When Thomas Vera wandered away from the UC San Diego Medical Center to die in a nearby canyon, executives across the University of California Health System were cutting the staff-to-patient ratio.
But those staff positions weren't limited because there was no money. UC takes in hundreds of millions of dollars in yearly profit. The payroll dollars were transferred to administrators. It seems that the University of California's priorities have been shifting away from patient care to profit over the past several years.
But the greed of the executives and doctors at UC isn't the only factor at play in tragic patient deaths.
I see another problem here, and we're all to blame for it.
It's our refusal to talk about what should be done for terminally ill or injured patients.
Sometimes hospitals are held hostage by families who demand miracles for their dying relatives. Losing a loved one is difficult, and some people can't accept the inevitable. They demand every test and treatment that might possibly give some short term benefit; some even threaten to sue when their 95-year-old grandmother dies in her sleep.
Few people want to talk about how to apportion health care dollars.
The major exceptions to this reluctance to speak are the vocal advocates of leaving large numbers of Americans without health coverage. In other words, these individuals want to let economics decide who should live and who should die. The advantage of this position is that it insulates its adherents from making specific choices about who should suffer or die. They want to let the market choose. Of course, the market is increasingly controlled by wealthy corporations and individuals who are taking a bigger and bigger share of the economy each year. The wealthy and their advocates apparently believe that fewer and fewer people should have health care.
Currently we spend an inordinate amount of money on the elderly during their last year of life, and, in particular, their last month of life. The truly disturbing aspect of this enormous outlay of healthcare dollars is that those who receive expensive hospital care during their final months have a lower quality of life than those who receive hospice or home care.
"In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise. In lay terms...the study found that the less money spent in this time period, the better the death experience is for the patient."
--from"Why 5% of Patients Create 50% of Health Care Costs"
Michael Bell
Forbes
1/10/2013
Obviously, if UCSD can keep the latest high-priced medical equipment in good repair, then it's perfectly capable of keeping bed alarms working. The California DHHS recently revealed some facts about the Thomas Vera case:
State inspectors said the hospital failed to routinely test the buttons and failed to repair them when broken.
Prior to Vera’s disappearance, the most recent test had revealed more than 1 out of every 4 panic buttons at UCSD’s two main hospitals didn’t work.
--from "Broken Bed Alarm Blamed for Walkaway Patient's Death"
By Steven Luke
NBC 7 San Diego
Sep 15, 2014
Is this the best that all these high-priced UC administrators can come up with? A patient dying of hunger, thirst and exposure in a nearby canyon? Obviously, UCSD can do better than this. AFSCME notes: "Care providers are forced to give special treatment to VIPs—so-called because of their wealth or relationship to UC administrators—at the expense of other patients."
It seems quite possible that Thomas Vera might not have recovered from his head injury even if he hadn't wandered away. He had apparently been in the hospital for weeks, too ill for surgery, and suffering from the delusion that he was being held captive in a garage in Texas. Perhaps he would never have become a good candidate for surgery. Would this man have had a better quality of life in his last days if he'd been in hospice care, or at home? It seems clear that he would have.
And would another person have benefited more from being in that hospital bed? It's hard to see how anyone could have benefited less than Thomas Vera did.
The University of California has an enormous amount of political clout. Why not use that power for something besides making billions in profits from its health care system? Why not lead the discussion about how much of our health care resources should go to the terminally ill or injured?
AFSCME explains the change in culture at University of California Medical Centers:
With the UC Medical System earning $6.9 billion in operating revenues and hundreds of millions in profits, it has the resources to do just that.
But recently, patient care advocates have witnessed something else: administrative decisions that prioritize UC’s profit margins over patients’ health. These decisions reflect a shift in values that reached a tipping point with a system-wide policy in 2011 that decentralized UC budget practices, and turned each medical center into an independent profit center.
This culture change is evidenced by a sharp rise in management salaries and compensation, excessive management costs, and unprecedented borrowing to construct new buildings.
Since 2009, management at UC Medical Centers has grown by 38 percent, adding $100 million to the annual payroll cost of management.
Debt service payments have almost quadrupled since 2006.
This diversion of patient care dollars results in management’s need to capture “efficiencies” to bolster profit margins.
While “efficiencies” can be positive, they can also have serious negative consequences. Often taking the form of aggressive cost-cutting measures, some translate into chronic short staffing, over scheduling of operating rooms, prioritizing “VIP” patients over everyone else, shortchanging charity care, and outsourcing essential services...
Chronic short staffing creates excessive workloads and stress. One nurse’s aide reports being afraid to take breaks because it would increase the ratio of patients to CNAs from 10:1 to 20:1...
The UC health system seeks to “re-align” Medicare and Medicaid patients to non-UC hospitals under the assumption that they often do not require the level of care UC provides.
Here's a case with some similarities:
Hospital patient’s death leads to $3M settlement
By Associated Press
December 13, 2014
SAN FRANCISCO — The family of a patient who went missing for more than two weeks before being found dead in a stairwell at the San Francisco hospital has settled a lawsuit for $3 million.
The San Francisco Chronicle reported Saturday (http://tinyurl.com/... ) that the city and University of California tentatively agreed to the payout. The city is responsible for $2.94 million. The city’s Board of Supervisors is expected to approve the settlement Tuesday.
Lynne Spaulding, 57, was admitted on Sept. 19, 2013, to San Francisco General Hospital with a bladder infection. When Spaulding was admitted, doctors concluded that she was disoriented and weak and ordered constant monitoring.
Nonetheless, Spaulding vanished from her room two days later. Two weeks after she went missing, Spaulding’s body was found during a routine check of the little-used stairwell. Four days before her body was found, a doctor reported to a nurse that he saw a woman slumped over in the stairwell.
Spaulding’s death sparked multiple investigations focusing on communication failures between the hospital and sheriff’s deputies who provide security and conducted the search for Spaulding.
A sheriff’s department dispatcher who assured the nurse a deputy would check on the report was fired. Two other sheriff’s employees were suspended and five others disciplined.
The coroner said Spaulding died of dehydration and liver failure related to alcoholism. The coroner said Spaulding had died several days before she was found, but could not determine an exact time of death.
Haig Harris, the family’s lawyer, said Spaulding’s 20-year-old son and 24-year-old daughter will split the settlement.
“No amount of money will bring back the mother of these two children,” Harris said.
Matt Dorsey, a spokesman for the city attorney’s office, said the settlement was fair.