ProPublica: Health & Science

Reporting Recipe Conference Call Set for Thursday, March 25 at 2 p.m. EDT

2010-03-18T08:50:51-05:00

by Mike Webb, ProPublica -

Earlier this month, Charles Ornstein and Tracy Weber took the unique step of publishing a reporting recipe to show people how they could do their own investigations of nursing boards and other state regulatory and licensing agencies. At the time, we said we would schedule a conference call so that the reporters could walk you through the reporting recipe and answer any questions you might have. Well, the cake has been baking long enough, and we've set the date for the call -- Thursday, March 25 at 2 p.m. EDT/11 a.m. PST. If you plan to participate in the call, please sign up here. Call-in information will be sent to those who want to participate.

Ornstein and Weber will share some of their reporting tips and give callers advice on where to find information, what to ask and how to turn your data into a coherent investigation. After we published our recipe, both the Texas Tribune and the Allentown Morning Call published stories about errant nurses and cited our investigation. And once you're familiar with Ornstein and Weber's process, we hope you'll take a closer look to see how your state boards and agencies are performing.

Haiti Loses Its U.S. Lifeboat

2010-03-14T13:00:18-05:00

by Sheri Fink, Special to ProPublica -

This story was co-published with The Daily Beast.

The U.S. Navy's vast hospital ship, the Comfort, departed Haiti Wednesday and is due back to its home port of Baltimore this weekend. In the harbor off of Port-au-Prince, its gleaming white topsides accented with red crosses have been a conspicuous symbol of U.S. generosity since the country's devastating earthquake.

But for 11 days before it departed, as some hospitals on the ground in Haiti overflowed with patients, no inpatients with earthquake injuries were treated onboard. Instead, the Comfort's personnel engaged Monday in an "abandon ship drill," and its overhead paging system has recently heralded the visits of a host of dignitaries, including the secretary of the Navy, who came to congratulate the crew.

As the staff awaited direction, debate brewed over whether it was an appropriate time to leave -- as many American and Haitian officials believed -- or whether the unique capacities of the ship should continue to be used to save lives beyond treating acute earthquake injuries, as some health professionals urged.

Not long after the earthquake, the hospital offered services that are scarce in Haiti, including CT scans, intensive care and advanced surgery in sterile conditions. Over a period of around six weeks beginning Jan. 19, staff members performed more than 800 surgeries and treated close to 900 patients, many of them severely injured, according to military public-affairs officers. The care the ship provided drew kudos from Haitians and civilian aid workers.

But last month the Comfort stopped taking admissions and began the careful and painstaking work of transferring its remaining patients to other facilities, according to military officers on board and doctors who received the Comfort's patients. On Feb. 24, workers mopped the near-empty wards and waited for word on the ship's deployment status. One of the last of the two dozen inpatients -- a tearful woman with an injured right leg -- was lifted into a helicopter on the way to a field hospital set up by Harvard physicians near Haiti's border with the Dominican Republic.

The decision to release the ship from service in Haiti was made by the U.S. Southern Command, which judged its humanitarian relief mission to be completed, according to a press release issued last week. That mission was defined mainly as treating critically injured earthquake survivors and international responders. By contrast, a similar hospital ship, the USNS Mercy, responding to the 2004 Indian Ocean earthquake and tsunami, had only just arrived on the scene at a similar time point as when the Comfort began drawing down its operations. The Mercy then stayed in Indonesia for five and a half weeks.

All land-based field hospitals and clinics operated by the U.S. Department of Health and Human Services, which provided surgery, wound care and childbirth services, have also closed in recent days. "The medical mission here in Haiti is converted," said Capt. Jim Imholte, who served as the head of the HHS mission in Haiti. Acute surgical needs, he said, were giving way to needs for rehabilitation and primary care. "It's a natural transition point for us back to the Haitian government and the medical institutions that are here and the [non-governmental organizations] that are here that have the skill sets perhaps in that area that we don't necessarily have."

One HHS field hospital was converted into an outpatient clinic run by a small charity. There, steps away from a soccer field filled with thousands of the dispossessed living under sheets and tarps, a curling piece of paper affixed to a wall announced the change in services in Haitian Creole: "We don't deliver babies. We don't do operations. We don't take people with gunshot wounds. We don't take people with serious injuries." Where patients could go to get those services was unclear.

U.S. officials say that decisions about withdrawing the highly visible -- and expensive -- governmental medical assets were made based on factors such as changing needs and capacities in Haiti. The number of patients requiring urgent surgery for wounds sustained in the quake has sharply declined. "The needs have shifted, and there are other more effective ways to meet the current needs," said Dr. Ron Waldman, who coordinated the medical response for the U.S. Agency for International Development.

The agency has provided nearly half a billion dollars in aid to date, including the donation of federal field hospital caches to Haitian hospitals and the ongoing support of private charities that are offering health-care services such as mobile medical clinics for the displaced. "USAID recognizes that the needs of the Haitian people remain great," Waldman said, "and will continue to adapt its programs to the needs even as they continue to change."

The Haitian government, which faced pressure from fee-for-service doctors who lost business to foreigners providing free health care, also supported the Comfort's departure. "The Haitian government thanked them for the good job that they did and invited them to leave," said Dr. Jack Lafontant, a Haitian physician who served as a liaison between national health officials and the Comfort. "After two to three weeks, the field hospitals, the Comfort and even the public hospitals in Haiti did not receive as many patients," he added. "There is no more emergency."

