The medical beat is so rich with documents and data that it can be hard to sort through everything. This is my humble attempt to break down the most useful sources for records to give your stories heft. Every source has its good and bad sides, and I've attempted to explain those below. Some records are available online. Many of the most useful records, such as coroner's reports, require you to leave the office.
I've broken the sources into two categories: research and regulation. I've cited examples of stories that used the records in question and included some first-hand testimonials from reporters. As you'll see, it doesn't take a year to dig for medical dirt. Some of these stories were turned around in one day. You'll find that once you develop the habit of checking these places, your story list will grow stronger. Let me know what you find!
RESEARCH
SOURCE: Scientific journals http://www.ncbi.nlm.nih.gov/entrez
WHAT THEY DO: Publish studies and essays by physicians and researchers.
WHAT THEY DO NOT DO: Make it crystal clear in all cases who funded the study or how the study relates to previous work.
RECORDS: Hospitals and doctors may claim to be experts, but what do their colleagues think about their work? Anyone can speak at a conference. Getting published in a journal that is reviewed by that doctor's peers is a higher hurdle. There are myriad highly specialized journals. Most are found at the National Library of Medicine's Web site, also known as PubMed. Often only a summary of the work is available. Use your outlet's library or your local library network, which can find the article for you and have it emailed to you. It may be faster to ask the authors themselves or the journals for a copy.
DRAWBACKS: Not all studies are created equal. The best studies are double-blind, placebo-controlled and randomized with a large number of participants throughout the country or world. Be wary of studies of a few dozen people in one shopping mall in eastern Montana. Always try to find out who funded the study. If a drug or device company paid for a study that makes a product look good, it doesn't mean the study is bad. It should make you push hard for sources outside that company's sphere of influence for a balanced look at the results. Find out what other types of research the authors have done in the past. Don't assume the first person listed as a study's author did most of the work. Often the lead author's name was used to get the paper published while the grunt, whose research methods may not be as solid, is second or third in line.
SUGGESTION: Ask for the resume of the medical director at one of your largest hospitals. If that person lists publications, track them down, and talk to a few of their co-investigators. You might find that the work doesn't exist or that the medical director was merely a college student making coffee for the other researchers. Remember, research is often incremental, so be cautious about repeating in your story claims of "breakthroughs" or "cures" without a lot of further research Check the references cited by the doctor. Contact those researchers to ask them about the work. You might find that there are gaps in the research that weren't obvious.
EXAMPLE: In 2002, Dr. David Ho made a splash when he announced that he had found a group of proteins that might block the HIV virus. Ho had a considerable amount of credibility in the research world and had been named Time magazine's "man of the year" in 1996 because of his groundbreaking AIDS research. http://www.time.com/time/magazine/article/0,9171,985762,00.html
But there were also doubts about what he had found. Other researchers pointed to potential problems in his methodology. http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=13716
Then, in January 2004, Ho admitted that his sample had been contaminated and part of his study was retracted by the journal. http://query.nytimes.com/gst/fullpage.html?res=9D05EFD81139F930A15752C0A9629C8B63
SOURCE: The Drug Industry Document Archive http://dida.library.ucsf.edu/
WHAT IT DOES: Posts documents in a searchable format from decades of pharmaceutical industry litigation and Congressional inquiries.
WHAT IT DOES NOT DO: Include every drug company.
RECORDS: The University of California San Francisco provides free access to more than 2,500 records. Most reporters will never have seen documents that provide this level of detail about the way pharmaceutical companies use scientific journals as marketing. The documents include internal memos, depositions, calendars and emails from drug companies and their affiliates, like the medical communications companies they hire to ghostwrite journal articles and find researchers to sign their names to them. The documents have been coded to allow for a nearly perfect full text search, meaning you can find doctor's names, company names, drug names, etc.
DRAWBACKS: The files are limited to cases that have become public in some way. You are seeing a window into a company that was opened by a conflict, and what you see should be judged accordingly. Just because an executive at a company sounds like an insane tyrant in one email doesn't mean that is a fair representation of how they run the company. All drug companies have been involved in lawsuits, but not all lawsuit archives have been given to DIDA. Some drug companies are left out entirely.
SUGGESTION: Pick a school in your area. Search in DIDA for the school name or for faculty members at the school. Find out how much of their research has been done with the help of ghostwriters and/or the medical industry.
