‘Superbug’ infection raises key questions about hospitals, data on causes of death

death-certificate-state-by-state-default-750_50California regulators have reversed themselves and decided to require hospitals to report outbreaks of “superbug” cases, rare infections that also can prove deadly. At the same time, officials in the Golden State haven’t moved to increase the information disclosed on death certificates−data that advocates suggest would give the public clearer outlines of just how severe a problem hospital-acquired infections have become.

Kudos to the Los Angeles Times, which delved in a recent front-page investigation into the dearth of information disclosed on death certificates, especially about hospital-acquired infections. The paper detailed how a Los Angeles area patient had contracted, while hospitalized, a rare carbapenem-resistant enterobacteriaceae or CRE infection. This superbug resists treatment with an array of antibiotics, eventually killing half those it afflicts. Its outbreaks are a huge concern for public health authorities.

But, The Los Angeles Times said, hospitals had cried “poor me” to the state, saying it required extensive resources to monitor and report CRE outbreaks. The death certificate for the patient with the CRE infection, the newspaper said, listed a perforated ulcer as her cause of death. Her family was outraged because they had urged Torrance Memorial Medical Center to report a CRE outbreak to the state.

California officials reacted to the story, saying such incidents should not occur again and must be reported to them. They said they will not disclose to the public the hospitals where they are occurring. Nursing homes also will be exempted from the reporting requirement.

As this case illustrated, health officials in California and across the nation have work to do on improving vital disclosures about causes of death, especially on that formal, final certificate. Physicians and hospitals now get too much leeway, the Los Angeles Times reported, to fill this data in as they see fit. They’re not always candid and transparent, effectively hiding critical information that could be valuable in lawsuits involving patient harm as well as leaving blanks in broader inquiries that would benefit the public.

I wrote recently how experts now estimate that medical error, including hospital acquired infections, may be the No. 3 killer in the country, claiming 250,000 lives annually. That research, in turn, led skeptics to caution whether medical errors were as lethal as proclaimed.

But the Los Angeles Times, in its reporting on hospital infections and death certificates, notes that many  mortality causes may be underestimated. It cites data from the federal Centers for Disease Control and Prevention estimating that 75,000 Americans die annually of hospital acquired infections. CDC officials, however, concede those numbers may be low, for example, because they may not include fatalities due to sepsis. As I have written, the CDC has declared a medical emergency about sepsis, the condition when the body reacts in overpowering fashion to infection. The agency says the sepsis toll, a quarter million Americans annually, may be as much as 140 percent higher, the Los Angeles Times reports. What percent and actual number of that bigger toll−600,000 deaths−might be hospital-acquired infections?

It’s difficult, of course, to determine the exact cause of death. But even the nonprofit group representing the nation’s records-keepers has called on politicians and policy-makers to improve the timeliness, detail, and accuracy in death certificates. That organization, as well as a prominent think tank, has said death certificates contain too many inaccuracies, some to prevent societal shaming of the dead (as was long the case when individuals died of HIV-AIDS, in suicides, or even at one time with cancers). But that has meant the nation may have been too slow to see the rise of opioid drug abuse and overdoses, persistent problems in drunk driving and car wrecks, and, of course, medical error or problems with other medications or devices.

Certainly many doctors and hospitals provide as much death information as they can and in well-intentioned fashion. But I have urged patients to secure their own records to protect their legal rights, and I have seen how important health-related records and documents have been mixed up or altered. Asking hospitals to concede error in death certificates may not be realistic, and better approaches are needed.

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