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Archive for March, 2011

— Medical investigators found that infections linked to a contaminated liquid nutrition supplement could have begun two months before officials realized there was a widespread problem at Alabama hospitals, the head of the state health agency said Wednesday.

Nine people died and 10 others were sickened this month after receiving nourishment from the kits. But because all of the patients were already seriously ill, investigators may not be able to determine whether the IV feeding liquid contaminated with bacteria was to blame for the deaths, said Dr. Donald Williamson, director of the Alabama Department of Public Health.

There was a single incident in January, but officials didn’t notice a pattern until this month. Officials have not released the names or illnesses of the patients who were sickened. However, patients who typically use the IV feeding liquid have severe illnesses such as gastrointestinal diseases or are undergoing chemotherapy, Williamson said.

Officials think the outbreak was linked to one batch of feeding liquid produced at a Birmingham-area laboratory of Meds IV, and all of the contaminated supplement has been recalled.

“From what we know right now, it is a closed circle,” Williamson said.

The contamination came from products that had not been sterilized thoroughly, health officials said.

“These infections usually have a very rapid onset, within a matter of hours or days, so we think we have captured all the cases of contamination that have been related to this particular pharmacy,” said Dr. Alex Kallen, health officer with the Centers for Disease Control and Prevention.

Officials with Meds IV, which was formed last year and is based in Birmingham, did not respond to calls and messages. The company website says it provides sterile products to hospital pharmacies, surgery centers and doctor offices.

The product was exposed to contamination while in the compounding process in the pharmacy itself. The final usable product was not distributed outside of Alabama, Kallen said.

BIRMINGHAM, AL (WBRC) -

The investigation is continuing into an outbreak that caused the deaths of nine patients in Alabama hospitals.

The Alabama Department of Public Health and CDC officials are leading the efforts. The outbreak involves 19 patients in six hospitals in the state, five of which are in the Birmingham metro area.   The hospitals are Princeton Baptist Medical Center, Shelby Baptist Medical Center, Cooper Green Mercy Hospital, Medical West, Prattville Baptist Hospital and Select Specialty Hospital, a long-term acute care hospital that operates within Trinity Medical Center.

The patients affected all received intravenous nutritional supplements that contained a lethal bacteria.  

State Health Officer Don Williamson said the supplements were compounded by a Birmingham pharmacy called Meds IV and have been recalled.  All hospitals have since stopped using the supplements.

“We believe based on everything we understand at this point with the product being discontinued, and hospitals not using product, there is no longer a risk to anyone else,” said Williamson, “this does not represent an ongoing health threat.”

Infection Control Practitioners at Shelby Baptist Hospital started the investigation after they noticed an unusual number of patients with blood stream infections caused by a specific type of bacteria. Baptist Health System Chief Medical Officer Dr. Elizabeth Ennis said employees contacted state and federal health agencies, and were able to keep the situation from growing.

“I think the important thing about this situation is that the process worked in a quick fashion,” said Dr. Ennis. “The outbreak was identified in a quick fashion, it was contained and resolved by using processes and notification in place for public health surveillance.”

Investigators maintain the threat has been contained, and they don’t anticipate any additional cases.  Officials at all of the hospitals involved in the investigation said they are fully cooperating and patient safety is a top priority.

Copyright 2011 WBRC. All rights reserved.

Augusta Health was today named one of the nation’s 100 Top Hospitals® by Thomson Reuters, a leading provider of information and solutions to improve the cost and quality of healthcare.

The 100 hospitals on the list demonstrate high-quality patient outcomes while improving efficiency. The objective, independent research evaluated nearly 3000 hospitals on measures of overall organization performance, including patient care, operational efficiency and financial stability. Augusta Health is the only hospital in Virginia to be named a Top 100 Hospital this year.

“We are delighted to be recognized as one of the 100 Top Hospitals by Thomson Reuters. While this is an extraordinary honor, it is important to remember that this is not really about winning an award; it is about what this award recognizes,” said Stuart Crow, chairman of the Board of Directors of Augusta Health. “It’s about the care and effort that our medical staff, employees and volunteers have provided to our community.”

