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Pill mills, puncture wounds and the Philly mob: More of Antidote's favorite health stories of 2010

Pill mills, puncture wounds and the Philly mob: More of Antidote's favorite health stories of 2010

Last week, I started listing Antidote's 10 favorite stories of the past year, in no particular order. Here is the rest of the list.

"Dialysis: High Costs and Hidden Perils of a Treatment Guaranteed to All," Robin Fields, ProPublica, November 2010

When the spin machine revs up before you have even published your investigation, you know you are onto something big. This is what happened when Robin Fields was about to publish her blockbuster package about the dialysis industry. Being a fantastic investigative reporter, though, Fields obtained a copy of the memo that was being circulated to try and trash her reporting. Fields had to have known she was going to face some serious flak when writing this piece, but she did not flinch.

A program once envisioned as a model for a national health care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world's highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy's, or France's, or Japan's, thousands fewer patients would die each year.

The stories have shed new light on a system that people have come to take for granted. They provide a lesson that, just because a course is well-established doesn't mean it is the best course. One dialysis patient told Fields, ""It's become ingrained that dialysis is expensive and dangerous and has terrible outcomes."

 

"Do No Harm," Marshall Allen and Alex Richards, Las Vegas Sun, June– December 2010

Two years in the making, this series was well worth the wait. Through deep reporting, clear-eyed writing and an innovative use of documents and graphics, Allen and Richards deconstruct their local hospitals in way no local reporter has done before. They take gripping personal stories and back them up with acres of data mined from a wide variety of sources. It all comes together beautifully. Many projects this ambitious collapse under the weight of the facts – and self-congratulations.

Hospitals in Las Vegas have a history of higher-than-expected surgical injuries, records show.The Agency for Healthcare Research and Quality uses hospital billing records to identify surgical injuries it calls them "accidental punctures or lacerations." Its experts use the injuries as one of many measures to evaluate patient safety in hospitals. The agency's software adjusts for risk including factors such as age and gender - so each hospital's risk-adjusted rate of surgical injuries can be compared with national norms.The Sun used agency methods to analyze every hospital inpatient billing record on file with the state from 1999 to 2009, almost 3 million in all.In 2009, the rates of surgical injuries that were statistically significant - meaning they weren't likely to have occurred by chance ranged from 34 percent higher than expected at Spring Valley Hospital Medical Center to 174 percent higher than expected at North Vista Hospital and St. Rose Dominican Hospitals San Martin Campus.

My favorite part of the series is the way the Sun handles the source documents. It posts them so readers can see exactly how they look. It zeros in on the critical parts, so that people don't have to hunt through boilerplate to find the essentials. And it makes the text searchable. If more papers did this regularly, it would go a long way toward restoring confidence in the "mainstream media."

 

"Inside Broward County's pill mills," Scott Hiaasen, the Miami Herald, April 2010

There has been great reporting on pill mills this year in Florida, including "Pipeline of Pain" by Kate Howard and Paul Pinkham at the Florida Times-Union and stories by Emily Nipps at the St. Petersburg Times. Hiaasen's work stands out for the strength of the reporting and the clarity of the writing. Reporting on drug mills tends to take one point of view – the view of law enforcement .There tends to be a lot of victim blaming and emphasis on drug addicts' doctor shopping, which means the focus is almost entirely on the demand for the drugs, not the supply. Hiaasen examines the totality of the problem.

More oxycodone is distributed in Florida than in any other state 40 percent more than in second-ranked California in 2006, according to DEA data. Driving this trend are Florida's "dispensing practitioners" -- doctors who have special approval to sell drugs directly from their offices. In 2006, they handed out 85 percent of all the oxycodone distributed by doctors nationally.

"Totally suspicious," said Dr. Charles Grudem, a board member of the Florida Society of Interventional Pain Physicians and a vocal critic of storefront pain clinics. He questions the need for doctors to dispense narcotics from their offices. "It creates an automatic incentive to dispense medicines that are profitable" Grudem said. Many patients go to pain clinics with genuine medical complaints, Grudem said, but the suspect clinics offer only one remedy: powerful drugs. Drugs that can make addicts out of patients."They get turned into criminals," he said.

The reporting by Hiaasen and the other reporters mentioned above has finally started to change Florida law. Because the problem is so entrenched, though, I have a feeling we will be seeing stories like this around 2013, too.

 

"Who Protects the Patients?," Blythe Bernhard and Jeremy Kohler, St. Louis Post-Dispatch, May – December 2010

Antidote has written about this series four times his year, and there's a reason. (No, it's not because I used to work with Bernhard at The Orange County Register, or that she was a California Endowment Health Journalism Fellow, but those are good guesses.)

The reason is Kohler and Bernhard didn't wait. They could have pulled together all their great material and dropped it in December, just in time to meet the deadline for all the big journalism awards. Instead, they have cranked out more than a dozen stories since May, including my favorite, a story that should embarrass the heck out of the Missouri Board of Registration for the Healing Arts, an agency as cumbersome and lackluster as it name implies.

Registration for the Healing Arts includes eight physicians and one member of the public. The board's public member is Kevin O'Malley, with the Greensfelder law firm in St. Louis. One of his specialties: defending doctors against medical malpractice. O'Malley was appointed by Gov. Jay Nixon in July 2009. That same month, in a two-day trial in St. Louis County Circuit Court, he successfully defended St. Louis doctor Stanley Librach in a malpractice case alleging that a procedure disfigured a liposuction patient, according to Missouri Lawyers Weekly.

The series prompted Nixon this month to vow to work with state lawmakers to strengthen the agency's ability to discipline physicians and increase the agency's transparency. Anything would be better than what Missouri has now.

 

"Heart-stent popularity is costly in many ways," Jay Hancock, The Baltimore Sun, January 2010

Hancock has been dogging the overuse of stents and the outright abuse of patients by money-minded doctors and hospitals all year. So much so that his reporting recently made one stent company official mad enough to send an internal email saying, "Someone needs to take this writer outside and kick his ass! Do I need to send in the Philly mob?"

Hancock has remained unfazed. As he wrote in January:

Most people getting stents don't need them even if scans show substantial blockage, studies suggest. Stents can be dangerous, too. "You're trading one disease for another - the disease of having a blockage for the disease of having a metallic stent in your heart. And that is a disease, make no mistake," says Dr. Michael Ozner, medical director of the Cardiovascular Prevention Institute of South Florida. "These procedures are not without risk."

Thanks to extraordinary promotion and advertising, stents have become a multibillion-dollar business, substantially contributing to soaring medical-insurance costs and federal deficits. They're a perfect illustration of why American health care costs more but delivers less.

Hancock and Sun reporter Tricia Bishop have done a great job tracking the scandal that erupted at St. Joseph Medical Center in Towson, where Dr. Mark Midei was accused of implanting stents by the crate. They, and Sun reporter Kelly Brewington, also have helped readers understand a broader issue: the difference between the narrow population of people who actually need and benefit from stents and the potentially huge number of people who are being encouraged to undergo stent operations unnecessarily. This is consumer-protection reporting at its finest.

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