EXAMPLE: In August 2009, Meg Kissinger and John Fauber at the Milwaukee Journal-Sentinel showed that Wyeth had funded the writing of journal papers that were then signed by researchers at the University of Wisconsin. They wrote: "The articles came shortly before a long-term $1.5 million arrangement between Wyeth and UW to educate doctors and patients around the country about hormone therapy. The initiative promoted the benefits and softened the risks of drugs that produced sales of more than $1 billion a year."
http://www.jsonline.com/features/health/53315032.html
SOURCE: The Cochrane Library http://www.cochrane.org
WHAT IT DOES: Collects medical and scientific research. Performs massive reviews of the available literature to weigh the evidence. These reviews usually include a "plain language summary" to help you understand the importance of the findings.
WHAT IT DOES NOT DO: The Cochrane research panel will leave out research it deems flawed or too small in scope. This can be a good way for you to weed out weak research, but you should make sure you understand the exclusion criteria.
RECORDS: Confused by all the seeming conflicts between studies of things like cholesterol and mammograms? The Cochrane Library gives you a great way to search meta-analyses that encompass decades of research. It can be a useful tool for broader understanding. You can read the summaries of the findings for free, and you can get the full documents for a subscription fee. You can search the entire site or you can click on the library link just to search for the meta-analyses. If you are a member of the Association of Health Care Journalists, you can get free access to all of the records.
DRAWBACKS: Questions sometimes arise on whether conclusions can be drawn from studies that have different methodologies.
SUGGESTION: The next time you see a report about a "breakthrough," plug the type of treatment or condition into the Cochrane Library search engine. That's a quick way for you to become familiar with the breadth of the science out there and know which questions to ask the researchers touting the latest advance.
EXAMPLE: In July 2008, reporters around the world saw the power of the Cochrane Library when it released the results of its review on breast self-exams and found that they don't do a good job of detecting cancer. A lot of reporters at the time wrote a "just another study" story and pooh-poohed the results, but Sharon Begley of Newsweek gave the review the weight it deserved while discussing the raging debate around self-exams in a short, impactful post.
http://www.blog.newsweek.com/blogs/labnotes/archive/2008/07/15/breast-s…
TESTIMONIAL: Begley looks at the Cochrane reports regularly and uses them to get away from the study vs. study type of reporting that can confuse readers.
"I have long had great respect for them, partly as a reaction against what I see as reporters' continuing tendency to do study-of-the-week stories with no clue or indication to readers as to whether the latest finding is in accord with the weight of evidence or not," Begley said. "As we all know by now, individual studies can be skewed every which way, and although analyses like Cochrane's--and meta-analyses in general--are not foolproof, they're pretty damn good."
Begley had written about breast self-exams while at The Wall Street Journal, and so the study resonated with her.
She wishes the library were simpler to navigate and that the underlying research for the meta-analyses was always available without paying a fee. She suggested that if more reporters asked the Cochrane for access Cochrane might comply.
SOURCE: The state office of health planning/finance/statistics
WHAT IT DOES: Gathers financial and patient care data from hospitals.
WHAT IT DOES NOT DO: Adjust the data to allow you to easily compare small hospitals to large, city hospitals to suburban, acute care hospitals to specialty hospitals.
RECORDS: Patient discharge data. The data include what patients came in for, how they were treated and where they went after they left (i.e. to another hospital, home or to a funeral parlor.) They do not include patient names or doctor names. The only patient identifiers are ages and the month and year the patients were admitted. It also includes the "Expected Source of Payment:" public assistance, private insurance, workers' compensation, etc. You can compare mortality and morbidity data. You can find out where hospitals are making their money (or losing it.) If a hospital boasts of having a "breast cancer center" or a "diabetes center," you can see how frequently the hospital has cared for those types of patients. Creating these "centers" is often just a way to bring in more revenue not evidence of excellence. In California, check with the Office of Statewide Health Planning and Development (OSHPD). http://www.oshpd.cahwnet.gov.
The agency has several layers of hospital quality data here:
http://www.oshpd.cahwnet.gov/HID/DataFlow/HospQuality.html
And it offers multiple financial data sets here:
http://www.oshpd.cahwnet.gov/HID/DataFlow/HospFinancial.html
DRAWBACKS: It helps to have at least basic database skills when trying to pull together tables from different hospitals or different diagnostic groups. But even if you just paste these tables into a spreadsheet you'll be able to see basic trends. Some of the quality data is out of date. Any hospital that had a high mortality rate in the past is going to tell you that it has improved. As it stands, though, you have no way of knowing if they're telling the truth.
SUGGESTION: Take a hospital in your area. Ask them where they think they excel or see what they're using in their marketing materials. Then go to the discharge data and count how often they perform procedures in this area compared to other hospitals or the statewide average. Look at patient deaths. Even though that number might come with caveats, it could give you a good indicator if it is much higher (or lower) than the average. Make sure you run any data by the hospital and outside experts. They may say something is incorrect, even though they submitted the data. Ask about inconsistencies.
