ON POLITICAL BOOKS: Ward is Hell

...She wasn’t kidding...

...It seems quite enough that he has provided us with an illumination of the problem...

...On the floor next to my feet was an open container filled to the brim with bloody test tubes, swabs, and latex gloves...

...From the first horror story to the last, The Great it nearly impossible for a prospective patient to play the odds based on hospitals’ track records...

...Bogdanich writes: White Lie is a truly terrifying book, a portrait of a health-care delivery system where the patients check in but don’t check out...

...Would I ever get on the witness stand and testify that we don’t make mistakes...

...People who have enough money to buy their own hospitals (the late Shah of Iran comes to mind) seem to like New York Hospital, the teaching adjunct of Cornel1 Medical School...

...Anyone who spends much time around doctors and hospitals, as I do, can’t have any doubt that the health-care industry is in some kind of trouble...

...Where a staff physician had been charged in another state with having billed a single patient for 288 unnecessary office visits, 285 unnecessary lab procedures, and 597 unnecessary injections...

...What might have happened had the injection not been given, the lab chief did not say, but he clearly seemed relieved...

...after all, a Washington-area RN was recently charged with, although never convicted of, murdering her most bothersome patients by injecting them with potassium chloride...

...Test tube maybes A tour of Bogdanich’s hospital begins at the nurses’ station, where perhaps you’re expecting to find your fantasy nurse: smart, tireless, dedicated, compassionate, equal parts Albert Schweitzer and Mary Poppins...

...Such assessments, of course, are so imprecise they are meaningless...

...X, a truly brilliant young physician in whose hands I would unhesitatingly place myself tomorrow, calmly describe over coffee how he had killed a patient the week before by overprescribing TPA, the anti-coagulant that stops heart attacks in progress (unless you overdo it...

...As I have suspected, and as Walt Bogdanich” now confirms, there are some really bad places in America to get sick...

...Where the resident psychologist had done hard time for Medicaid fraud...

...there is more than one hospital in Cambridge...

...But isn’t the “hospital from hell” exactly what all those state and federal boards and agencies that oversee the health-care system are supposed to prevent...

...High on the list is Bellevue, where you’ll probably end up if you become cyanotic while choking on a chicken bone, and where you’ll discover that the chicken-bone chokers have to get in line behind the hit-and-runs and the heart attacks and the gunshot wounds...

...The good news is that New London was discovered, eventually, for the deadly patient-packing scam it was...

...ON POLITICAL BOOKS: Ward is Hell Why even American's best hospitals can kill you by John Crewdson I am writing this in Los Angeles, where I arrived yesterday from New York...

...Perhaps we will have to accept that, just as the drug epidemic and other problems appear to be insoluble, we simply will have to become accustomed to living in a nation where decent health care is available only to the very, very rich...

...Don’t misunderstand...

...Only yesterday I visited a well-rethe hospital’s discharging office, whose job is to push patients out the door the Dr...

...Slill, I am middle-aged and overweight and lately I have been wonder ing, as I travel here and there, about what to do if I get run over by a taxi or fall off a hotel balcony or choke on a chicken bone-or if, God forbid, the Big One hits...

...But Bogdanich, a Wall Street Journul reporter who won a Pulitzer for exposing the sorry state of the medical laboratory business, is trying to tell us about something more- important than the inevitability of human error in the practice of medicine...

...You might actually find her, since such nurses still exist, although in ever-diminishing numbers and against all reason (considering what nurses get paid for what they have to do...

...The man is still alive because of the machine, but not for long...

...Most patients lack the research tools, for example, to learn that three open-heart units in northwest Indiana had mortality rates in the late eighties two to three times greater than some hospitals an hour away in Chicago...

...But neither President Reagan nor President Bush has done so...

...But so far we’ve never been sued...

...Here in Los Angeles my chances are better...

...Maniacally overbuilt in response to the promise of guaranteed Medicare revenues, then left with excess capacity in the wake of mandated cost controls, hospitals are now struggling to make up the difference by fighting one another for patients and by pushing high-end elective surgeries and contrived substance abuse and “health-enhancement’’ programs, while discharging nonessential staff and overworking and underpaying those who remain-not the indicators of an industry in good shape...

...or 4) not be a registered nurse at all, but a vocational or practical nurse foisted on the unsuspecting hospital as a certified RN by an unscrupulous nursing agency like the one Bogdanich discovered in Florida...

...if he knows you well enough, to having killed the odd patient at some point in his career...

...Also in his favor is the fact that he is hardly the first to have sounded an alarm about the quality, availability, and affordability of health care...

...he said to me after the technician had gone back to work...

...What exactly does “linked to” mean, or “figured in...

...Simon and Schuster, $22.50...

...The good hospital-bad hospital game can be lots of fun-doctors play it all the time-but as the doctors themselves are the first to admit, it’s ultimately misleading...

...pita1 is also where Andy Warhol died, not because of some rare affliction or inoperable complication, but because he was left unattended following a routine operation on his gallbladder (and he had a private nurse...

...Health to pay So doesn’t it follow that the solution to the healthcare mess is simply more money...

...Not only am I not sick, but according to my doctor I am healthier than I deserve tobe...

