The Intensively Careless American Hospital


Simon & Schuster -- 320pp -- $23

Walt Bogdanich begins his new book with an extreme and already well-publicized horror story. It is an account of how Dr. Kathryn Hinnant, a pregnant 33-year-old physician, was raped and murdered in 1989 at New York's Bellevue Hospital Center. Her assailant, Steven Smith, was wearing surgical scrubs and a stethoscope. A recently discharged Bellevue psychiatric patient, Smith had spent nearly two weeks living in the hospital and masquerading as a doctor.

By opening this way, Bogdanich invites the suspicion that he's playing to potboiler sensibilities. But wait: The Great White Lie: How America's Hospitals Betray Our Trust and Endanger Our Lives turns out to be a detailed and serious look at the nation's troubled medical system. The disturbing lesson: Routine care in many hospitals can be as harrowing as this sensational incident.

Bogdanich, a Pulitzer prize-winning writer for The Wall Street Journal, marshalls wide-ranging and often surprising examples of medical malfeasance, from hospitals run by felons to computer programs designed to cheat the federal medicare system. Drawing on more than 15 years of reporting on the industry, he argues that such cases are not "freak accidents or anomalies" but "the direct result of systemic health care problems of enormous proportions."

Take the murder at Bellevue. The year before, nearly 1,000 felonies and 2,700 misdemeanors were committed in New York City's hospitals. Still, facing the same sort of financial pressures that had by then pushed one-third of the nation's 6,000 hospitals into the red, Bellevue had reduced its security staff. But the primary villain, in Bogdanich's view, is a makeshift collection of health care policies that gives doctors and hospitals financial incentives to skimp on care. Consider Leelamma Mathew, R. N. We first see her midmorning, passed out drunk on the lawn of Maryland's Leland Memorial Hospital. In time, after multiple doses of the painkiller Demerol disappear during her shift, Mathew is dismissed. But like other temporary nurses with appalling work records, Mathew soon finds a new position because many agencies don't care, and hospitals often don't check. Since the early 1980s, hospitals have been rewarded for keeping treatment costs below government reimbursement rates. One way they've done so is by replacing staff nurses with lower-paid temps. That, says Bogdanich, has given rise to imposters, forgeries, false billings, forced labor, and theft.

Bogdanich details how the use of young, untrained workers to cut labor costs affected the care that Dillon Murphy received during a coronary bypass at North Carolina's Charlotte Memorial Hospital & Medical Center. A transparent plastic bag of what the doctors believed was a cardioplegic solution was used to stop his heart during surgery. When the time came to restart his heart, nothing happened. A 19-year-old employee had pulled the wrong fluid from the pharmacy's refrigerator. Murphy's heart had been bathed in glucose. The 33-year-old father of three died.

Underlying many such tales, Bogdanich detects the profit motive run amok. Charlotte Memorial, like many other hospitals, had kept pharmacy staff at a minimum on weekends to save money. At the same time, it had begun an orgy of construction -- including a $40 million office tower, a new parking garage, and a helipad -- all to lure doctors and their patient referrals.

Nashville-based Hospital Corporation of America, Bogdanich writes, tried to influence physicians to refer patients to one of its new facilities by paying them as much as $12,500 a month for "medical directorships." Illinois' Leyden Community Hospital considered a plan to boost surgeries during the slow holiday season by offering physicians who performed 10 major operations within a certain period a fax machine or portable phone. The idea was rejected only after it was made public by the Chicago Tribune.

Many of these practices are legal, since regulations forbidding such kickbacks apply only to medicare and medicaid programs. But Bogdanich also trots out medical felons. Meet Dr. George Gotsis -- drug dealer, suspected murderer, and chief of staff (before it closed) at New London Hospital in Lorain County, Ohio. Meet James C. Giuffre, head of the now-shuttered Giuffre Medical Center in Philadelphia, known as matadero, or slaughterhouse, to Hispanics living nearby. Despite Giuffre's extensive use of underqualified or unlicensed personnel and such horrifying cases as a neglected patient whose mouth became infested with maggots, the industry's chief regulator, the Joint Commission on Accreditation of Healthcare Organizations, allowed the hospital to remain open for years.

Bogdanich says he chose to write about the failures of the health care system rather than its accomplishments because he believes the failures are gravely underestimated. The system's "great white lie," he writes, is "a myth holding that all hospitals and doctors are equally good and deserving of our complete and unquestioning trust." Bogdanich's book should help shatter that myth. If nothing else, Bogdanich makes a compelling case for tougher outside regulation, letting those who pay for health care -- primarily government and employers -- know what they're paying for, and publicly identifying providers that do a bad job. Until that happens, maybe hospitals should have to post this sign above their admitting room doors: Caveat Emptor.

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