EXAMPLE: When I was at The Orange County Register in 2003, we put together a comprehensive report card on all local hospitals, making heavy use of patient discharge data to show differences in mortality and morbidity rates.
http://www.ocregister.com/news/hospitals-2605-report-card.html
SOURCE: U.S. Department of Health and Human Services' Hospital Compare www.hospitalcompare.hhs.gov/
WHAT IT DOES: Pull together data based on self-reporting in four areas.
WHAT IT DOES NOT DO: Cover the same broad range of as the discharge data.
RECORDS: Hospitals voluntarily provide data on the care they provide patients in four areas: heart attacks, heart failure, pneumonia and preventing surgical infections. Hospital data are updated quarterly. You can download data for all hospitals in your region and find the best and worst.
DRAWBACKS: These are process measures and not outcome measures. They do not tell you whether a hospital had more deaths than expected in these four areas. Rather the data will tell you whether hospitals administered appropriate medications to patients and whether they provided proper discharge instructions, among other things. They'll tell you whether heart patients were given aspirin upon admission but not how many heart attack patients died. Not all hospitals provide data, and sometimes small patient loads make the data meaningless.
SUGGESTION: Check the site once every six months to see how your hospitals are stacking up, and keep a spreadsheet of their scores over time. If one starts to pull ahead of the pack or fall behind, you could have an interesting story.
EXAMPLE: Don Finley at the San Antonio Express used the Hospital Compare site for an innovative feature he wrote about hospitals being bad neighbors.
http://www.mysanantonio.com/health/Hospital_hopes_stoplights_signal_end_of_noisy_nights.html
SOURCE: Dartmouth Atlas of Health Care www.dartmouthatlas.org/
WHAT IT DOES: This report looks at health care nationwide and shows that the kind, amount and cost of health care can vary dramatically across regions.
WHAT IT DOES NOT DO: Evaluate hospital quality.
RECORDS: You can use this site to see if your area has any unusual medical practices. This site is especially useful if you cover one hospital in a large area. The Atlas team released data on individual California hospitals and how they treat patients with chronic illnesses and at the end of life. It found that hospitals in Los Angeles spent far more than hospitals in other parts of the state and provided more treatments for patients during their dying days. Dartmouth research has shown that more care doesn't necessarily matter. Patients that get more care have a slightly higher death rate. The best part is that you can download all the results into Excel and analyze them any way you want.
DRAWBACKS: There is a little bit of data overload here. If you've never looked at Medicare spending data before, it can be unclear which Medicare numbers mean what. And it makes you pick each hospital individually when comparing them, and that can be cumbersome. Fortunately, Consumer Reports has done a lot of the work for you. www.consumerreports.org/health/doctors-and-hospitals/hospital-home.htm
SUGGESTION: Try a few categories, comparing one hospital against others in the region and then others across the country, or an entire region versus another region in another part of the county. See if there are any strong variations. Talk to health care experts about what that might mean. To talk directly to Dartmouth, call Roland Adams at (603) 646-3661 or roland.adams@dartmouth.edu.
EXAMPLES: In May 2008, the San Francisco Chronicle compared northern and southern California hospitals using the Consumer Reports data.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/05/30/BUPM10US9F.DTL
It's rare that you can know with certainty what the most powerful person in the world reads with his Cheerios, but during the beginning of the health reform debate, multiple news stories reported that President Barack Obama had read and then asked his staff to read Atul Gawande's piece in The New Yorker that used Dartmouth Atlas research to explore the wide variation in health utilization nationwide.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
SOURCE: State district courts
WHAT IT DOES: Provide reporters with a rich source of medical records, sworn testimony from doctors and hospital officials and, sometimes, photos, audio and video.
WHAT IT DOES NOT DO: Distinguish between sound lawsuits and frivolous ones.
RECORDS: Start with a Nexis search for the hospital, the doctors in question and doctors groups, but don't assume that Nexis gave you everything. If you're lucky enough to live in an area like LA, where most of the court records are online, you can go straight to the court's Web site. Go to the courthouse and check on that computer system, too. When you get the files, look for patient names, addresses and phone numbers. Look for other doctors who can provide more information. They are often included as expert witnesses or co-defendants. Look for patterns of behavior. Is this doctor being repeatedly accused of misreading X-rays? Does she seem to have an unusual number of patients claiming she seduced them and stole their money?
DRAWBACKS: Lawsuits are not reason alone to write off a doctor. Check with the different medical societies to find out the average number of suits. For example, ob/gyns are sued about three times in their career.
SUGGESTION: Even if a case has been dismissed by the court, settled or the records destroyed, check with the attorneys for both sides. They likely are holding on to records that could be valuable.
EXAMPLE: In July 2008, Patricia Wen at The Boston Globe made good use of court records in documenting a serious child abuse case that local authorities had missed.