In addition to being named one of the 100 Top Hospitals, Augusta Health was one of six of the Top 100 hospitals to receive the Everest Award. The Everest Award honors hospitals that have the highest current performance and fastest long-term improvement over five years. The Everest Award winners represent a special group of the 100 Top Hospitals that have set national benchmarks on a balanced scorecard of performance indicators.

“I am in awe of the effort and dedication of our medical staff, employees, volunteers and Board of Directors. Their commitment to our patients and our community is clearly reflected in this award,” added Mary Mannix, FACHE, and CEO of Augusta Health. “I congratulate them all on earning this prestigious recognition. I could not be more proud to call them my colleagues.”

Thomson Reuters estimates that if all hospitals performed at the same level as the 100 Top Hospital award winners, nearly 116,000 additional patients would survive each year, more than 197,000 patient complications would be avoided annually and the expense per adjusted discharge would drop by $462. To recognize the best hospitals in the United States, Thomas Reuters analyses independent public data and objective research methods. Hospitals do not apply for this award and winners do not pay to market it.

Augusta Health is an independent, nonprofit community hospital whose mission is to promote the health and well-being of our community through access to excellent care. One of the 100 Top Hospitals in America, Augusta Health has also been nationally recognized by HealthGrades for clinical excellence and patient safety and received the Foster McGaw Prize for community service. Online at www.augustahealth.com.

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One patient nearly received a transfusion of the wrong kind of blood — a life-threatening mix up.

The cause? A bogus medical file that had been created by an identity thief. The criminal used the victim’s name to obtain medical care. The criminal’s blood type was recorded in the victim’s medical records, leading to the almost fatal mistake.

“It was a close call,” said Larry Ponemon, a nationally recognized authority on identity fraud. Researching medical identity theft, Ponemon found that case and another instance where medical identity theft had placed a victim’s health in jeopardy. The second patient nearly got an inappropriate and unneeded procedure.

Ponemon, chairman of the Traverse City, Mich.-based Ponemon Institute, a think tank, declined to provide the individuals’ names, nor the name or location of the health care system with the bad records, for privacy reasons.

“Those could have been deadly,” Ponemon said of the incidents.

Affecting an estimated 1.5 million Americans overall, according to estimates from Ponemon, medical identity theft poses a threat beyond the headaches associated with fixing financial fraud: The crime alters your medical records and can compromise your care.

Unlike financial ID theft — which can be flagged through credit bureaus — there is no central source for checking your medical records, according to the Federal Trade Commission, the federal consumer watchdog agency.

Medical providers say that federal law hamstrings ID theft victims from seeing files created in their name: That’s because medical records created about all patients — including identity thieves who use your name — are covered by privacy rules in the Health Insurance Portability and Accountability Act (HIPAA), according to Lawrence Hughes, assistant general counsel for the American Hospital Association.

“You must protect all persons’ information — whether it is a real patient or a patient that has committed a case of identity theft,” Hughes said.

For America’s victims of medical ID theft, there is no system to identify and correct the damage left by an impostor. In fact, a Scripps Howard News Service investigation finds:

Medical providers are refusing to give ID theft victims access to records, invoking the privacy rights of the thieves, according to victims, experts and hospital officials. The only way for this to change is for federal authorities to create explicit rules to help medical ID theft victims, some say.

Even when hospitals are alerted about erroneous medical files, they have no systematic way to fix the records, experts say.

The move toward networked electronic medical records — spurred by $19 billion from the 2009 economic recovery act — may amplify the threat that incorrect records spread “quickly and broadly,” according to a government-commissioned report.

For nearly five years, Joanna Saenz, of Denver, has tried to see the medical file created by an impostor at a Nebraska hospital. Saenz first learned of the medical care when a credit check revealed that the hospital, the Fremont Area Medical Center in Fremont, Neb., had billed her for a broken arm.

