Texas Hospital Resorts To Calling 911
It is a known fact that if you are at the hospital then you will receive the best care and have the professional people surrounding you. After all that’s what hospitals are for, are they not? Unfortunately the confidence that people once had in hospitals and their staff being able to do the jobs they are hired to do is slimming down. After all who would want to be in a hospital where they have to call 911 for help?
That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. There were no doctors at the hospital that night when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead not long after. The episode occurred at a small hospital that is both owned and run by doctors. Hospitals like these have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.
Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals. But the Texas case, and others like it, have invited new scrutiny from regulators and members of Congress about these hospitals’ ability to care for patients who suffer complications after their operations. While some of these hospitals are large sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. For example, small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient’s recovery.
A similar case involved an 88-year-old woman two years ago at a small doctor-owned hospital in Portland, Ore., where the nurses called 911 after she was given too much pain medicine following spine surgery. She, too, later died. As the number of doctor-owned surgical hospitals grows, federal and state officials now acknowledge that the government rules may be too vague about the emergency abilities a hospital must have in place. Regulators are particularly concerned about the very small hospitals that focus on only a few kinds of surgery but perform operations that frequently require an overnight stay.
While Medicare’s rules currently say a hospital must “meet the emergency needs of patients in accordance with acceptable standards of practice,” the details are left largely to the hospital’s discretion. Federal and state officials say they are now reviewing the guidelines to toughen the rules and make them more specific. “We’re concerned about good quality of care in any or all settings,” said Thomas E. Hamilton, who oversees hospital certification for the federal Centers for Medicare and Medicaid Services.
Medicare recently terminated its agreement with the facility involved in the Texas case, West Texas Hospital, a 14-bed hospital in Abilene that performed procedures ranging from plastic surgery to complex spine operations. “It is horrific that Steve Spivey had to sacrifice his life in order to expose the problems associated with physician-owned hospitals,” Mr. Keith said. West Texas, citing patient privacy, said it could not comment, although it defended the quality of its care.
After a review of the hospital following Mr. Spivey’s death, federal officials decided last month that the hospital could no longer continue treating patients covered under the government’s Medicare program. Although the chief executive of West Texas Hospital defended its practices, he said it would not appeal the government’s decision. The hospital has since closed. The doctors who set up the specialized hospitals defend them by saying that by running the centers themselves and concentrating only on certain procedures, they can provide the best results for patients.
“This is really about the physicians getting back in control,” said Greg Weiss, chairman of USMD Hospital, a small physician-owned hospital in Arlington, Tex. USMD, which has 18 beds, has an emergency department and a doctor present around the clock, and is also building an intensive-care unit, Mr. Weiss said. Proponents of the specialty hospitals say the Abilene and Portland cases are aberrations that critics are exploiting to defend the turf of full-service hospitals. They say they are able to handle their patients’ medical emergencies, whether or not they have emergency departments.
But some members of Congress are now pushing Medicare to take a closer look at how such hospitals are regulated. “The problem with physician-owned specialty hospitals is that decision-making is more likely to be driven by financial interest rather than patient interest,” said Senator Charles E. Grassley, Republican of Iowa, who is a longtime critic of such hospitals. “You see it in the cherry-picking of patients, and with policies that instruct hospital staff to call 911 for the local community hospital if emergency care is needed,” said Mr. Grassley, a ranking member of the Senate Committee on Finance, which oversees Medicare.