The Tampa Bay Times, formerly known as The St. Petersburg Times, deserves a shout-out for jumping on the local angle of The New York Times’s two-part expose on HCA, the nation’s largest hospital chain—and advancing the story. And complicating it, too.
Tampa’s contribution makes clear how important it is to report on the tensions between patient care and profits, and how difficult such reporting can be, too.
After the two New York Times articles, the Florida paper reached back into its own archives and recapped its coverage of HCA over the past decade. The first resulting story, on August 8, retold the tale of the suspensions of nine doctors in 2004 who the regional medical center Bayonet Point said had been performing unnecessary cardiac stent procedures. Unnecessary stents was also the nub of The New York Times’ s first piece. For that story the Florida reporters tried to contact the doctors, seven of whom still have privileges at Bayonet Point, but they could not be reached for comment. Only their lawyer provided a quote, saying they were still “devastated” by the suspensions.
But two days later. one doctor decided to talk after all. In the Florida paper’s second piece, which ran August 10, also in the A1 spot, he offered his version of events.
The result: the additional reporting in Florida raises some uncomfortable questions about the coverage of an increasingly thorny issues in medicine: What treatments are necessary and what treatments are just being done to generate bills. Sometimes the disputes about this pit doctors against hospitals, as seems to be the case here. And what’s the public to do when the answer is gray? How do we cover what we really don’t know when lives and health are at risk?
Tampa Bay Times health editor Charlotte Sutton dispatched reporter Kris Hundley to talk to Dr. Sudhir Agarwal, one of the nine suspended doctors (whose case was also described in the New York Times expose, which reported that Agarwal did not return its calls for comment).
When Hundley arrived for the interview in Agarwal’s office at the Medical Center of Trinity, in Trinity, FL, another HCA hospital, he told her that back in 2003 the doctors were putting more stents in patients because stents saved Medicare money. More stents, he said, meant fewer heart bypass surgeries—a more costly procedure. Agarwal added that during the suspensions, the number of bypass surgeries increased. Were the doctors doing cheaper procedures, but HCA wanted more expensive ones done? Was he simply covering his behind, or did HCA, with its history of aggressive pursuit of profits, prefer that its doctors perform more of the higher-cost procedure?
After Bayonet Point suspended the doctors in 2004, the hospital bought a two-page ad in the Tampa Bay paper reassuring the community that “patient care and safety have always been the number one priority.” Meanwhile, though, the suspended doctors continued to work at the hospital. They could not insert stents but, Hundley reported, “They could do diagnostic catheterizations, a technically demanding procedure.” Agarwal told her he was performing “caths” at the Bayonet hospital and at another HCA hospital the day after his suspension.
“If HCA thought he was so dangerous, why was he back there? To us this was a very big question, and HCA wouldn’t come to the phone to talk about it,” Sutton told me. “Are you really telling the whole story when two or three sides won’t talk to you? Where is the truth?” She answered her own question: “We don’t know.”
Sutton’s reporters checked the available public information about the doctors—Medicare rankings for hospitals, licensing and malpractice data, state disciplinary actions. Agarwal, she said, “was squeaky clean.”
But there is no 100 percent reliable rating system that advises patients if they really could benefit from a stent, or where to find a hospital that will do the right procedure if they need cardiac treatment—without regard to its bottom line. Such information would help patients—and journalists, too, who must sometimes report on whether a doctor gives good medical care or simply is a good revenue producer for a hospital. As the marketplace gods increasingly dictate the medical care we get, the press will be called on to figure all this out.
What’s the public to learn when we hit brick walls—when public data doesn’t really help, and when the medical-industrial complex believes that silence is the best policy?
UPDATE: On Sunday, the Tampa Bay Times published a story adding some light as well as another layer of complexity to the saga of HCA.
The paper examined insurance billing records and found Florida’s for-profit hospitals, as a group, perform nearly 50 percent more catheterizations and one-third more angioplasties than nonprofit hospitals on a per bed basis. HCA, which accounts for about half of the state’s for-profit hospitals that report invasive cardiac procedures, did more of them on average than other Florida for-profit facilities.
The story raised good questions: Are hospitals doing these procedures because patients demand them—patients who would rather undergo invasive procedures than try medicine, diet, and exercise? Are patients attracted via the heavy advertising that hospitals use to reel in patients for more profitable treatments? These go to a larger ongoing story—the mix of money and medicine, and we hope the Tampa Bay Times and others will stay on the beat.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.