The suspected culprit was a woman who used Saenz’s identity for years, obtaining for credit cards, a driver’s license and other accounts, Saenz said. While living out this elaborate lie, the thief needed medical attention for a broken arm and, later, a pregnancy, Saenz said.

Saenz said she refuses to pay the impostor’s bills.

The hospital has no record of anyone trying to access Saenz’s file, according to a spokeswoman there.

“I am still trying to convince them to give me the records,” said Saenz, 27.

Saenz said she is staying away from the area — about 30 miles from Omaha — on fear that if she needs medical attention there, her records might be wrong.

There are many ways criminals engage in medical ID theft. Common schemes include organized rings that defraud insurance companies and Medicare.

One such ring, busted last October, stands accused of submitting false patient claims on thousands of Medicare beneficiaries to steal more than $163 million, according to the U.S. Department of Justice. The New York-based enterprise made money by using the identities of doctors and patients to submit false claims, according to an indictment.

Methamphetamine abusers also steal identities to access prescription drugs or insurance payouts, according to the Justice Department.

Thieves can gather medical information from a variety of places, including breaches from health care companies. Just last week California state authorities reported that Health Net Inc., an insurance company based in Woodland Hills, Calif., had lost personal information on 1.9 million current and past enrollees around the nation in January, and only now is making the breach public.

The risk of inaccurate medical records is mushrooming. As the medical industry replaces paper files with linked, electronic databases, the potential harm from inaccurate patient information will cascade, ID theft experts and data security analysts warn.

That’s because in the electronic world, incorrect medical records will have an ever-greater chance of making their way to the doctors seeing the identity victims.

“You have someone else’s medical history entangled in your medical records,” said Linda Foley, founder of the Identity Theft Resource Center in San Diego.

Unaddressed medical identity theft can also take a financial toll. It can drag down a credit score and victims may have a harder time getting private insurance, experts said.

Federal authorities have been alerted. Months before the February 2009 Recovery Act set aside $19 billion for electronic health records, a report commissioned by the U.S. Department of Health and Human Services warned that the move to computerized medical files could spread false records “quickly and broadly.”

Electronic record systems could move inaccurate files “across countless systems,” making it more difficult for victims to remove mistakes, consultancy Booz Allen Hamilton wrote in an Oct. 15, 2008 report.

But even when ID theft victims determine which hospitals have the doctored records, they frequently cannot view the files, experts and ID theft victims said. When an identity theft victim asks to see records created by thieves, hospitals frequently deny them, citing HIPAA. The law safeguards medical patient privacy — and hospitals have interpreted this to include ID thieves.

“There’s a very significant Catch-22 that has not been resolved here,” said Pam Dixon, executive director of the World Privacy Forum, a San Diego-area nonprofit that works with identity theft victims.

Both the U.S. Federal Trade Commission and Health and Human Services said that hospitals should give you access to the file created in your name. But those agencies acknowledge that medical providers sometimes deny ID theft victims access to the records.

Rick Kam, whose company helps hospitals respond to data breaches, said he knows why hospitals are not providing access to the records: They fear legal liability under HIPAA, said Kam, president of Portland, Ore.-based ID Experts.

What’s necessary is a new law creating a medical ID theft victim’s bill of rights, spelling out how a victim can access and correct the file and providing immunity for hospitals that do release the information, Kam said.

Even when hospitals grant access to the tainted records, they are not necessarily doing a good job fixing them, Ponemon said. His research has found that medical institutions have no consistent system for correcting the mistakes.

“There is not a set of standard procedures that we observed,” he said. “You are relying on the judgment of individuals, and that is not a good thing.”

A routine delivery at St. Luke’s The Woodlands Hospital costs Texas Medicaid twice as much as at Christus St. Catherine Hospital in Katy, just 50 miles away. The Harlingen Medical Center bills Medicaid nearly $5,500 less for a coronary bypass than does the Laredo Medical Center, though both hospitals are along the Texas-Mexico border. The disparity is the result of a payment formula that gives each Texas hospital its own rate. State health officials, seeking ways to curb Medicaid costs and address the concerns of hospitals on the lower end of the payment spectrum, have proposed a single base rate for all hospitals — with a variety of allowances for expensive-to-operate facilities.

