News Roundup [abridged Versions Appear In The Paper Journal]

US Congress scrutinises hospitals owned by doctors after patient's death

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:442
  1. DC Nellie Bristol
  1. Washington

    The death of an 88 year old woman after an incident in a hospital in Oregon when no doctor was on the premises has renewed scrutiny of specialty hospitals in the United States owned by doctors.

    The hospitals have been controversial and are subject to a congressionally imposed moratorium on federal payments for new facilities. The moratorium was extended by six months in a bill signed into law earlier this month by President Bush.

    A Congressional committee said that the patient, Helen Wilson, was injected with the painkiller hydromorphone after back surgery at Physicians' Hospital, Portland, and went into cardiac arrest. The nursing staff called the emergency number, 911, to get help when she did not respond to efforts to revive her. Paramedics resuscitated the patient, but she died days later at another facility.

    “The case of Helen Wilson raises overall patient health and safety concerns of physician- owned specialty hospitals,” said a letter sent this month by Senate Finance Committee leaders to the US health and human services secretary, Michael Leavitt. “The public expects any facility labeled as a ‘hospital’ to be able to appropriately deal with urgent medical situations.”

    The committee, which has jurisdiction over federal health programmes, is seeking clarification on the requirements for a doctor's presence at the facilities and whether patients are told that appropriate personnel may not be available in an emergency.

    A spokeswoman for the hospital disputed many of the claims in the committee's letter, including the facility's designation as a specialty hospital. She said it provides a number of services and is licensed by the state as a general acute care hospital.

    She said that state licensing does not require the constant presence of a doctor at facilities without emergency departments. She said that staff sought a higher level of care for the patient when it became clear that the facility could not treat her. The spokeswoman also disputed a claim by the committee that the hospital opened during the moratorium on funding for new facilities. She said that it first opened in 1964 but filed for bankruptcy and reopened in 2004, during the moratorium period.

    “The whole letter is fairly misdirected,” she concluded.

    Staff of the committee say that its chairman, Senator Charles Grassley of Iowa, continues to believe that the Physicians' Hospital is a specialty facility. He said that even if the moratorium did not apply to the facility, he “would still have significant concerns about major surgical procedures being performed on complex patients with doctors then not available for postoperative complications.”

    Mr Grassley and the next senior member of the committee, the Democrat senator for Montana, Max Baucus, have been outspoken critics of doctor owned specialty hospitals, which tend to concentrate on cardiac, orthopaedic, and surgery services.

    Critics of the facilities argue that they siphon off patients requiring procedures that are paid more by the federal Medicare health insurance programme, leaving less lucrative patients to general services hospitals. They also say that specialised facilities fall short in efforts to provide community services, such as care for poorer patients, and should be subject to federal prohibitions on referrals by doctors to facilities in which the doctors have an ownership interest.

    Proponents say that the facilities promote competition and allow doctors to have more say in how they treat patients. Medicare administrators are now developing a strategic plan for the facilities that will address investment in hospitals by doctors and care for poorer patients. The US has about 100 specialty hospitals owned by doctors.

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