SOURCE: Federal bankruptcy court http://pacer.casb.uscourts.gov
WHAT IT DOES: Gets you inside the finances of a local medical institution with amazing detail.
WHAT IT DOES NOT DO: Hold your hand while you're trying to make sense of literally mountains of financial statements and other data.
RESOURCES: These can be a gold mine of info about topics well beyond the scope of the bankruptcy. Look for hospital suppliers that went bankrupt. Doctor groups. Nursing homes. Often the same players who sent one entity down the tubes are involved in a new venture. Look first for the statement of claims. Talk to some of the people who are owed the biggest amounts of money. Entire medical histories are often are filed, including patient names. Many of the records are online. Ask the attorneys for their records, too. Where's your nearest bankruptcy court? www.uscourts.gov/courtlinks/
DRAWBACKS: Too much information. You will want to have some good sources inside the target organization to help you navigate these records. You have to register and pay just to look at the records, but it still beats flying to the city.
SUGGESTION: When a group of investors is talking about buying a hospital or a doctor group, check to see what has happened to their earlier ventures. Always check aliases and alternate spellings.
EXAMPLE: Bob LaMendola at The Sun-Sentinel wrote an excellent piece about uninsured doctors in July 2008 that used bankruptcy records to provide key details.
www.sun-sentinel.com/business/custom/consumer/sfl-flrxdocs0727sbjul27,0,1966484.story
TESTIMONIAL: LaMendola said he turned to the bankruptcy records after hearing from sources that there might be good material there. He found everything he needed electronically.
"To be honest, I never left the building to check the bankruptcy records. I used PACER solely," LaMendola said.
He was able to download the actual filings and find out which debts remained unpaid.
"I tried getting fancy by searching the PACER system trying to identify bankrupt doctors, but that went nowhere," LaMendola said. "That would be a nice feature, to be able to search by profession or type of business. In the end, I had to just do it the old way and ask experts and lawyers."
SOURCE: HealthGrades Inc. http://www.healthgrades.com/
WHAT IT DOES: Ranks hospitals in various categories, from women's health services to coronary bypass surgery. The site uses a five-star system (with five being the best) to rank hospitals, but hospitals can only earn one, three or five stars. It also provides pricing data.
WHAT IT DOES NOT DO: Provide an overall assessment of the hospital's performance.
DRAWBACKS: Some of the data the company uses to arrive at its rankings are up to four years old. A review by a Yale University professor found that while hospitals rated highly by Health Grades performed better, on the whole, than lower-rated hospitals, ratings on individual hospitals were often misleading.
SUGGESTION: Use it as another indicator of hospital quality, particularly if your local hospital treats a lot of Medicare patients. You can reach HealthGrades vice president Scott Shapiro at (720) 963-6584 or sshapiro@healthgrades.com.
EXAMPLE: Several reporters have looked into HealthGrades and written insightful pieces about how hospitals pay HealthGrades to use their information as promotion and what the weaknesses of the data are. Aliza Marcus at Bloomberg in September 2009 used Health Grades to help provide context for a surprising story about mining companies providing their employees with top notch health care.
http://www.bloomberg.com/apps/news?pid=20601109&refer=home&sid=atHEjVNWVXow
REGULATION
SOURCE: The state medical board
WHAT IT DOES: Licenses and disciplines state medical doctors.
WHAT IT DOES NOT DO: Actively police doctors. Also, the board only regulates medical doctors, not osteopaths or other health professionals.
RECORDS: Even if you are talking to a doctor for a story about free flu shots, you should check with your medical board to make sure he or she is, indeed, licensed.
In California, go to www.medbd.ca.gov for MDs. Also try the Osteopathic Medical Board of California www.ombc.ca.gov.
For other states, go to the Federation of State Medical Boards. www.fsmb.org/directory_smb.html. You might also try the National Organization for State Medical & Osteopathic Board Executive Directors. It has a halfway workable search function that lets you cover many smaller states. And it has links to the medical boards of the rest of the states. www.docboard.org/docfinder.html. These same boards will also have disciplinary records, which have varying degrees of detail depending on your state. In California, many of the records are posted online. But it's always good to request the full file. The records will give you details not only about that specific case but also about how medicine is practiced at hospitals.
DRAWBACKS: The boards will not give you names of patients, but you can deduce the names with a little gumshoe. They often use initials that match plaintiffs who have sued. Don't assume that because the discipline is light the offense must have been inconsequential. These doctors often have good lawyers and plea bargain so their records remain unblemished. Remember, too, that doctors make mistakes. Being accused of botching one surgery doesn't mean a doctor is incompetent. One of the most common charges is just that, "incompetence," and it typically requires more than one mistake for a conviction.
