Mending Broken Hearts
Renaissance and denial play role as St. Joseph grapples with high mortality estimate for heart failure
(Feb. 12, 2009) Brent Hawkins sat down to breakfast in a Minnesota Marriott last summer. A Eureka resident for the past eight years, Hawkins heads a division of the agricultural giant Cargill. He travels frequently. Minnesota is his territory; USA Today his breakfast companion.
It was Aug. 21 — the official unveiling of the government’s best estimates of risk-adjusted death rates for heart attack, heart failure and pneumonia patients in every U.S. hospital. With a wife on the St. Joseph Hospital Foundation board and St. Joseph physicians among his friends, Hawkins is an informed health consumer, someone who would be interested in a story about the “extreme differences between the worst and the best” hospitals. And he was.
“I was shocked to find our hospital among the worst in the country,” Hawkins said. “Everybody kind of expected us to be average.”
The paper reported that the government’s estimated 30-day heart failure death rate for St. Joseph Hospital in Eureka is 15.4 per 100 Medicare patients served from July 1, 2006 through June 30, 2007. The national rate is 11.2. (The figures are adjusted for the age, income and general sickness level of each hospital’s patient pool.) Despite a statistically conservative approach that labeled less than 1 percent of all hospitals as better or worse in a particular category, St. Joseph Hospital is one of 35, nationwide, to find itself on the “worse” list for heart failure.
“Four more deaths is a big difference,” Donald Berwick said last month from his office in Cambridge, Mass. Berwick is president and chief executive officer of the Institute for Healthcare Improvement, a nonprofit center working with hospitals to improve the quality of care and eliminate errors.
“Most people who die are destined to die because they have things we can’t change the trajectory of,” Berwick said. “Health care doesn’t affect mortality that much, so you are looking at a huge difference in the impact of health care. It’s very unlikely the difference is random. Something is probably there.”
Hawkins would like to know what.
“I haven’t even heard them acknowledge this ratings issue, and I’ve heard nothing about what they are doing to fix it.”
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FIVE Comments
Comment / By Marc Levin / Feb. 13, 2009, 9:15 a.m.
One question not addressed in this article is what would be the mortality rate if St. Joseph had no heart program at all? The delay in treatment because of the need to be transferred to Redding or Santa Rosa, especially with the complications of weather on air ambulance flights, could mean that a program that has room for improvement is better than no program at all.
Comment / By Kathryn Donahue / Feb. 13, 2009, 12:46 p.m.
In all the numbers, and talk about “standardized processes developed from evidenced based guidelines” no one address the elephant in the room, the lack of nurses. It is not the nursing shortage that has produced this effect. It is the working conditions in which nurses are required to function. The words “goal of perfect care” are easy to state. What nurses are demanding….increase nursing staff. The Lean Toyota Model requires minimal staffing, work faster,staff to numbers,(we do have a ratio law in California), not to patient acuity. For each patient added to a nurses’ work load, above what is safe, as determined by the nurse who evaluates the patient’s “acuity” status, mortality goes up. This fact is well documented in scientific studies. The SJHS must include this piece, and staff appropriately, if they expect changes in patient outcome statistics. The SJHS must address the need to restore safe nurse staffing levels to protect patients from risk caused by managed care driven staffing changes.
Comment / By unanonymous / Feb. 14, 2009, 12:57 p.m.
according to the numbers, Redwood Memorial is the best place to get health care. Something that goes against conventional wisdom.
Comment / By loretta JKM / Feb. 20, 2009, 12:12 a.m.
No longer is St. Joes ran the way of the sisters.They risk patients lives to save a buck.Katherine Donahue is correct in her comments about staffing issues and dangers to patients and liability to the nurses, with too many high risk patients to care for at once.
They ask the public for donations,to benefit the community as a whole, Yet behind closed doors, St. Josephs Health care system ,makes decisions that are detrimental to the public their mission statement claims to serve. Poor,disabled, And yes Children. That is most evident in their recent decision to shut down the home health respite program that served medically fragile children.There was no other such nursing program in this county.Their spokes person stated in the Oct. 08 issue of the times standard, that their resources needed to go to a larger community interest.Do we need more medically fragile children for them to be considered worthy of care? who is this larger community interest? the richer? the well insured? Most of these kids funding came from regional center contracts,and some had medical or private insurance. who knows what the children of the future may have had for financial resource. St joes Health system didnt care. Hmmm. They found funds though to match the donated funds ( 2 million) the McClean foundation donated .Look at some of the board members of the McClean foundation youll notice a name on there who happens to be a community services advocate for st. Joes. She refused to return a phone call regarding the closing of the program. Rude Ceos called me instead. Sounding more and more like its all about who,s in who’s pockets like any other corporately corrupt, organization in our society today. They except money from the public under the guise of the sisters mission statement,while they quietly close off the public members it was designed to serve, from receiving the services they deserve from their local health care system. Seems wrong coming from a hospitol that made itself the monopoly in this town. The hospitol and home health network,are under the same umbrella of the st. joes health care system. In reference to the closing program , I was told by CEOs,In sept. 08, that i” wasn’t supposed to know about this”. They’ve Tried to call it Regional centers program, but Regional center(RCRC) was just a source of contracted funds for their(yes St Joes) home health respite nursing program. RCRC has never been in the business of running a nursing program. All hiring and the recent firing of the nurses was done by St. Joes. The program is closing and the nurses are losing their jobs and benefits, some have been loyal employees for over 15 years. The families with severely ill children, are losing their respite nurses and left scrambling,along with RCRC, to find an out of town vendor to come here and set up and hire some nurses to step in and cover the loss of a vital one of a kind service, once offered to the community by st. joes health care system.
Comment / By jac / March 5, 2009, 1:23 p.m.
Does this hospital have care for someone with a Medtronic ICD????? Its a heart device that paces and diffibulates.(sp) Medtronic ICD has been recalled as well. any medtronic icd people or doctors or hospitals to monitor my ICD?