1,100 hospitals think that when an adverse event is reported "it feels like the person (reporting it) is being written up, not the problem."

As is generally the case with health care studies that reveal essentially premeditated criminal behavior, the "Call to Action" report pleads with leaders of health care organizations only to do the right thing "and assure accountability."

You can bet this plea will have the same results as every other one: nothing.

It is well past time to drag the arrogant, amoral thugs running health care organizations into criminal courts and to honor, not punish whistle-blowers, or rather lifesavers. If, for example, hospital executives know they have a butcher cutting on people and do nothing about it, that amounts to failing to provide care "as is reasonable and necessary to maintain the health or safety of a patient" under Nevada statutes dealing with criminal neglect of patients.

Mary Berkheiser, a professor at the University of Nevada, Las Vegas' Boyd School of Law, says prosecutors can use the law.

The same statute could be used for hospital-acquired infections, particularly when you consider that a health care watchdog organization found that 65 percent of hospitals do not have recommended policies in place to prevent common infections and 75 percent do not meet the standards for 13 safety practices, beginning with hand washing.

Again, we're talking about premeditated behavior by health care executives creating a problem ---- potentially lethal infections ---- either in the name of saving, or making money. Surely this is criminal neglect of patients under Nevada law, where "the consequences of the negligent act or omission could have reasonably been foreseen."

Joseph Perz, a Centers for Disease Control and Prevention researcher who worked on the hepatitis C outbreak in Las Vegas, told me more liberal use of criminal laws should be studied in health care: "There's a certain potential benefit upfront letting providers know they are on notice."

You bet there is. Once they know premeditated negligence will lead them to the slammer and fears of rape instead of a bonus and gin and tonics at the country club, they'll do far more justice to the tenets of the Hippocratic oath: First do no harm.

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal.com or 702-387-2908.