SUGGESTION: Look for patterns. If this doctor has been in and out of drug rehab and has injured five patients, you might not only have a story about the doctor but about the hospitals that failed to stop him.
EXAMPLE: Rong-Gong Lin II at the Los Angeles Times did this while reporting a story prompted by the death of rapper Kanye West's mom during plastic surgery.
http://articles.latimes.com/2008/may/26/local/me-plastic26
TESTIMONIAL: Lin covered the West story from the beginning and started wondering about why Dr. Jan Adams had been allowed to practice so long with so many lawsuits and other accusations of bad practices.
"The medical board's disciplinary records were extremely useful and detailed in talking about the doctor's records," Lin said.
He read through all of the records related to Adams and thought something seemed amiss.
"From a lay person's point of view, it seemed like it took a long time for Adams to be disciplined on this issue, considering his history of driving under the influence. So it seemed natural to figure out how Adams' disciplinary record compared to his peers," Lin said.
"When we found that it took more than 900 days per case to resolve each case, that seemed like a compelling figure to use as the point of the story."
There were some records that remained off limits, though.
"It would have been helpful to have known whether Dr. Adams was in the diversion program, but the state deems that information confidential."
SOURCE: Other health profession boards
WHAT THEY DO: License and discipline nurses, chiropractors, counselors, dentists, podiatrists, pharmacists, etc.
WHAT THEY DO NOT DO: Actively monitor these professions. Instead, they usually respond to complaints.
RECORDS: Nearly every piece of the healthcare profession has a licensing board attached to it. Even hearing aid dispensers have their own state licensing branch. (If you do a hard hitting story about hearing aid dispensers, I will buy you lunch.)
Links to all California boards can be found listed under the Department of Consumer Affairs: www.dca.ca.gov/about_dca/profession.shtml
Here are a few links where you can find national compilations of boards in other states:
Nurses: https://www.ncsbn.org/515.htm
Chiropractors: www.fclb.org/boards.htm
Physical therapists: https://www.fsbpt.org/LicensingAuthorities/index.asp
Dentists: www.dentalwatch.org/org/boards.html
DRAWBACKS: These boards are not used to being asked for records because so few reporters pay attention to them. Don't let them dissuade you. Tell them that the records are public and that you want prompt access to them.
SUGGESTION: All of these health professionals may claim to be more than their degree implies. Dentists try to do extensive oral surgery without the training. Chiropractors prescribe drugs. Nursing assistants claim to be full-fledged RNs. Look at the initials people are putting behind their names on business cards, signs outside their doors, Web sites. Find out what the initials stand for and contact the relevant boards to find out whether they are licensed in that area and whether they have any discipline on their records. These lesser known boards are so underfunded, for the most part, that they themselves are ripe for stories. Dentistry, for example, is an area where professionals are almost never disciplined. So if you get calls from someone about a particular dentist or think that some of those ads on the sides of buses for "snow white teeth in 30 seconds" seem fishy, look for lawsuits against the dentist and his practice and then find out why the board hasn't done anything.
EXAMPLE: Steve Twedt at the Pittsburgh Post-Gazette started reporting in 2004 about an unlicensed midwife who was implicated in a baby's death.
http://www.postgazette.com/pg/04156/326816-85.stm
SOURCE: Medical specialty boards
WHAT THEY DO: Certify doctors in a wide variety of sub-categories: Cardiology, anesthesiology, orthopedics, etc. They require doctors to undergo a specific amount of training and then require them to pass an exam, known as "the board." Most of them also require doctors to maintain their level of skill by taking exams at certain intervals.
WHAT THEY DON'T DO: Force older doctors who earned their certification before the renewal rules went into effect to keep up their skills. Regularly discipline doctors. Go after doctors who are claiming to be certified when they are not. Remember, these are not government agencies. They are run by the doctors, which brings with it all the problems associated with self-policing.
RECORDS: If a doctor says he is a specialist or if a hospital hypes its expertise, check with the group that governs the specialty. Not all of them make their records public. A good first stop is the American Board of Medical Specialties (http://www.abms.org/) Also, go to the individual board and ask them whether the doctor is certified and what is required for certification. ABMS sometimes lags behind the actual board in updating its information. More than 80 percent of specialists have their certification and in some areas, like anesthesiology, the number is closer to 100 percent.
DRAWBACKS: A doctor doesn't always have to be board-certified to diagnose and treat patients in a particular area. Doctors who are foreign trained may have undergone a similar level of certification outside the U.S., although many retrain here and take the boards. If doctors can persuade a hospital to give them privileges, they can do the work. But if you find a hospital or medical group has an inordinate number of doctors working outside their specialties, it could be cause for concern.
