The heralded Obama-Berwick plan to reduce health care infections and errors by 40 percent by 2014 is much too cautious. It falls short of goals already achieved by infection-control advocates in hundreds of hospitals throughout the country and would still leave us with an annual toll of more than 120,000 preventable health care deaths, more than a million preventable illnesses and injuries, and an annual taxpayer cost of $21 billion.
The Centers for Disease Control and Prevention and the Institute of Medicine report that about 100,000 Americans die annually from health care errors, e.g., administering patients the wrong medication or a lack of backup oxygen during surgery, and another 100,000 die from health care-acquired infections such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, unsterile catheter insertion, and ventilator-acquired pneumonia.
All in all, 200,000 deaths a year — a figure that has not changed since the Institute of Medicine first announced it in 1999. Indeed, the real figure is probably higher. Adverse events in hospitals are often unreported. Our health care providers are killing us faster than the Axis did in World War II, when our military fatalities averaged 116,000 per year.
The East End has not been spared. Betty Fox, a producer at LTV, and the artist Howard Kanovitz died in the past few years from infections acquired in the area’s hospitals. Others have been seriously sickened. I am among them, having nearly died of a staph infection followed by Clostridium difficile, which I acquired after surgery at the Stony Brook University Medical Center in 2009.
The Obama administration’s low target of a 40-percent reduction reflects reluctance to properly address this carnage in the face of health care industry obstinacy. There is ample proof we can do better. The recently released Veterans Administration study of its 157 hospitals reported a 62-percent drop in cases of MRSA in its intensive-care units and 45 percent in other wards. A five-year study of 10 North Carolina hospitals, published in The New England Journal of Medicine in November 2010, reported that 63 percent of patient harms it identified were preventable. A remedial program in 2006, led by Dr. Peter Pronovost of Johns Hopkins in more than 100 Michigan intensive-care units, reported an 85-percent reduction of central line infections, which are estimated to kill 30,000 Americans a year.
We are not dealing with complex science here. The solution is low cost, low tech, and has been known for nearly two centuries. Ignaz Semmelweis and Oliver Wendell Holmes preached it in the 1840s. You prevent infections by keeping your patient, yourself, your equipment, and your surroundings clean. You prevent errors by being careful. Some remedial steps are as simple as altering dress codes to prohibit male physicians from wearing neckties, which can transmit germs by draping on patients.
Another step would be for hospitals to invest a little more money in the most effective infection-control products. Studies reported in The New York Times in January 2010 suggest that hospitals largely reject a superior preoperation swab, chlorhexidine-alcohol, because it costs $8.50 more per patient than povidone-iodine, which hospitals use 75 percent of the time, even though researchers have found that patients receiving it were significantly more likely to develop infections.
Dr. Betsy McCaughey, a former lieutenant governor of New York and founder of the effective advocacy group Reduce Infection Deaths, reported that in an Ohio hospital, MRSA, C. difficile, and other lethal germs survived on 78 percent of near-bed surfaces and implements, such as call buttons and TV remotes, even after the areas were vacated and presumably sterilized for incoming patients. A more thorough cleaning with disinfectants reduced the rate to 1 percent.
A faster, more effective way to reduce this carnage is to disaccredit the most dangerous hospitals so they cannot receive Medicare or Medicaid payments or bill patients for co-pays. They and other hospitals would get the message and snap to. Medicare and Medicaid payments provide health care facilities with 67 percent of their income. The mere threat of disaccreditation by Lyndon Johnson in 1967 integrated Southern hospitals that had declared they would not accept African-American Medicare patients. The hospitals changed their ways, as they would now. Physicians and hospitals know what needs doing. Threaten their wallets and they’ll do it.
Standing squarely in the way of disaccreditation, however, is a conflict of interest akin to the bond rater to bond broker relationship that gave us the economic calamity of 2008.
Here’s how it plays out. The Department of Health and Human Services deems that the Joint Commission, a $150 million per annum private nonprofit, can judge the safety, integrity, and efficiency of a hospital or ambulatory surgical center at least as well as H.H.S. can. So if the Joint Commission says that Fixup General Hospital doesn’t cheat the government too much or conspicuously botch too many operations, H.H.S., via the Centers for Medicare and Medicaid Services, okays the Medicare and Medicaid payments that keep Fixup afloat.
The Joint Commission accredits 80 percent of the country’s hospitals and ambulatory surgical centers for these government payments.
But guess who pays the commission for the inspections required for the accreditations and triennial reaccreditations. Yes, the very hospitals they are accrediting. And guess who pays a subsidiary of the commission for advance instruction on how to pass inspections. Yes, it’s the about-to-be-inspected hospitals. And who do you think sells the hospitals “We Are Accredited” coffee mugs and other PR doodads following their certification of worthiness in the face of such disinterested scrutiny? Right again. The proceeds go to the Joint Commission.
It is Moody’s AAAing Lehman Brothers all over again, or, if you prefer, Arthur Andersen extolling Enron’s financial purity. Only in this case it kills people rather than their home ownership and life savings.
In 2008, following the scandal of vermin infestation at Walter Reed Army Medical Center, which the Joint Commission had recently blessed with a 97-percent approval rating, Health and Human Services pressed the commission to strengthen its accreditation procedures. The commission responded with exhortations and education programs to get hospitals to right themselves but apparently did not exercise its authority to disaccredit dangerous medical facilities.
In 2010, David Eddinger, who handles accreditation matters at the Centers for Medicare and Medicaid Services, affirmed to me that there had been no safety-related disaccreditations for the previous two years. A board member of the Joint Commission later informed me that the commission had not disaccredited a hospital for safety reasons during the previous 10 years. Nevertheless, the government renewed the commission’s deeming authority through 2014.
The solutions we are proffered for this ghastly human and economic toll reflect Republican free-market theology and Democratic trepidation. Republicans tout removing government from the infection-error scene on the mystical premise that a market free of regulation will enable patients to identify and employ conscientious medical care. Democratic measures, embedded in Title III of the Affordable Care Act and recent proposals, remain tepid and subject to vaporization by industry lobbyists in the rule-making phase.
The disaccreditation weapon, which H.H.S. can invoke without Congressional approval, is not on the table, and the carnage continues.
Richard Rosenthal’s local television show, “Access,” won the 2010 Alliance for Community Media’s Jewell Ryan-White Award for the quality of non-mainstream programming. He is the author of “The Dandelion War,” a novel about class warfare in the Hamptons, and lives in East Hampton.