When Hospitals Kill or Maim

Every year's release of the Best Hospitals rankings brings me an earful (or screenful or sometimes even an actual letterful) from patients or their families or friends who want to vent. This year is no different. Some complain that we left out a wonderful, caring, lifesaving hospital. More typically, they are upset because a certain hospital got in. They tell tales of breathtaking callousness—appointments to see a dying child repeatedly broken at one prominent hospital; a rude, arrogant physician at another high-ranked facility who ordered a woman and her ill mother off the premises.

By SHARE

Every year's release of the Best Hospitals rankings brings me an earful (or screenful or sometimes even an actual letterful) from patients or their families or friends who want to vent. This year is no different. Some complain that we left out a wonderful, caring, lifesaving hospital. More typically, they are upset because a certain hospital got in. They tell tales of breathtaking callousness—appointments to see a dying child repeatedly broken at one prominent hospital; a rude, arrogant physician at another high-ranked facility who ordered a woman and her ill mother off the premises.

They aren't placated by pablum I feed them like "every organization, even a 'best hospital,' has breakdowns" and "awful things happen at every hospital." It wouldn't satisfy me, either. Rightly or wrongly, we—me included—expect more from those who treat us when we put our fate in their hands. But what else can I say? These anecdotal lapses have no business being factored into the rankings. I don't know that what I'm told is accurate, and if we decided to penalize the hospitals, what about others? For every sad story that comes my way, there have to be 20 or 100 more I never hear about at other hospitals.

And then there are hospitals that kill or injure patients. The wrong drug or an overdose of the right one, a transfusion of the wrong blood type, an infection that runs wild because of sloppy postoperative care, amputation of the wrong leg or excision of the wrong kidney—every year, without fail, patients die or suffer when their caregivers do not live up to the trust placed in them. The accrediting body for hospitals, the Joint Commission, calls such avoidable deaths and injuries, as well as those that didn't occur but easily could have (my favorite is fires in the OR that are snuffed out before they do serious harm), "sentinel events." Last year, the Joint Commission tabulated more than 500 such events.

Note that word "tabulated." The Joint Commission expects but does not require (emphasized because I simply don't get it) that hospitals report sentinel events. More than a third of last year's total were not self-reported. The Joint Commission found out about them through media reports or other sources. The toll, therefore, has to be higher than 500. We don't know, of course, which hospitals had a problem and chose not to report it, so sentinel events can't be worked into the rankings except in one way: When the physicians we survey each year mark down the names of the hospitals they consider the best in their specialty for the toughest cases, they might hesitate before nominating a center they know had a sentinel event.

Over my past four blogs, I've been candid about some of the information that we would love to capture but for various good reasons cannot. I still believe strongly, and obviously U.S. News agrees, that the methodology produces rankings that are both credible and useful to people trying to make comparisons that will lead them to the best possible hospital and that we will continue to make them even more so in the years to come.