I had wanted to write something about a major study that came out last week in the New England Journal of Medicine, which makes a strong case that nearly all Americans, no matter their wealth or education or where they live, receive less than 60% of “recommended care”—the procedures and tests they should be receiving. In other words, despite our huge and rapidly rising insurance and other healthcare outlays, we receive shoddy treatment. The authors concluded that “problems with the quality of care are indeed widespread and systemic and require a system-wide approach.”
Then, by chance, I met a man this past weekend who is challenging the quality of care provided by a major hospital and several of its doctors and nurses and realized that the problem is much worse than the study suggests. That the system is deficient is scary, because it says that if you find yourself in the wrong hospital at the wrong time, your life could be in danger because of negligence and/or incompetence. What is truly horrifying, though, is the absence of any sense of accountability when mistakes are made. The inmates truly are running the asylum, and for that reason, there seems no immediate way of getting it fixed.
The man challenging the system is Roberto Glaubach, an architect from Argentina. Some friends put him in touch with me because they know I write about business and health care. He is seeking a measure of justice for the death of his daughter, Veronica, nearly four years ago, at age 28. She died in Huntington Memorial Hospital, a teaching hospital near Los Angeles, just hours after giving birth to a daughter.
Veronica was a beautiful woman who loved to paint. From all the evidence Roberto has accumulated, and he has accumulated files full, Veronica died from complications of childbirth because she wasn’t receiving anything close to the “recommended care” for her rapidly escalating illness.
Veronica had shown some worrisome symptoms prior to giving birth, most notably unexplained protein in her urine and a complaint of “seeing spots” the day prior to being admitted to the hospital. But she had a seemingly normal delivery just before 7 a.m. July 1, 2002. From there, it was nearly all downhill. First, she complained of severe upper abdominal pain, nausea, and vomiting. Her blood pressure was rising. Her blood platelet count was declining. At 4:30 p.m., she had a seizure. A few hours later, she was unconscious and by 6:10 the next morning, less than 24 hours after giving birth, Veronica was brain dead.
A report by the Los Angeles County Public Health Department pointed to numerous lapses by both the nurses and doctors on duty at the time. The nurses seem not to have reviewed Veronica’s prenatal medical records showing the elevated protein in her urine, which is a warning sign of a condition known as preeclampsia. Nor had the nurses alerted doctors that Veronica’s blood pressure was rising to dangerous levels.
Two doctors who examined Veronica at various points did little independently to help Veronica. One doctor apparently came on the scene at several points, but his notes were completely illegible, to the extent that his signature couldn’t be identified, the report states. Another doctor whose notes could be read apparently never made the diagnosis of preeclampsia, which progressed to eclampsia, and caused Veronica’s death.
Preeclampsia and eclampsia are uncommon, though not rare, occurrences during childbirth, and happen most often in first pregnancies, like Veronica’s. There is no guarantee Veronica would have been saved had she been treated earlier, though one study I looked at indicated a better than 80% survival rate when the conditions are identified and appropriately handled.
While the Los Angeles County Public Health Department found serious problems, it’s not charged with handing out justice. All it does is recommend changes in hospital procedures, and it recommended a number to improve responses by nurses at Huntington Memorial.
Roberto has had to go elsewhere to seek justice. He hired a lawyer, who told him he had a malpractice case. The hospital quickly responded with a settlement offer, which the lawyer recommended Roberto accept. He went along with the lawyer, and several hundred thousand dollars was paid to support Veronica’s daughter.
Remember, Roberto is Argentinian, and is trying to wend his way through a foreign country’s legal and medical system. Knowing what he knows now, he isn’t sure he should have recommended that his granddaughter’s father accept the settlement. (Veronica wasn’t married; her boyfriend’s family cares for Veronica’s daughter.)
But Roberto says this isn’t about money. He wants to see the doctors involved called to task. Here he has run up squarely against a system in which the doctors police themselves.
He filed complaints with the Medical Board of California, which is responsible for licensing and disciplining physicians. Its investigators rely on the judgment of physicians they call in to evaluate cases.
Having read through its responses to Veronica’s death, I can tell you that even a well educated American accustomed to dealing with our legal system would have difficulty understanding its terminology and criteria for action. It certainly has upset Roberto. According to a letter from an area supervising investigator of the board, Laura Sweet, last August, if a doctor is found guilty of “a simple departure from the standard of care, the case is closed but maintained for a period of five years…The expert {physician} who reviewed the care rendered to Veronica identified simple departures from the standard of care.” In other words, case closed.
One thing is crystal clear from the Medical Board’s response: physicians rule the roost. As Ms. Sweet’s letter states, “The final determination as to whether a physician violated the law, in quality of care cases, must be made by an independent, board certified expert who practices in the same field of medicine as the subject physician.” In other words, colleagues judge each other. Have you ever heard a physician criticize another physician?
In a letter to Ms. Sweet, Roberto conveyed his “astonishment” at the Medical Board’s response. “{It is}one thing if your son or daughter died as a consequence of a terminal disease…But a very different thing if your child is killed in such a stupid way (as my healthy Veronica has been)…”
Roberto will continue pressing his case. But he realizes now that he is up against a system in which the accused police themselves. It’s time to open the windows of the medical ivory tower and get the stink out.
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