Doctors and hospitals across the country push the frontiers of medical science every day, finding new ways to improve health care and to change and save lives. But at the same time, some of medicine’s basics—like delivering babies safely and protecting mothers’ well being—also keep getting botched, especially for poor and black women. It’s a national disgrace, and it’s on sad, terrible display in the growing scandal in Southeast Washington’s only full-service hospital, which recently was ordered to stop delivering babies.
Why? The Washington Post, which has done some good digging and needs to do more, says that health regulators for the District of Columbia have provided sketchy details to officials of United Medical Center, which serves the poor and predominantly African American residents of the neighborhoods east of the Anacostia River, as to why the public hospital’s obstetrics unit was shut down for 90 days.
The paper says United’s staff failed to properly care for a newborn to ensure the infant didn’t acquire HIV from the baby’s mother, who was infected and had a high viral load. The hospital didn’t test the baby properly for HIV, failed to deliver the child via cesarean to reduce the chances of HIV infection, and didn’t administer a recommended antiretroviral drug as a postpartum precaution.
In another case, the medical staff mishandled the monitoring and treatment of a morbidly obese, 35-week pregnant mother in severe respiratory distress and with a history of potentially fatal blood pressure problems.
United personnel also mishandled, in unspecified manner, the physical screening of another newborn.
District regulators provided no names or details of any of these incidents, and no information on what happened to the babies or mothers. They continue to insist that rigorous federal laws on patient privacy prevent them from such disclosures—not that they are concealing key information about the quality or safety or care at a troubled hospital.
But then, that’s what might you expect. In my practice, I see not only the huge harms that patients suffer while seeking medical services but also the concerted efforts that doctors, hospitals, and high-paid administrators go through to keep secret some significant problems in medical care.
Washingtonians, as local politicians have been howling, have both a right and a need to know exactly what’s going on inside United Medical Center, especially as to the safety, quality, and accessibility of care there. It is, among other matters, a multimillion-dollar taxpayer nightmare. The center long has been on shaky financial grounds, and has received substantial public support so it can keep providing care for a community that has been demanding and deserves better.
Federal officials, in fact, also have smacked the hospital and its operators for possible overbilling of Medicare, which, with Medicaid, represents a major source of revenue to an institution caring for the poor. Federal regulators fined United for lapses in a nursing facility that led to patients suffering skin infections and bed sores. Veritas, an outside, Washington firm, is getting millions in tax dollars to help turn the hospital around.
If you’re the sort who looks at situations like these and starts to think, well, this is a busy place that cares for some pretty sick and disadvantaged patients so … Sorry to disabuse the forgiving. The sorts of treatment that regulators say United staff failed to deliver is painfully familiar and must be routine:
Although the District has made huge strides, Washington persists in having one of the nation’s highest HIV-AIDS prevalence rates in the nation. Medical science has made huge advances in protecting newborns from maternal HIV infection, and the successful approaches have been widely disseminated. Meantime, black women face four times higher risk of death from pregnancy complications, especially from pre-eclampsia, a blood pressure-related condition, than do white women. Other cardiovascular challenges also take a greater toll on black versus white moms. These issues, too, are well known, and therapeutic approaches are readily available.
Washington is blessed with a wealth of medical and scientific expertise, and deep health care resources. Shouldn’t some alarms be sounding among top docs and administrators at these elite centers that they might want to pitch in or do more to ensure our city doesn’t get lumped in with impoverished capitals around the world, also with poor and lagging maternal care?
It’s a national shame, of course, that 700 to 900 American women die each year from pregnancy-related causes, and 65,000 nearly die. It’s frustrating and head-scratching that ProPublica, a Pulitzer Prize-winning investigative site, reports that a “nationwide survey [finds] that postpartum nurses often fail to warn mothers about potentially life-threatening complications, mainly because they need more education themselves.”
Can we look at ourselves in the mirror, or look into happy, healthy babies’ faces and know that separate, unequal, poor, and maybe even lethal care persists for a major chunk of mothers and children who live in America’s capital?