S U P R A S P I N A T U S

McCaughey opened with this question:

If you took your car in for an oil change, and the garage dented the door panels while putting the car on the lift, would you pay for the repairs? Of course not.

Astoundingly, when a patient contracts an infection in the hospital, the hospital charges for the antibiotics, surgery and extra days needed to treat the infection.

Of course, people aren't cars and you can't really equate infection with a ding in a car door. But that's not really McCaughey's main point. Her point is, rather, that:

Starting Oct. 1, medicare, the federal health program for people 65 and older, will stop paying hospitals for several types of obviously preventable infections, so preventable that Medicare authorities call them "never" events. That means they should never happen.

. . .

Now here's the shocking news. New York state refuses to follow Medicare's example. New York's Medicaid program for low-income patients will continue to pay for treating infections contracted in the hospital.

Immediately after, she takes a dig at GNYHA:

Not surprisingly, the Greater New York Hospital Association, a lobbying organization, applauds the state's decision as sensible. Kenneth Raske, head of the hospital association warns against "going whole hog on matters that are controversial in relation to the science."

Controversial? Hardly.

Then in a parting shot at GNYHA she offers this backhand:

The outrage is that New York state's Medicaid program, the largest in the nation with an annual budget of $47 billion, is bowing [to] the hospital industry instead of protecting patients. Hospitals will not lower infection rates until their biggest customers, Medicare and Medicaid, demand it.

That is an odd closing position to take, given that much of the center of McCaughey's piece described the success of Beth Israel Medical Center in reducing mainline catheter infections to zero since 2005. Odd, because the reforms leading to that reduction would have taken place before Medicare's declaration of "never payment" which McCaughey argues must precede such reforms. It also seems odd to antagonize GNYHA, an organization which seems to have made good strides with its member hospitals towards reducing infections - - the very cause Ms. McCaughey champions.

Anyway, Mr. Raske responded a few weeks later with this:

While McCaughey’s commitment to reducing hospital infections is admirable, she is not, as Sen. Daniel Patrick Moynihan used to say, entitled to her own facts.

After stating that New York hospitals are "national leaders in reducing infections," he upends McCaughey's statements about "never events":

As for her claim that the Medicare program will cease paying for "never events" while New York’s Medicaid program will continue to pay, McCaughey has it exactly backward. New York’s Medicaid program has announced that it will no longer pay for what it considers to be "never events," such as surgery on a wrong body part. The Bush Administration, by contrast, is simply engaging in a budget reduction exercise, refusing payment for conditions that can develop in vulnerable patients and are not always preventable —such as ventilator-associated pneumonia.

Medicaid did make such an announcement (you read about it here in Marcia Smith's June 6 post). However, that doesn't exactly refute McCaughey's statement. McCaughey said, "[Medicaid] will continue to pay for treating infections contracted in the hospital," which by all accounts still appears to be true.

One also pauses at the statement that New York hospitals are national leaders in reducing infections. Certainly some New York hospitals are, as the Beth Israel project points out. But the Department's infection survey released a few days before McCaughey's first editorial shows that, as a lot, New York's hospital infection rates are still higher than the national average.

This week (August 14), McCaughey takes to the Wall Street Journal with an ominous prediction:

Hospital infections will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos.

Why? Here's why:

On July 30, a jury awarded over $2.5 million to James Klotz and his wife Mary in a medical malpractice lawsuit against a heart surgeon, his group practice and St. Anthony's Medical Center in St. Louis, Mo.

. . .

The germ that Mr. Klotz contracted, hospital-acquired MRSA, infects about 880,000 patients a year and accounts for only 8% of all hospital infections. Hospital infections caused by all kinds of bacteria sicken millions.

She also notes that "In 2004, Tenet Healthcare Corporation agreed to pay $31 million to settle 106 lawsuits by patients who contracted infections after heart surgery at Palm Beach Gardens Medical Center in Florida."

Attention-worthy numbers to be sure, though it seems a bit bold to predict that hospital surgical infection class-actions will be bigger than asbestos.

Ms. McCaughey's July 11 article is here. Mr. Raske's July 25 response is here. McCaughey's August 14 WSJ editorial is here.