...No way...

...After that the list gets short, and it’s even shorter in San Francisco, which hasn’t had a truly great hospital since French Hospital closed down...

...Down the corridor from the pharmacy is the hospital’s laboratory, where workers just as ill-trained and underpaid as the pharmacy clerk are matching (or mismatching) blood for transfusions, testing (or mixing up) patient samples, and performing (or misreading) complicated diagnostic assays under conditions that may be at best unhygienic and at worst appallingly disorganized and dirty...

...The best hospital in the world is probably the Cambridge University Hospital in England, where patients are frequently transported from London, 60 miles away...

...Where the chief of staff had been charged with putting out a contract on his former boss...

...Every day, after all, thousands of Americans are discharged from hospitals cured of whatever ailed them (I myself have been hospitalized for surgery three times and have survived to write this review...

...Even so, I remember having dinner with a group of doctors and nurses there and listening to Dr...

...He’s saying that no matter what the American Hospital Association and the American Medical Association and all those other associations maintain, the notion that hospitals and doctors are somehow deserving of our complete and unquestioning trust is medicine’s great white lie...

...General, where employees frequently don’t answer the telephone and often seem confused about whether a particular doctor is on the staff...

...John’s in Santa Monica, Pasadena’s Huntington, and Valley Presbyterian in the San Fernando Valley...

...Where the chief administrator was a local real-estate salesman and convicted felon, and his assistant a lapsed Catholic priest who had married a divorced belly dancer named Saudi Arabia on a Mississippi riverboat...

...None of them,” she said...

...And here is Her fatai error is mitigated only slightly by the fact that some idiot decided to store the two solutions in the same kind of bag...

...While the precise extent of such failings remains unknown, one of the most disturbing aspects of Bogdanich’s book is the lengths to which the health-care providers and regulators, and, of course, those who represent them, will go to keep the rest of us from becoming informed consumers of the services they providenot just by covering up suspicious deaths and protecting incompetent practitioners, but by making Overall, hospital care remains a crapshoot for most American families...

...Just come on over,” said the calm, cheerful emergency-room nursing supervisor when I telephoned the other night to ask how things were going), with the UCLA Med Center a close second...

...The same stonewalling characterized Congress’s 1986 decision to deny patients access to a national data bank that collects records of malpractice judgments and disciplinary actions against doctors...

...But human blood, which is perishable, comes to hospitals on a “use it or lose it” basis, and those units, which were donated for free by civicminded citizens, represent pure profit for the hospitals and the blood bankers...

...The Los Angeles suburbs also have some first-class hospitals: St...

...Walt Bogdanich...

...On the other hand, doctors are human and it’s hard to find one who won’t admit...

...One of the few scams Bogdanich doesn’t mention is the overtransfusion of blood, which costs the patient $400 a unit...

...During the operation the patient will be kept alive by a heart-and-lung machine while his own heart, temporarily out of action, is bathed in cardioplegic fluid, which the surgeon has asked the pharmacy to send up to the operating room...

...On the other hand, such factors may be impossible to measure in the aggregate, and Bogdanich points out that numbers define only one dimension of the problem...

...Here in the hospital’s billing department, bf stahc or shrinking revenues, is putting the finishing touches on his latest scheme for “incentive payments” to doctors who send their patients to him rather than to the competing hospital across town...

...The operation goes well, but at the last moment the surgeon discovers that the patient’s heart can’t be restarted...

...So it’s possible that this is less a systemic indictment than simply a shocking collection of worst possible cases, tales from the crypt...

...Midway through, he was interrupted by one of his technicians, an unkempt fellow with two days of grey stubble on his beet-red face who might have passed for a homeless person on the street outside the hospital...

...Finally, and perhaps most convincingly, it is harder now than ever to find someone who’s recently been hospitalized, or even someone whose friend or relative has been in the hospital, who doesn’t have a scary story about unattended nursing stations or understaffed emergency rooms or unwatched monitors or misprescribed medications...

...There are plenty of New York City hospitals worse than Bellevue, but not many that are better...

...Tell the ambulance driver you want the “new hospital” or you’ll end up at the wrong place...

...No one wants to end up pushing daisies because somebody like Andy Warhol’s nurse wasn’t paying attention...

...It could put it in every public library...

...It should be obvious that the nexus of all this trouble is money...

...Not feeling quite so sanguine about that vision in white who’s materialized by your bedside with a hypodennic in hand...

...Upstairs in the operating theater is the surgeon Bogdanich describes who is preparing to perform coronary bypass surgery on a 33-year-old father of three...

...I am hap- py to be here, not only because the midJanuary temperature is 40 degrees warmer, but (and this is the truth) because Los Angeles is a better place than New York to get sick...

...Or where, at the time he assumed office, the chairman of the hospital’s board was under indictment for grand theft...

...In attempting to give the reader perspective, Bogdanich offers a few statistical extrapolations: In New York state in a single year, he writes, poor medical care “figured in the deaths of nearly 7,000 patients,” from which he deduces that “poor medical care may be linked to 80,000 deaths a year” nationwide...

