May 21, 2008--Rx: "Collateral Damage"

Not until late 2005, less than three years ago, did New York City’s public hospitals take aggressive action to reduce the number of dangerous bacterial infections caused by the failure of the hospitals themselves to maintain sterile conditions.

Since then, after taking routine action, preventable bloodstream infections such as those caused by bacteria that enter the body through heart catheters have been reduced by more than half, and pneumonia caused by microbes transported to the lungs via ventilators have plummeted by nearly 80 percent.

Before that time, infections of this kind were sloughed off by hospital administrators as something they charmingly dismissed as “collateral damage.” They claimed that they were using such “advanced lifesaving techniques” that this was expected and unpreventable. When employing such cutting-edge procedures, they said, inevitably there are downside risks.

But to even a layperson heart catheters and breathing tubes, though excellent treatments, do not by 2008 standards sound that experimental or exotic. And the fact that once the hospitals began to crack down on simple things such as requiring medical staff to wash their hands or wear latex gloves when treating hospitalized patients, that fact that this alone led to such dramatic reductions in infections and unnecessary deaths, makes one wonder what was really going on and what really happened to change the situation.

The latter is easy to explain—those who pay the bills, the federal government and private insurers began to refuse to reimburse for the care of patients with preventable infections. This did not mean that critically ill patients would be sent home—hospitals couldn’t legally get away with that—but rather that hospitals would have to eat the cost of that care. This for certain got their attention and caused them to get into the hand-washing business.

But there is also a darker side to the story that needs widespread attention if we want to ferret out other examples of, what else to call it, malpractice.

Perhaps the major reasons hospitals did not require staff to take standard precautions was because they made more money by not doing so.

According to the New York Times (article linked below) here’s how this worked:

Since few hospitals these days fill all their beds, if they can keep admitted patients longer, and insurers will cover the costs, they will run at higher in-bed capacity and thus net more income. So the (literally) dirty little secret was that it was not in the hospitals’ best financial interest to maintain a sterile environment—if after heart surgery a patient developed a virulent bacterial infection that required a few more days in the hospital—assuming they didn’t die first—what’s the problem? Patients most times survived and the medical center pocketed a few thousand extra dollars.

Win-win, no? Not exactly. And hopefully at least this often deadly scam is being exposed and perhaps will end.