Hospital depot: a victim of hospital error takes a critical look at the healthcare system.

This is one person's story--from a belly-up viewpoint and armed with one of the best private health insurance policies available in 1999--about one of Pittsburgh, Pennsylvania's, best hospitals. An anecdotal story is useful only if representative, which I'm afraid this is.

Having lost control of my bladder and intestines due to an acute life-threatening attack of diverticulitis, which required surgery, and from an angle flat on my back, I saw a healthcare system so cash starved that most days there were no clean linens. I noticed the linen shortage right away because I needed so much of it.

Late one night I rang for help with the illiostomy bag attached to my intestines. The bag became unattached several times over the course of the day and night, leaking dark bile all over my abdomen and onto the sheets. "I'll be back as soon as I can," apologized the night nurse who answered my call for help. "Your problem right now isn't life threatening. I have thirteen other patients and I'm the only one on the floor."

I felt sorrier for her than for myself. We were both stuck here in this mess, managed by forces out of touch and beyond our control. At the nurses' station I saw a sign that read "Just deal with it." In the operating room I heard my surgeon say there was none of my blood type stocked. Just before I lost consciousness someone went for it.

This hospital seemed to be operating on a just-in-time inventory system, with the doctors and nurses having to be ever watchful and solely responsible for something not there or something going wrong. This was a health care system where even as you lay flat on your back you had to stay on your toes.

Robert Wachter in his recently published book, Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes, says there are about 90,000 medical errors committed annually in the United States and that hospital computerization functions at the level of circa 1980, about ten years behind the level of public schools and twenty years behind Wal-Mart. An updated version of this study, done by HealthGrades Inc., reported in August 2004 that 200,000 people die each year in U.S. hospitals due to "preventable medical errors." The Institute of Medicine in its report issued in 1999 says that the level of hospital errors is equal to that of a jumbo jet crashing every day. American medical mistakes are killing more people than al-Qaida. Most of these mistakes occur, says Wachter, during what he calls the "hand-offs" period when the patient is switched from one area of the hospital to another with few procedures in place to ensure that adequate instructions regarding care are given.

Twelve days after my surgery, my bag still popping off like an overheated radiator cap, the insurance company said time was up for the kind of surgery I'd had and it was necessary for me to go home. Just like Home Depot does with plumbing problems, hospital personnel were going to instruct me on how to take care of this problem at home. "How can I do that," I asked becoming panicky, "when you guys in here can't get it to stay on?" The insurance company relented a bit and decided I could go to a nearby nursing home for maintenance care.

It was a nicely decorated nursing home, bright and chipper, with no private rooms but a physical therapy room and good food. I was finally beginning to eat again. When I shuffled into rehab the first morning, the nurse said I looked so healthy I should be working there. Recovery was moving along nicely until the second or third day when my blood pressure fell dramatically to a level it had never been before, something like ninety or eighty over sixty.

I asked the nurse why I was still being given blood pressure medication when my blood pressure was so low. She told me to take it anyway but I refused. I told her to ask the doctor why I was still receiving it. The next day the nurse came back and said she had asked the doctor about my medication and he had said I needed to continue taking it. I did and a few hours later I was fighting for my life. Lucky for me Carol Matthews, an ostomy specialist from the hospital, paid an above-and-beyond-the-call-of-duty visit and saved my life.

"You look weak," she said. "Something is wrong." She ordered a potassium test that indicated I was in kidney failure that could soon lead to heart failure. Blood pressure medicine had built up in my kidneys due to dehydration and, as a result, my kidneys were shutting down. The nursing home, unlike the hospital I had been sent out of, doesn't do daily checks for urine output that would have immediately indicated dehydration and caught it before it became a life-threatening condition.

The nursing home called my husband to come immediately. I was put in an ambulance and sent back to the hospital. The ER staff attached a blood pressure cuff to me and called the code blue team, which surrounded me all night watching for cardiac arrest from heart failure due to low blood pressure. All night long I listened to the sound of the blood pressure cuff attached to my arm as it automatically inflated. My pressure kept going down. "I can't believe you never lost consciousness during all of that" the nurse told me the next day. Eventually, sometime in the early morning hours, my pressure began creeping slowly up. The code blue team left. I had almost been killed by my insurance company.

Recent statements by Karen Wolk Feinstein, president of the Jewish Healthcare Foundation, indicate that problems such as mine aren't isolated occurrences. Pittsburgh's health system is in serious trouble, she says. In 2001, due to demand being at an all-time high and a shortage of healthcare workers in the Pittsburgh region, Feinstein was asked to chair a summit to address the healthcare gap. "We were shocked at the size of the gap," she says, "and awed by its economic, medical, and social implications. For thousands of people requiring home nursing care, rehabilitation services, or immediate surgery in the future, the requisite work force may be alarmingly insufficient."

Feinstein didn't say it but the "alarmingly insufficient" healthcare workforce has probably resulted in lot of people being no longer around to tell about it. Doctors and nurses talk of feeling demoralized, their incentives ruined by cutbacks in salary and staff caused by the managed care cost-cutting squeeze. Trained nurses have left patient care in droves, many having gone to work at better paying jobs at the insurance companies. Not boding well for the future, out of 100,000 newly hired nurses in 2003 half were foreign and the vast majority of the rest were over fifty.

The National Academy of Sciences reported recently that "many hospitals and nursing homes are endangering patients by allowing or requiring nurses to work more than twelve hours per day" and "many hospitals and nursing homes have too few nurses to take proper care of patients."

It's been a long time since I've thought of the phrase killing for profits, but in the healthcare system I suspect that's exactly what's going on. The word greed having nearly disappeared from the American lexicon, as well as from the list of sins that anyone gets worked up about, it is probably no surprise that Richard Scrushy--founder of Health South Corporation, the nation's largest operator of rehabilitation hospitals, and recipient of a lavish $267 million in compensation from Health South over seven years--was indicted on charges of running a $2.7 billion accounting fraud. In an era when billionaires have become convinced they're victims, he probably feels he was entitled--one of the deserving, overburdened rich.

Despite the serious state of healthcare in America and the dearth of qualified care professionals, writes Robert Pear in the New York Times, "the Bush administration said last year that it had no plans to set minimum staffing levels for nursing homes, in part because such requirements would generate billions of dollars in additional costs for Medicaid, Medicare, and nursing homes? Sometime around the time I was recovering from my crisis, I remember hearing the Republicans fight against the Patient's Bill of Rights, which permitted patients to sue their HMOs.

I recently heard a Democratic congressional representative lamenting on Lou Dobbs Tonight that, due to the ongoing exportation of high-paying American jobs, we are going to be left with nothing but low-paying service jobs. "We are becoming no longer a nation," she said, "but just a market." Being "just a market" may be fine for stores selling hardware supplies like Home Depot, with its warehouses full of cheap labor, no-frills service, and megabucks for just a few people at the top. But now--run for your life--the Hospital Depot is here, replacing compassion-based patient care with lean and mean profit machines, coming soon to a neighborhood near you.

Sarah J. McCarthy is a freelance writer and contributing editor at Liberty Magazine. An earlier version of this article was published in the December 2003 issue of the Pittsburgh Tribune Review.