SUGGESTION: Put together a list of all the directors of the various divisions at your local hospitals and then check to see how many of them are certified in their specialties. Remember, too, that there's a difference between being a "fellow" in a specialty or a "diplomate" and actually being board-certified. Some specialty groups are really just professional organizations that elect members to these positions. Those designations are not necessarily validation of the doctors' skills.
EXAMPLE: In 2003, Chuck Philips at the Los Angeles Times wrote a comprehensive piece about the doctor who had been overprescribing painkillers to Ozzy Osbourne. One of his key findings was that the doctor was claiming to be an addiction specialist but was not certified as such.
http://www.smh.com.au/articles/2003/12/07/1070732072719.html?from=storyrhs
SOURCE: The state health department
WHAT IT DOES: Licenses and inspects public and private hospitals and nursing homes; investigates complaints involving deficiencies of safety and health standards.
WHAT IT DOES NOT DO: Reveal the names of doctors, nurses or patients involved.
RECORDS: State inspectors do both full institutional reviews and narrow investigations based on complaints. They write up reports, or statements of deficiencies, that cover everything from nursing shortages and broken chairs to negligent deaths. In California, the forms are called 2567 forms. A review of several years can show patterns of medication errors or nursing lapses etc. or highlight one horrific case. By law, the hospital or nursing home must make these inspection reports available, but it is often easier to get them from the agency. The form is divided in half. On the left are the things the inspectors found wrong. Once an inspection is complete, the hospital or nursing home is given a report. The institution then files a "plan of correction," which often is as interesting as the inspection findings. That plan is on the right of the document. Make sure the copy you get includes the hospital's response. The inspection reports are generally kept in regional offices by the name of the institution. You can look through them there (and make copies with your personal copier) or request a specific report by hospital and date. Also, if you find a report that interests you, file a request for the back-up investigative notes, an often blunt and detailed account of what went wrong.
You can see recently posted 2567 forms and other hospital inspection records here:
http://www.cdph.ca.gov/certlic/facilities/Documents/Forms/AllItems.aspx
You can review administrative penalties by county here:
http://www.cdph.ca.gov/certlic/facilities/Pages/Counties.aspx
For older records, find your regional state health department office in California here:
www.cdph.ca.gov/certlic/facilities/Pages/LCDistrictOffices.aspx
DRAWBACKS: State inspectors don't distinguish between citations that involve patient deaths and those in which no one was injured. In fact, if a patient dies, these reports sometimes irritatingly leave it out. Because fines are not levied, it can be hard to determine if a particular citation is worth reporting.
SUGGESTION: Make an arrangement with your local health department to receive copies of all inspection reports quarterly.
EXAMPLE: Tammy Worth at the Los Angeles Times in September 2009 wrote an insightful piece detailing the problems in trying to find out information on nursing homes and talking about 2567s.
http://www.latimes.com/features/health/la-he-nursing-homes28-2009sep28,0,5321203.story
SOURCE: U.S. Internal Revenue Service www.irs.gov
WHAT IT DOES: Gathers financial reports from nonprofit hospitals.
WHAT IT DOES NOT DO: Dictate how much they can make or spend.
RECORDS: Form 990s. These can give you a detailed breakdown of hospital costs and revenues. They also will show you who the top paid executives are. They are self-reported, and some hospitals are more forthcoming than others. The IRS can give you 990s going back several decades. The quickest source for current 990s is Guidestar, a nonprofit Web site. http://www2.guidestar.org/. Also, the hospitals themselves are supposed to provide them upon request.
DRAWBACKS: The information can sometimes lag more than two years.
SUGGESTION: Look at the executive salaries at nonprofit hospitals in your area and then compare them to similar-sized hospitals in areas with similar property values/business climates. Don't be fooled by the, "We have to pay more or else these executives will leave to make millions in the for-profit sector" argument. If they could make millions, and they wanted to make millions, they already would have left.
EXAMPLE: In July 2008, Bill Donovan at the Gallup Independent in New Mexico detailed a local hospital's record profits using its 990 form.
http://www.gallupindependent.com/2008/07july/071508rmch.html
SOURCE: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/
WHAT IT DOES: CMS certifies that hospitals and nursing homes meet standards to receive Medicare and Medicaid funding. Typically, it uses state health inspectors to investigate more substantive complaints. It also investigates whether hospitals illegally dump uninsured emergency room patients on other hospitals before they're stabilized. These are called EMTALA violations, named after the Emergency Medical Treatment & Labor Act. If CMS finds a hospital out of compliance, it can threaten to withhold funding -but that almost never happens.
WHAT IT DOES NOT DO: Examine the care provided by doctors.
