Hurray for the St. Louis Post-Dispatch

For puncturing the secrecy around doctors’ mistakes

It’s not often that editors let their reporters detail the steps they took to report a story, but a wonderfully refreshing and candid piece appeared in the St. Louis Post-Dispatch yesterday and did just that. Investigative reporter Jeremy Kohler got a tip from several sources that a surgeon at DePaul Health Center in Bridgeton, Missouri, removed the wrong kidney from a patient in 2007. A pretty serious medical error ripe for a newspaper investigation, one might conclude. “You think it might be information that patients in need of a surgeon would be interested in knowing,” Kohler told his readers.

Ah, yes, they would—except Kohler couldn’t get any information about what happened, even though he tried every agency in his attempts to find out. The short, clipped chronology of his detective-like quest to learn more about the surgeon and his unfortunate patient should be required reading for journalists and the public interested in the topic of America’s epidemic of medical mistakes.

Kohler began his search at the Joint Commission, a private organization that accredits hospitals, which is not exactly known as a transparent or journalist-friendly source. The Joint Commission told him yes, there had been a “wrong-site” surgery at the hospital, but nothing more. Kohler then went to the Missouri Division of Insurance to search its malpractice database. Someone probably sued, he reasoned. Well, he found a case involving one wrong-site surgery that resulted in a $1.7 million settlement for the patient without having to file a lawsuit.

Next, Kohler went to the National Practitioner Data Bank, which tells about docs who paid malpractice claims or who were professionally disciplined. Too bad the data bank is only for practitioners, not the public. The public gets to see sanitized data, with names scrubbed out. Still, Kohler discovered one Missouri case that involved a surgeon in his fifties and his patient, also in his fifties, who was “significantly and permanently injured.” But he needed documentation.

Kohler hoped to find it at the Missouri Department of Health and Senior Services, which investigates hospital errors. Sure enough, he found a case involving a serious error in 2007 and other stuff about urologic surgery at DePaul. The records give no names, although Kohler learned that there were many problems involving urology at the hospital. Doctors were performing minimally invasive surgery without a record of proper credentials. That sort of thing. One doctor removed a patient’s diseased kidney without completing a proper medical history in advance. Instead, he wrote one up by hand on the day of the surgery. Was that the case Kohler was after?

If it was, the good regulators of Missouri wouldn’t say. Kohler turned to federal regulators, who explained that the report doesn’t reveal what went wrong with the surgery because the error was found to be the sole fault of the doctor. The feds referred the case to the Missouri Board of Professional Registration for the Healing Arts, which disciplines doctors. None of the board’s actions involve a doctor removing the wrong kidney. So much for doctor self-regulation! When he finally talked to the hospital, officials were mum. Kohler learned that the hospital could not even acknowledge such a mistake, because it would violate federal law on patient confidentiality.

So where does that leave the public? In the dark, it seems. Kohler’s story is super-important—and not only because it describes what reporters are up against with the agencies supposedly protecting the public and what families are up against when a loved one is maimed or killed by a doctor. It speaks to the broken medical system we have just spent the last two years debating, the supreme position of physicians, and the government and private regulatory structures in place that keep them on their pedestal. It also calls into question the usefulness some of the data that are available.

A Google search brings up a page giving some stats for DePaul Health Center. I learn that that 67 percent of patients would definitely recommend the hospital to family and friends; five percent probably or definitely would not. I clicked again on a link leading me to patient satisfaction survey results, and found that 69 percent of patients give the hospital their highest or a very high rating.

But what about the patient and his wrong-site kidney surgery? Families might be interested in what procedures led to the doctor’s error, and other troubles at the hospital. Kohler tells us, though, that is precisely what we cannot find out.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.