It was not surprising hospitals didn’t want to talk to the reporters. Only one of them did. Nor was it surprising that the reporters uncovered what they said were failures by the hospitals to report incidents, as state law requires them to do. The Sun’s reporters looked at the state’s regulatory efforts to pass a law intended to bring greater transparency to the problem of hospital mistakes. In 2002, Nevada passed a law requiring hospitals to report “sentinel events,” which the state defined as “unexpected incidents that cause serious physical injury or the risk thereof.” However, the numbers available to the public are reported only as state-wide aggregated data, not as hospital specific breakdowns—the result of a compromise between the industry and lawmakers.
Even though the paper reported that the compromise made the “information essentially meaningless to consumers,” it took the giant step of analyzing the data that existed, and guess what? Some hospitals may not be reporting all of their sentinel events as the law requires. Allen and Richards analyzed 1,363 incidents of statewide hospital-acquired harm in 2008 and 2009 that appeared to fit the state definition of sentinel events. Yet during that period, they found Nevada hospitals reported only 402 sentinel events. Hospitals reported only one sentinel event involving an advanced stage decubitus ulcer, a bedsore surrounded by dead flesh. The paper found seventy-two.
In part two, Allen and Richards zoomed in on hospital-acquired infections, a problem in almost every nook and cranny of the U.S. In 2008 and 2009, lethal, drug-resistant “super bugs” infected Las Vegas hospital patients more than 2000 times; 239 patients died, although the reporters could not tell from hospital billing records whether the infections played a role in patients’ deaths.
No health agency tracks these cases, and the paper pointed out that hospitals had scotched proposed legislation in 2009 that would have required them to publicly report cases of MRSA infections. In fact, Nevada’s state epidemiologist, Dr. Ihsan Azzam, did not know how many patients had contracted infections until the Sun told him.
I especially liked the context provided about a Nevada VA hospital that has a zero tolerance policy toward hospital infections. Each patient is swabbed at admission, and carriers are immediately isolated. Each test costs about $25, and the hospital says the test is cost effective. Las Vegas hospitals issued a statement to the paper, saying they screen only high-risk patients, claiming that it is “a cost-effective and efficient method to reduce the rate of MRSA in hospitals.” The paper pushed back, reporting that despite such policies, “the overall rate of infections at hospitals is rising.”
What makes the Sun series so powerful is its effective blend of personal stories, interpretation of how people relate to the numbers, sharp analysis of the data, and context—lots of context—about the failures of the state and federal regulatory processes, the power of a very powerful industry, and the clinical facts about the harm caused by the hospitals. The stories were long enough for readers to understand what may happen to them, but they did not overwhelm, as some kinds of these investigations do. Neither were they typical of the all-too-brief health stories that settle for the standard formula: a lede anecdote, a few graphs of data, a rebuttal from the medical stakeholder, and a weak kicker.
Perhaps the industry’s refusal to talk actually made the story stronger. The facts and the reporting stood on their own without dilution by a PR quote from some hospital official. The paper also made creative use of multimedia, like posting reader stories and audio from voicemails, so others could hear for themselves the anguish that patients experience.
At the end of part one, the Sun urged others in the media to follow its lead. “The Sun’s investigation can be replicated, imposing a new era of transparency within the hospital industry,” Allen and Richards wrote. Allen told me the paper got a ton of response to the stories, including a state investigation and two new laws proposed. “This is incredibly encouraging,” he said. “We’re shifting the political power structure by exposing these things.”
That is exactly what journalism is supposed to do.