Julie Creswell and Reed Abelson of the NYT are writing a series of fascinating articles exposing hospital giant HCA (Hospital Corporation of America), now the largest for-profit hospital chain in the US. Their NYT article today “A Giant Hospital Chain is Blazing a Profit Trail” finally explains to me the story behind the strange digital billboards I saw in June when I was visiting my father in Richmond, Virginia. They seemed to be everywhere along major roads, flashing obnoxious red-lighted wait times for the emergency rooms at two HCA hospitals–one being CJW, which the NYT article calls out as being one of the worst hospitals in the US in terms of bedsores (bedsores being a fairly good indicator of poor nursing care).
Last week (8-6-12, “Hospital Chain Inquiry Cited Unnecessary Cardiac Work) they wrote about a whistleblower, C.T. Tomlinson, a traveling nurse, who in 2010 worked as a cardiac nurse at the Lawnwood Regional Medical Center in Florida. Tomlinson was present in the cardiac catheterization lab when an HCA cardiologist inserted a stent into a patient who did not need it. Tomlinson reported the incident to his nursing supervisor who supposedly told him to forget about it. So he wrote a letter to the chief ethics officer of HCA’s hospitals in Florida who investigated his complaints and found them to be substantiated. Soon after Tomlinson wrote the letter of complaint, his contract to work as a nurse with HCA was terminated. It is not clear from the article whether or not he has filed a lawsuit for wrongful termination under Whistleblower protection. The HCA chief ethics officer’s investigation found that about half of all the cardiac catheterizations at Lawnwood Regional Medical Center were unnecessary, but did not alert the patients involved. It is unclear how many patients may have been harmed by the unnecessary cardiac work they had done. HCA also did not alert Medicare, state Medicaid or private insurers who were charged for the expensive procedures.
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Here is a link to one hospitals QI standards for interventional cardiac procedures:
In my view hospitals need to keep QI records for interventional procedures and make them public in aggregate. It is just too financially tempting for cardiologists to do marginal cases and hospitals (who share the payments) are not likely to say anything.