Conflicts, County Parks and Kwashiorkor: More of My Favorite Health Stories of 2011
1. "Prime Healthcare reports outsized rates of unusual conditions," Michael Corey, Christina Jewett, Lance Williams and Stephen K. Doig, California Watch, October
The rapid expansion of Prime Healthcare in the hospital market has been one of the most interesting but underreported stories in the industry. Fortunately, we have the nonprofit, online news outlet California Watch keeping close track of Prime's moves. In this piece, the team uses an interactive graphic and tables to show just how out of whack Prime's billing rates are:
Kwashiorkor is a rare form of malnutrition caused by protein deficiency, often found in very poor countries during a drought or other natural disaster. State records show Prime hospitals reported kwashiorkor 20 times more often than other California hospitals from 2009 to 2010. Shasta Regional Medical Center billed Medicare for more than 1,000 cases. Medicare pays providers significant bonuses for treating kwashiorkor.
And it's not just disorders usually found in the developing world that are being milked by Prime. Be sure to check out the sections on septicemia, autonomic nerve disorder and malignant hypertension.
2. "Financial transparency skin-deep at medical journals," Frederik Joelving, Reuters Health, June
Joelving dismantled the conflict-of-interest disclosure policies at one journal to illustrate the pervasive problems in academic journals. His work is a blueprint for other journalists covering breaking news on drugs and devices:
The disclosure policy of the British Journal of Dermatology (BJD) is deceptively simple. According to an e-mail from its editor Dr. Tanya Bleiker, "Authors are responsible for disclosing all financial and personal relationships between themselves and others that might be perceived by others as biasing their work." That includes signing a statement that relevant patent rights, stock ownership, consultancy fees and employers have all been declared -- even if the employer was also listed at the beginning of the manuscript. That statement will show up in the report.
Yet of the 50 most recent BJD reports from scientists at L'Oreal, Shiseido, Novartis and similar companies, 13 declared no conflict of interest.
As I wrote recently for Health News Review, it is understandable why so many reporters miss conflicts of interest, especially when the journals aren't acting as gatekeepers. The only way the journals will get tougher is if reporters and their readers demand a higher standard.
3. "HHS rules, secrecy protect doctors with long histories of problems," Alan Bavley, The Kansas City Star, December
When the feds pulled the National Practitioner Data Bank from public view this year in response to Bavley's reporting, Antidote tried, unsuccessfully, to make Bavley the poster child for government overreach. Bavley did not want the attention and instead focused on continuing to show the dangers posed to the public by keeping physician histories secret:
Buried deep in a federal database is Practitioner No. 222117, perhaps the most frequently disciplined doctor in America. This doctor has been accused of violating drug laws, prescribing unauthorized medications, providing substandard care and obtaining licenses through fraud. From 2002 through 2006, 20 states and the District of Columbia revoked or suspended No. 222117's medical licenses.
Two professional societies took away the doctor's memberships. The Department of Health and Human Services banned the doctor from billing Medicare and Medicaid. And the Drug Enforcement Administration revoked the doctor's permit to prescribe controlled drugs. For most of these years, the doctor's home base was Missouri. But who is this doctor? And is he or she still practicing? We don't know. The federal government won't say. And it won't even let reporters or anyone else investigate to find out.
"It's hard to argue that people shouldn't be able to know about their doctors," said Charles Ornstein, president of the Association of Health Care Journalists and a senior reporter at ProPublica, told Bavley.
I'm going to go out on a limb and predict that, like the recent federal policy change on the Medicare claims database, it is going to take a lawsuit to restore sanity to this debate.
4. "OC Park History Is a Tale of Two Counties," Tracy Wood, Voice of OC, June
If you told me that I would read a story about parks in Orange County from start to finish – in fact that I would read the entire series – and still want more, I would have told you to stop sniffing rubber cement. Yet Wood gave this history an immediacy and urgency, showing the real consequences of a county that is full of fantastic parks in the south and yet is a park wasteland in the poorer and more heavily populated north.
The consequences of this disparity go far beyond aesthetics. Health in a community can be directly affected by the amount of neighborhood parkland. Not just acreage statistics matter. Community parks need to be within a short walk for residents to benefit. According to research, adults in a neighborhood without safe, nearby, outdoor space are more sedentary, more stressed and more overweight, leading to higher health insurance rates. And children who live without parks pay less attention in school and have more obesity and even eyesight problems than those who can play outside on grass and among trees.
Then there's the self-interest factor. Economic researchers at Texas A&M University have confirmed what community designers knew 200 years ago: that safe, usable park space increases the property values of surrounding neighborhoods.
The next time you are pushing your kids on the swing at your neighborhood park – or wishing there was a park nearby – think about putting together a story like this.
5. "Parkland in Dallas has been among Texas' worst hospitals for patient safety for years, analysis shows," Ryan McNeill and Daniel Lathrop, The Dallas Morning News, October
In explaining hospital quality data, it is tempting to gloss over the many quirks and caveats. McNeill, a California Endowment Health Journalism Fellow, and Lathrop did not shy away from the complexities of the data. Instead, they broke things down carefully and used those complexities to help readers understand how troubled Parkland really is:
The News' findings raise particular questions about Parkland, which serves as a regional trauma center, and UTSW's St. Paul. Both are taxpayer-funded institutions subject to Texas' open-records law, so they must release more information than private hospitals, generally speaking. But they have not released data supporting their long-standing claims of excellent care. Parkland and St. Paul are teaching hospitals, staffed largely by UTSW faculty and doctors in residency training.
Both ranked poorly on many of the same patient safety indicators, such as accidental punctures and lacerations during procedures. Their virtually identical composite scores were also among the state's very worst, 64 percent higher than the combined composite for patients at all 105 large hospitals in Texas. In 2009, Parkland was the worst-ranked large hospital in Texas for accidental punctures and lacerations during procedures. The analytical software found that Parkland had 172 potential cases that year, a risk-adjusted rate of 8.4 per 1,000 patients.
In all, it's been another tremendous year for health journalism. I could easily have made a list of the 100 best health stories from outlets large and small. I'd love to hear what you think should have made the list. Share a comment below, send me a note at askantidote [at] gmail [dot] com or ping me on Twitter @wheisel.
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