Such a formula, they say, would save Texas, which faces an enormous budget shortfall, an estimated $74 million over the next two years — and up to $2.8 billion if lawmakers set the rate at the bare minimum.

Hospitals are divided on the proposed change. Some say an average rate is unworkable, because it cannot take into account all the hospital-specific factors that eat away at the bottom line. Almost all say the bare minimum rate would be catastrophic.

The rate “should stay hospital-specific, to give recognition to those hospitals offering a greater scope and level of service,” said Joel T. Allison, president and chief executive of the Baylor Health Care System, adding that Baylor University Medical Center in Dallas has to account for the costs of trauma and neonatal units, as well as transplant, oncology and graduate medical education programs.

Other hospitals support an average rate as long as lawmakers are thoughtful about the allowances and make some consideration for cost-of-living increases and capital expenses.

“It doesn’t seem reasonable to see huge differences within a geographic area,” said Ron J. Anderson, president and chief executive of Parkland Health Hospital System in Dallas, which, in addition to its trauma, burn and neonatal units, is a teaching hospital, has large volumes of charity patients who require social workers and translators, and is building a new hospital. “If they would take those things into account, along with some kind of reasonable wage index, this isn’t a bad reform.”

The current Medicaid payment system gives the largest average reimbursements to hospitals that have complex costs, the Tribune analysis shows, like those that predominantly treat children, teach medical residents or are trauma centers.

But it also rewards private suburban hospitals that perform fewer procedures with higher average payments. Medium-size hospitals in East Texas, West Texas and along the border tend to get lower average reimbursements, as do large county hospitals that have high volumes of patients.

Not including outliers — the expensive, complicated procedures that skew the data — the average appendectomy in the 2009 fiscal year cost Medicaid $2,200 at a hospital in El Paso versus $6,200 at a Houston children’s hospital. Having a pacemaker installed in Laredo cost $600, compared with $8,500 in Harris County’s nonprofit hospital system.

Prices even varied within the same hospital system. In the 2009 fiscal year, the average Caesarean section cost $4,300 at Texas Health Presbyterian Hospital Dallas and $2,400 at Texas Health Presbyterian Plano — which Stephen O’Brien, the system’s spokesman, said was because the Plano hospital had been “grossly underpaid by Medicaid for many years.”

The formula that Medicaid uses to reimburse Texas hospitals is convoluted. Every medical condition or procedure has its own “weight,” or relative value. That weight is multiplied by a hospital-specific rate called a Standard Dollar Amount, or S.D.A., which is determined by the state’s Health and Human Services Commission.

The S.D.A. takes into account all of a hospital’s costs, including the percent of uninsured patients and the salaries it pays. Even after all of that math, hospitals are not paid the full amount; Medicaid reimburses hospitals only at about 60 percent. State health officials say calculating a different S.D.A. for every hospital is a mathematical mess that does not reward efficiency or performance and leads to large disparities in reimbursements.

“It has become very obvious that there is a wide range in average costs for hospitals,” said Thomas M. Suehs, the commissioner of health and human services. “And we cannot explain it all.”

Mr. Suehs proposes setting the same S.D.A. for all Texas hospitals, then giving extra allowances to those that have high costs because of services they provide. Hospitals that have trauma and burn centers, specialize in cancer treatment, predominantly treat children or have many uninsured patients would most likely qualify for an increase, he said.

That would level the playing field for hospitals forced to run a lean, efficient operation, said Susan Turley, the chief financial officer at Doctors Hospital at Renaissance in Edinburg, where 80 percent of patients are covered by Medicaid or Medicare.

“Speaking as a taxpayer, why should I pay $2,000 for a surgery in South Texas and $7,000 for that same surgery in Dallas?” Ms. Turley asked. “Hospitals will be incentivized to provide efficient care. And those that already are won’t be penalized.”

eramshaw@texastribune.org