RECORDS: Inspection reports similar to state reports. Reports of EMTALA violations. Threats to cut off Medicare funding. You'll typically need to file a Freedom of Information request to the regional office that encompasses your facility. The state regional offices also often have copies. If a hospital has been fined for patient dumping, that information can be found at the HHS Office of Inspector General: http://oig.hhs.gov/fraud/enforcement/cmp/patient_dumping.asp
DRAWBACKS: CMS inspections are rare and often are done in conjunction with the state inspections. Sometimes the state will investigate violations of its own EMTALA laws at the same time it investigates federal EMTALA violations. Don't double count.
SUGGESTION: Once a year, put in a request for all EMTALA violations and look for patterns. Does one particular hospital stand out? Is patient dumping on the rise?
EXAMPLE: When Phil Galewitz was at the Palm Beach Post, he wrote numerous articles about hospitals caught dumping patients on other hospitals. He wrote a well documented story about St. Mary's Medical Center in 2004.
TESTIMONIAL: Galewitz, a veteran healthcare reporter now working for Kaiser Health News, has made patient dumping a regular part of his beat.
"Patient dumping has been a big issue in Palm Beach for the past five years as hospitals here struggle to get specialists to cover their ERs," Galewitz said.
Galewitz got a tip in 2004 about a patient dumping case involving St. Mary's Medical Center in West Palm Beach. He followed it up by contacting the state, which does the EMTALA investigations on behalf of the federal government.
"The inspection documents were usually quite detailed, though they do not include any patient names because the state redacts the names," Galewitz said. "You don't just want to get the inspection reports but any correspondence between the state agency and the hospital."
To get the actual warning letters that CMS sends the hospitals and the fines that they give them later, you probably will have to go through CMS, though. Here's the catch: "I found going through CMS quite difficult and time consuming. You basically have to call their regional FOIA person almost everyday to get documents."
Now, Galewitz makes it a habit to collect hospital inspection reports from the state at least every four months.
SOURCE: Joint Commission on Accreditation of Healthcare Organizations www.jcaho.org
WHAT IT DOES: The commission is an independent, nonprofit, peer-review organization. If a hospital is accredited by JCAHO, it automatically is eligible for Medicare funding. Every three years, JCAHO does a routine inspection of participating hospitals to ensure they meet the standards required for accreditation.
WHAT IT DOES NOT DO: Like the CMS Hospital Compare program, JCAHO is very process driven and doesn't spend much time looking at hospital quality trends, staff qualifications, patient deaths, etc.
RECORDS: Until 2004, the group gave hospitals a score and also released statistics on how all hospitals in the nation performed. Such scores are no longer available, but you can get a sense of how well a hospital performed based on the number of standards it did not meet during the inspection. This information is still public. JCAHO also places hospitals in different accreditation tiers-and if a hospital has an overwhelming number of problems, it can lose its seal of approval altogether. If your hospital fared poorly on, say, medication management, you might want to inquire with hospital officials about what happened and how the hospital corrected the problem. JCAHO compiles public reports on each hospital, which are available on its Web site, but they are limited in scope.
DRAWBACKS: JCAHO does not release its detailed inspection reports to the public, and many states' open records laws specifically exempt the reports from public disclosure. Often, their inspections are not surprises, as they contend, and they are not likely to take any harsh action against hospitals (extensively covered by the Chicago Tribune and Washington Post.) Also, JCAHO rarely takes punitive steps against hospitals, preferring to work with them to improve.
SUGGESTION: Use JCAHO as a backstop to your reporting, not as a starting point. You can reach JCAHO spokeswoman Charlene Hill at (630) 792-5175 or chill@jointcommission.org
EXAMPLE: Cheryl Clark at the San Diego Union-Tribune has written repeatedly about Southern California hospitals running afoul of both CMS and JCAHO.
http://legacy.signonsandiego.com/uniontrib/20061111/news_1n11paradise.html
SOURCE: The United Network for Organ Sharing/The Organ Procurement and Transplantation Network http://www.ustransplant.org/default.aspx
WHAT IT DOES: This is basically a nonprofit agency and a government agency working together to regulate the organ transplantation system. UNOS, the nonprofit, monitors hospitals that perform transplants and compiles statistics on regional survival rates. Based in Richmond, Virginia, it runs the OPTN under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
WHAT IT DOES NOT DO: Take disciplinary action frequently. This makes it all the more important for you to pay attention to your local programs, find out how many transplants they are doing and what their survival rates are. Programs can limp along for years with long waiting lists and bad outcomes.
