A Tale of Two Scandals

British Scandal: According to Britain’s Independent, the recently released report on Stafford General has ignited the “worst hospital scandal in more than a decade.”

For years, Stafford “routinely neglected” patients. The taxpayer supported management focused on financial targets rather than patient welfare. According to the Guardian, the hospital was understaffed. Clinical decision units (CDUs), areas within a hospital for patients who require further observation and assessment before a treatment or discharge plan can be developed, were used as “dumping grounds to avoid breaching the four-hour target for being treated in [the emergency room].” The Healthcare Commission reported that Stafford dumped “quite unwell” patients into its CDUs “without a dedicated nurse to look after them” just before it reached the 4 hour target, and that its smaller CDU was not even staffed.

The Telegraph reports that basic hygiene was neglected, receptionists triaged casualty arrivals, and thirsty patients resorted to drinking from flower vases. When hospital management was given notice of a “damning inspection report,” they “responded by hiring a public relations team and promised to ‘get MPs [Members of Parliament] on [their] side.’”

The staff were “deterred from speaking out through fear and bullying,” a problem throughout the National Health Service (NHS). The Independent notes that employees who report on substandard NHS treatment can spend years in court. In settlement cases, courts routinely impose gag orders so that allegations of misconduct cannot be made public. Despite whistleblower shield laws, the health care bureaucracy protects itself by initiating investigations without end.

U.S. Scandal: For three decades, Los Angeles County’s Martin Luther King Jr./Drew Medical Center was a scandal waiting to happen. According to the Los Angeles Times, reports of substandard care at King/Drew surfaced three years after it opened in 1972. They didn’t stop and the hospital became known as “Killer King.”

The Los Angeles County Commissioners who ran the hospital were unwilling to face up to the activists and members of Congress who protected it. After repeated warnings, it failed an unannounced federal inspection in September, 2006. According to the Centers for Medicare and Medicaid Services (CMS) notice, medical equipment was improperly sterilized, patients were ignored, and staff was poorly trained.

CMS revoked King/Drew’s Medicare participation and took its money elsewhere. Because Medicare patients paid for half of the hospital budget, financial pressure forced the Los Angeles County Commissioners to finally act. They closed the hospital at the end of 2004. Despite decades of scandal and reform efforts, it finally stopped harming patients only because an outside payer decided to take its money elsewhere. King/Drew reopened under new management in 2009.

Meanwhile, Stafford General continues treating patients.

Lesson: As the current scandal at the National Health Service’s Stafford General Hospital shows, when the hospital is part of a government-run system, administrators tend to get paid no matter what. As the 2006 scandal at Los Angeles County’s King/Drew hospital shows, when payers and providers are separate entities, the power to withdraw patronage is the power to change performance. Financial pressure spurs reform far more effectively than dying patients.

(Hat tip: Russ Faria, DO.)

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