...X, a truly brilliant very moment those reimyoung physician in whose bursements are cut off by fed er a1 cost - c o n t ainni en t whether the patients have re- place myse1f covered...

...As Bogdanich notes, however, more than half the big-city hospitals in this country employ, or have employed, temporary rent-a-nurses who may 1) have spent less time in that particular hospital than you, the patient...

...Don’t get sick in New York...

...In Beverly Hills there’s the redoubtable Cedars Sinai (“We have plenty of room...

...Perhaps there is no solution...

...The truth is, ’even at the newest and bestequipped hospitals staffed by the best-trained and most conscientious staff, fatal mistakes are made with some regularity...

...New York is probably the worst...

...Washington, D.C., where I live, has a couple of well-known hospitals that are OK (and a couple of well-known ones that are less OK), but unless I was bleeding to death I’d head for Johns Hopkins in Baltimore, consistently rated as top in the nation...

...Since then, while reporting on AIDS, I have visited a number of New York hospitals in which I would never, under any circumstances, want to be a patient...

...garded Southern California medical center to observe a demonstration of a new piece of equipment...

...The bad news is that the discovery was made not by Ohio’s hospital regulators but via a newspaper expod...

...In fact, I’d try to make it to Stanford before I’d check into S.F...

...How else can one explain the New London Hospital of Elyria, Ohio, where the chief of surgery had previously lost his medical license for dispensing illegal drugs...

...Sidney Wolfe, head of the Public Citizen Health Research Group, has been doing so for years, and so have successive squadrons of congressional investigators...

...This Darticular hands I would unhesitatingly guidelines, regardless of described over coffee how he discharge office has a spehad killed a patient the week patients to local nursing cial section that steers such the anti-coagulant that stops ly, is the office of the hospiheart attacks in progress who, rather than waste time tal’s chief administrator, searching for ways to improve patient care in the face -unless you overdo it...

...The question it inevitably raises is not whether the stories are true (Bogdanich’s facts are documented and he is a careful reporter) but whether they paint a representative picture...

...Bogdanich’s answer is that while the regulators certainly exist, they often don’t do their job...

...The nursing stations, operating rooms, pharmacies, and labs at the Bogdanich Medical Center are not the only places where problems are waiting to happen...

...When no transplant can be found, he dies...

...Anyone wishing to know where not to go may drop me a stamped, self-addressed envelope in care of this magazine...

...Don’t put your hand in there,” the lab chief warned me, not that I was about to...

...The reason for the interruption appeared to be some sort of mistake that had taken place earlier that day...

...A nightmare vision to be sure...

...clerks spend their time searching for the precise combination of diagnostic codes for each patient that will bring the hospital the greatest possible reimbursement from Medicare, whether or not those diagnoses accurately reflect the patient’s condition...

...A couple of years ago, as I began to get in touch with my mortality, I asked my friend, a New York doctor, which of that city’s many distinguished hospitals I should choose in the event of cardiac arrest...

...No problem,” the lab chief assured the tech...

...But as Bogdanich points out, New York HosJohn Crewdson is a senior writer for The Chicago Tribune...

...3) be on the short end of a 24hour shift that started in another hospital...

...What constitutes “poor medical care...

...The federal government could provide that information to the public...

...2) never have been trained in the hospital’s fundamental practices and procedures...

...The Great White Lie...

...Although the book he has written leads there inevitably, the question of how the health-care problem might be solved is not addressed by Bogdanich except in passing, as when he suggests replacing the current conglomeration of competing and conflicting health-care policies with one coherent national policy...

...But it does seem unfortunate that the nation that has the best physician training in the world and is the clear world leader in biomedical research should be unable to translate those accomplishments into affordable, first-rate health care for all of its citizens...

...The doctor gave the injection anyway, so everything’s OK...

...It’s a hard one to spot, because nobody can fault the surgeon for transfusing a couple of extra units on the ground that “I had to keep the patient’s vascular volume up...

...Or buy Bogdanich’s book...

...Yes, because anyone can see that more resources are urgently required, even though it’s not clear how or on what that money should be spent...

...Where the surgeon who headed the hospital’s review committee had failed a national licensing exam...

...Where unsuspecting patients were often brought by ambulance from hundreds of miles away...

...The health-care crisis is only going to compound itself as my generation of baby-boomers moves along the wellness curve toward coronary artery disease and colon cancer...

...During the demonstration the lab chief, who claimed to have a master’s degree in biochemistry, couldn’t seem to remember the difference between “antigen” and “antibody” (there’s a big difference...

...The essence of the “great white lie,” after all, is the industry’s denial that the odds even exist...

...Then climb out of bed and come visit the pharmacy, where life-and-death decisions are made every hour by employees who may be the most poorly trained and overworked in the hospital...

...Or maybe Nurse Nancy happens to be a psychopathic killer...

...But why should Bogdanich have a solution to offer when no one else does...

...Instead of cardioplegic solution, which sustains the heart tissue by temporary paralysis, an untrained clerk in the hospital pharmacy-a 19-year-old previously employed as a dry cleaner and an ice-cream store clerk-sent the surgeon plastic bags filled with glucose and water...

...That’s stuff from the AIDS tests we did this morning...