RECORDS: You can find regional transplant data here: http://optn.transplant.hrsa.gov/organDatasource/
You can find hospital-specific data here: http://www.ustransplant.org/csr/current/csrDefault.aspx
DRAWBACKS: Comparing hospital survival rates can be tricky. You need to look at what was expected at each hospital and how the program deviated above or below that number. The agency helps with this by saying whether the number is "statistically higher," "statistically lower" or "not significantly different."
SUGGESTION: Take a look at the number of patients on your center's waiting list at the beginning of the last five years and at the end. Then look at how people were moving on and off the list at centers of comparable size nearby and nationwide. What you'll find if you are in California is that the lists tend to grow, while in other parts of the country, people are able to get transplants more quickly.
EXAMPLE: The Pittsburgh Tribune-Review has been dogging the transplant story recently, finding examples of people who received unnecessary transplants.
www.pittsburghlive.com/x/pittsburghtrib/news/s_572903.html
And while I was at The Orange County Register, we wrote a series of stories talking about how organ agencies were part of a network of nonprofits and for-profits that funneled donated tissues like skin and bone into a massive surgical products industry.
http://www.lifeissues.net/writers/kat/org_01bodybrokerspart1.html
SOURCE: The county clerk and recorder office
WHAT IT DOES: Collects birth and death certificates.
WHAT IT DOES NOT DO: In many cases, make it easy for you to get access to them.
RECORDS: A great way to find the families of deceased patients. You can look up who died on what day. This can help you find patients who are unnamed in court and medical board records but who have a date of death. Same goes for birth records. If you have a baby who was killed during childbirth, for example, you can go here. These records are almost never online. You have to go to each county office where you think the death or birth may have occurred and look through the records there.
DRAWBACKS: California and other states have made it tougher to get birth records in recent years, but your county may still grant you access.
SUGGESTION: When you are writing about someone who has died, get a copy of the death certificate. Families can be vague on the cause of death, for one. And it also will give you their last known address, next of kin in some cases and the doctor who signed off on the death. That person could be a source or the subject of your inquiry.
EXAMPLE: The information on the death certificates is sometimes suspect. The Journal of the American Medical Association in April 1993 found that asthma as an underlying cause of death was underreported, meaning that more people probably die from asthma-related causes than the numbers that are usually cited.
jama.ama-assn.org/cgi/content/abstract/269/15/1947
SOURCE: The county coroner
WHAT IT DOES: Performs autopsies in the case of most unexpected hospital deaths as well as deaths that are subject to a criminal investigation.
WHAT IT DOES NOT DO: Coroner's office typically is reluctant to assign blame. Also, if a hospital does not report a death, the coroner often won't know about it.
RECORDS: The reports often include diagrams and photos showing what happened. Coroner investigators are often loath to part with their notes, but make it clear to them that their work is public record. Their reports can differ greatly from the hospital spin.
DRAWBACKS: Because the coroner's office is tied to an elected official, the sheriff, and is often understaffed and underfunded, the coroner doesn't like to draw any heat by going after a prominent physician or hospital. They rarely launch criminal investigations based on their findings, even if the underlying facts seem clear. That doesn't mean you shouldn't write a story.
SUGGESTION: Don't forget to follow up weeks later and ask about the toxicology report. Medication errors abound, and nasty drug habits sometimes turn up in the most unsuspecting people. Reporters on the celebrity beat have known this for years. Also, find out what the coroner looked for.
EXAMPLE: The New York Daily News examined the number of athletes dying from heart attacks and found that steroids might be a hidden culprit.
SOURCE: Accreditation Council for Graduate Medical Education http://www.acgme.org
WHAT IT DOES: This private, nonprofit organization accredits doctor-training programs run by hospitals. Funded by fees from hospitals, ACGME monitors compliance with resident work rules, examines scores on board exams and looks at the academic credentials of faculty. ACGME reviews the programs as frequently as annually and as infrequently as every seven years.
WHAT IT DOES NOT DO: Provide detailed information about what the review found.
RECORDS: Its Web site tells you the status of each program at the hospital, but sanctions are only listed after an organization's appeals are exhausted. In addition, the group won't tell you why a program has been placed on probation or had its accreditation revoked. You need to talk to the hospital about that. The Web site has a link for withdrawn programs, which should be checked regularly.
SUGGESTION: If your hospital has several programs with sanctions, it could point to a lack of oversight and deeper problems. You may also ask the hospital for the ACGME report or seek a copy from one of your sources. Finally, ACGME keeps aggregate figures for programs on probation and programs that lose accreditation. If your hospital argues that these actions are common, the data can refute that.
EXAMPLE: Nell Smith at the Arkansas Democrat-Gazette wrote a great story in 2007 about two Arkansas residency programs that found themselves in trouble.
www2.arkansasonline.com/news/2007/sep/17/2-uams-residency-programs-state-fail-accr-20070917/