Background--The USA--Australia--Business Practices--Mayne--Conclusion--References
The many extracts on these pages are from copyright material. They are owned by the reference given or its owner. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes. The material is selective and I have not included denials and explanations. I am not claiming that all of the allegations are true. The intention is to show the general thrust of corporate practices as well as the nature and extent of any allegations made.
"We can provide a better product at a better price," Scott proclaimed in an interview in 1994. And over the years, in its advertising and presentations in communities, Columbia has repeated that. A Hospital Chain's Brass Knuckles, and the Backlash The New York Times May 11, 1997
Scott and Columbia/HCA have insisted that they provide both cheaper and better care. They have rejected any suggestions that this was not so. Columbia's business practices, particularly large incentives to unsupervised administrators who make large profits make this unlikely.
A Review by a group of lawyers commissioned by a not for profit group in 1996 used government data. It compared Columbia/HCA hospitals with comparable not for profit hospitals. It found that Columbia/HCA hospitals charged more, and employed fewer nursing staff. They provided less free care, did not provide care which was less profitable and provided fewer services to the community.
While there are no reports looking at actual care there are accounts which suggest that care was compromised due to understaffing.
Some doctors, nurses and administrators, angered by rapid staff cuts that raise profits, are questioning whether care is being compromised -- an accusation that the company sharply disputes.
"You have a highly decentralized system that grants a lot of autonomy to local and regional officers, and those officers have very significant monetary incentives tied to the net profitability of their markets," Leifer said. "I feel that this could be a prescription for disaster, because it can create tremendous temptation to make budget at times by inappropriate action."
There is no definitive evidence that the care at Columbia is better or worse than that provided elsewhere. Company executives said they monitored how patients fared to insure a high level of medical care. And some doctors and nurses said that care at hospitals acquired by Columbia had remained the same or improved even after personnel were cut.
But others around the country expressed concern about their hospitals. In 1995, Columbia Women's Hospital in Indianapolis shrank its nursing staff and cut some nurses' pay. The result was an acute nursing shortage, with more responsibilities turned over to lesser-trained technicians.
Problems quickly arose. In July 1995, Dr. Bonnie Miller found herself caring for a newborn with breathing problems without the help of a qualified nurse. The baby pulled through, but Dr. Miller was disturbed.
In a letter to the hospital administrator, she wrote, "I hope that our quality of care at the Women's Hospital of Indianapolis would not be jeopardized by your endeavor to save money."
Ms. Calahan expressed her concerns to her superiors. The response was quick, according to state records and interviews. Ms. Calahan was told that if she was unwilling to accept the assignment, she could find employment elsewhere, according to nurses and state records.
Nurses and doctors had begun contacting the state health department. And a state inspection soon found widespread problems.
Nursing levels were short around the hospital, according to the inspection report. The neonatal intensive-care unit was in particular disarray. Investigators found technicians -- without appropriate supervision from registered nurses -- handling complex tasks like inserting feeding tubes in premature newborns.
The findings led to a $25,000 fine. Columbia settled the Indianapolis case without admitting wrongdoing, paying $12,500.
"With the current patient load of a minimum of 15 patients, you are sacrificing safety and care," Ms. Lorenzo wrote in her resignation letter last April. "I lie awake at night going over and over in my mind the events of the day. Did I do what needed to be done?"
Doctors express similar concerns. "Somebody's going to get hurt; we've come close to that," said Dr. Jamal Modir, a general surgeon at Good Samaritan Hospital in San Jose, Calif., who last year, a few months after Columbia took over, bemoaned nursing cuts and shake-ups that led to the replacement of many of the hospital's experienced nurses.
"I think the people who decided it didn't know much about how hospitals run or how staffs function," Lansing (heart surgeon) said. "These people don't understand about quality of care. And they don't want to listen to those of us who do." A Hospital Chain's Brass Knuckles, and the Backlash The New York Times May 11, 1997
The 44-year-old Scott co-founded Columbia in 1987 in El Paso, where he was a lawyer specializing in health-care mergers and acquisitions. His cost-cutting efforts helped the company grow and prosper but also produced critics who said it put profits before patient care. Columbia forces out 2 top executives Hospital giant's billing investigated Houston Chronicle Jul 25, 1997
The profit pressure that left Lawrence County, which is 71 miles southwest of Nashville, without an obstetrician also helped make Columbia the target of federal investigators. And it began affecting patient care immediately after Columbia's 1994 takeover of Hospital Corp. of America, current and former hospital employees say. Columbia/HCA Profit Pressure Blamed The New York Times September 7, 1997
Additional information of poor care and understaffing in the years suggests that the problems continued after the fraud scandal broke in 1997. Most of the reported problems in care relate to understaffing i.e. cost cutting.
But court records, internal hospital documents and interviews with a dozen nurses reveal a pattern of staff reductions targeting registered nurses after Columbia/HCA bought Wesley in 1994 and began improving the profit margin there.
"There are frequent days, over and over, that we cannot monitor or follow up on our patients. When we are rushed, that's when the nurses overlook things, miss things and make mistakes," according to a letter written to the Keck family by a concerned registered nurse, Marvin Jack, who has been employed at Wesley since 1975.
According to interviews and internal hospital incident reports, patients sometimes received the wrong medicine or the wrong dose. Nurses often were too busy to help patients reach the bathroom, forcing them to wait for hours. Patients routinely received time-critical medicine up to three hours late, typically because a nurse was dealing with a crisis elsewhere on the same floor.
And in one incident that didn't lead to an injury, a registered nurse infused an elderly cardiac patient with blood earmarked for another patient.
But Wesley staffed only by numbers of patients, never by acuity, and with the budget always in mind, three Wesley administrators and more than a dozen nurses testified during depositions.
Deaths spur reforms
At Presbyterian/St. Luke's, five deaths were linked to nurses there over three years, beginning in 1997. And, in a rare action, both state and federal regulators intervened, placing the hospital on probation and threatening to rescind federal funding.
In late 1995, Columbia/HCA, the nation's largest hospital chain, assumed control of Presbyterian/St. Luke's as part of a five-hospital deal with a charitable health-care network, HealthOne.
Although hospital revenue tripled, savings came at the expense of the nursing staff, which was reduced by 10 percent, hospital records show.
State and federal investigators found that patient loads sometimes tripled as well. Training was abysmal and many nurses lacked even rudimentary skills. Some nurses didn't know how to use infusion pumps, how to check for skin ulcers or treat ulcers, or how to use a diabetes treatment kit, a common task required with elderly patients.
Two more deaths linked to nurse error took place in 1999. On Jan. 29, Mary Heidenreich, 78, was killed from a morphine injection administered by a nurse, Lala James, who had flunked a medication competency test given by the hospital, but continued working without additional training, according to state investigative reports. Almost three months later, James Curran, 83, fell from his bed and lay on the floor undiscovered for 95 minutes. The pneumonia patient died of a fractured spine.
By early 1999, after threats of Medicaid suspension, hospital officials implemented widespread reforms, and the hospital no longer is on probation. Nursing mistakes kill, injure thousands Cost-cutting exacts toll on patients, hospital staffs Chicago Tribune10 Sep 2000
Indeed, two of the largest-ever verdicts against the industry -- $312 million and $83 million -- came against one nursing home in Texas, the Heritage Hills Nursing Center in Fort Worth, owned by Columbia/HCA. Juries Treat Nursing Home Industry With Multimillion Dollar Verdicts The National Law Journal April 23, 2001
Background--The USA--Australia--Business Practices--Mayne--Conclusion--References
This page created August 2003 by Michael Wynne