DC Medical Malpractice & Patient Safety Blog

When you walk into the lobby of Johns Hopkins Hospital in Baltimore, you can't help but notice all the signs informing you that Hopkins is ranked No. 1 hospital in the United States by U.S. News & World Report. Hopkins is justifiably proud of reaching that top spot year after year, but does it mean anything for patient safety and quality of care?

A new study in Annals of Internal Medicine finds that for the 50 top-ranked hospitals, there is little correlation between their U.S. News rank and any objective measures of quality of care. But when the authors crunched the numbers, they found the hospital's subjective reputation among doctors accounted for 90 to 100 percent of the hospital's overall U.S. News ranking. In other words, the word of mouth reputation of the hospital among doctors -- not among patients -- counts for a huge amount of the news magazine's popular ratings system.

In my book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, I discuss how to find the right hospital. The short answer is: It's not easy. But there are some simple steps. I would focus on the brand-name hospitals like Hopkins only if I had an exotic condition that very few doctors had ever seen. Here's a short excerpt of what I wrote about the U.S. News rankings, and what I think is a good alternative:

In its 20 years of rating hospitals, U.S. News has never asked a single patient what they think; its ratings of a hospital’s reputation in a particular specialty is based solely on what doctors in that specialty believe. But now Medicare has started requiring hospitals to have patients fill out a standardized survey when they leave the hospital, and the questions focus on a lot of issues that people care about and have a big impact on the quality and safety of their care, such as:

• Did the doctors and nurses always communicate well?
• Was the bathroom always clean?
• Was your pain always well-controlled?
• Was the area around your room always quiet at night?

Note that little word “always.” These are things patients have a right to expect – always.

You can find the results of the patient surveys on Medicare's Hospital Compare website by clicking here. You will find that many community hospitals do a better job than the mega-hospitals of taking care of patients in the ways that patients notice.

One chain that is quite good that I urge people to check out is called Planetree, which takes its name from the tree under which Hippocrates sat teaching medical students in ancient Greece. Planetree is dedicated to humanizing health care by making it “patient-centered.” Planetree has affiliated hospitals in 31 states; you can see a list at planetree.org.

A tragic death in Albany, New York proves the power of the civil justice system to spur safety improvements to prevent injury to other patients.

In settling out of court a lawsuit for the death of 32-year-old Diane McCabe, who bled to death after a Cesarean section delivery, the Albany Medical Center agreed to fund for the next 20 years a Diane McCabe Memorial Quality Lecture series focusing on enhancing patient safety. The settlement also requires the hospital to buy a maternal and neonatal simulator to be used in staff training on the labor and delivery unit and to change procedures on the use of a machine that monitors a patient's vital signs during childbirth.

The attorney for Ms. McCabe's family, John Powers, said:

"It was never about the money with the family. It came down to the non-monetary aspects involved with the settlement. They wanted to do something to make certain this doesn't happen to someone else and to create a memorial to Diane for the children as they grow up that they'll know that their mother is being remembered in this way."

Read more in the Albany Times Union here.

Unfortunately the medical industry continues to push for "reforms" that would curb the right of patients and their families to seek legal redress for tragic incidents of malpractice. The industry actually argues that hospitals would work harder to improve patient safety if they were freed from the risk of lawsuits when they fail to live up to their promises. Joanne Doroshow, the author of the Pop Tort blog, has a one word response to this notion: "Pul-leze!" Read more from her column here.

The Food and Drug Administration has canceled its policy of giving rubber-stamp approval to marketing of powerful new radiation therapy equipment like linear accelerators. From now on, the manufacturer of the machine is going to have to prove the equipment has proper safety checks to prevent dangerous overdoses of radiation to patients.

The New York Times ran a series in January 2010 that exposed some horrific tragedies that occurred, particularly when hospitals rushed into operation new and complicated equipment without thorough safety checks and training of technicians. The series also showed that the equipment often lacked simple fail-safe devices such as a way of preventing the machine from delivering a walloping overdose of radiation even if one had been inadvertently programmed by a technician.

But since the FDA only has power over manufacturers and not over hospitals themselves, it still will be possible for poorly trained technicians to cause errors that hurt patients by either delivering overdoses or underdoses of radiation.

In a follow-up article, the New York Times' Walt Bogdanich quotes Dr. Howard I. Amols, chief of clinical physics at Memorial Sloan-Kettering Cancer Center in New York, as saying the more serious problems stem from shortcomings in staffing, personnel competency and hospital quality assurance programs:

“I’d also caution that however commendable tougher standards for premarket approval of software may be, its not clear that F.D.A. has the expertise to police this,” Dr. Amols said. “In fact, I’m not sure anybody does. That’s one of the big problems with software. It comes down to a qualified user recognizing that something is amiss.”

While the government regulators are getting their act together, my advice for patients is to always make sure you get radiation therapy at only a leading center that has been doing it for a long time. Make sure the center employs licensed, certified technicians to operate the therapy machines. Don't be dazzled by the new smell and clean look of a spanking-new therapy center. That could be a sign that people aren't well trained yet to keep you safe.