But that characterization was disputed by longtime aid workers who expect the emergency phase of Haiti's disaster to continue for a long time, as the rainy season begins and hundreds of thousands continue to live with inadequate shelter. Other Haitian physicians pointed to the need for skin grafts, complicated wound treatment and the correction of surgeries performed hastily under less-than-optimal conditions. "You can't expect to come in for six weeks, restore [medical services] to what they were previously, and leave," said Dr. Vanessa Rouzier, who works with the Gheskio medical clinic in Port-au-Prince. "Everybody knows full well that's inadequate." While international planning to support Haiti's evolving health care needs is under way, she said, "the concern is that all these institutions are leaving and there's still a huge gap."

A short boat trip away from hospital ship's empty wards, one type of gap was evident. Volunteers at the partially destroyed general hospital said that patients in the crowded, bare-bones medical ward are visited rarely by doctors, and nurses are in short supply.

On a recent day, a child died for lack of an oxygen regulator, a common piece of equipment that fits atop an oxygen tank, according to leaders of the medical organization Partners in Health. "The system, such as it is, is pretty well broken," said Dr. James Wilentz, a cardiologist at Lenox Hill Hospital in New York who recently volunteered at the university hospital. "I don't know whether there was that much of a system prior to this."

Bringing advanced medical care to a developing country that had little of it prior to a disaster presents built-in ethical questions: What level of care must be restored before it is acceptable to depart? And does "earthquake-related" medical need include only broken bones suffered during the event -- much as the Comfort defined it -- or does it extend to children injured weeks or months later playing around mounds of sharp concrete rubble, or an asthma attack brought on by living outdoors breathing burning garbage in a tightly packed camp?

"The problem is that need is never going to go away 100 percent," said Dr. Miriam Aschkenasy, who served as a rotating director of the Fond Parisien Disaster Recovery Center in Haiti run by the Harvard Humanitarian Initiative. Aschkenasy said the timing of the Comfort's departure was reasonable. "They're not a solution. They're an emergency bridge. To me, that's what I see their role is, and I think they played that perfectly."

Whether outside health organizations have risen to replace that bridge fully remains to be seen. A number of non-governmental field hospitals have remained open, helping to replace collapsed or damaged Haitian health facilities. Foreign medical volunteers, including many Americans, continue to work alongside Haitian colleagues at public and private hospitals around the country. However, as some medical groups depart, others committed to staying for a longer period are experiencing difficulty covering all needs. And development experts say that strengthening Haitian government institutions -- a goal of international assistance before the earthquake -- has scarcely begun.

On a morning in late February, an inflatable field hospital established by Doctors Without Borders had 20 percent more patients than beds. Dr. Michel Jannsen, then the hospital's head, said nearly 100 additional patients arrived in a single day after military and governmental field hospitals from Europe, North America and Asia as well as smaller non-governmental organizations had pulled out of the country.

The patients, he said, "are not cured. They are still sick." What's more, he said, given the massive destruction of the city and the few options for decent shelter, even those well enough for discharge and outpatient care had no place to go. Two months after the quake, hundreds of thousands of displaced Haitians are still squatting in vast fields under sheets and tarps. As surgical activities wound down on the Comfort, Lt. Cmdr. Thomas Olivero, department head of the ship's main operating room, said staff members were still itching to offer aid. "Particularly military people, when they're deployed they like to be kept busy," he said. "You want to take care of people. We know there's a lot of people out there that still need help."

Experts agree that support to Haiti's medical and public-health infrastructure will be needed for the long haul to protect the investments the U.S. has already made. "There are big challenges ahead," said Dr. Helen Miller, a pediatric emergency physician from Oregon who worked at a government field hospital last month. People living in crowded camps are at risk for infectious-disease outbreaks, she said, and their regular illnesses may worsen under the stressful conditions. "This is a marathon."

New Orleans Coroner Rules Post-Katrina Death ‘Unclassified’

2010-03-11T12:44:13-05:00

by Sheri Fink, Special to ProPublica -

March 11: This post has been updated.

Frank Minyard, the Orleans Parish coroner, has concluded that he cannot determine what caused the death of Jannie Burgess, a 79-year-old patient who perished at Memorial Medical Center after a doctor ordered that she be given multiple doses of morphine in a short period. The hospital was cut off for several days by the floodwaters of Hurricane Katrina and a number of patients were found dead with elevated levels of morphine and other drugs.

"We cannot tell what she died of except that she was extremely ill," Minyard said in a phone interview several hours before a scheduled press conference. "She had a lot of physiologic reasons to die." Minyard said his official finding was that the cause of Burgess' death was "unclassified." His ruling makes it highly unlikely that any charges will be brought in the case.

The details of Burgess' death were first disclosed in a ProPublica report published in The New York Times Magazine last August. Her medical records showed that she was repeatedly dosed with morphine after the hospital had lost power, temperatures soared, and rescue helicopters failed to arrive in sufficient numbers.

The physician who ordered the medication, Dr. Ewing Cook, said that he intentionally "hastened her demise" because Burgess, who had advanced, metastatic uterine cancer, was close to death, was being cared for by nurses whose help was needed elsewhere, and would have suffered greatly if her pain medication wore off during any attempt to evacuate her.

"Dr. Cook thinks that he knocked her off," Minyard said, "but we can't prove that. He might have, he might not have. Because it's not 100 percent proved, we have to call it unclassified." He said some of the experts he consulted pointed to the fact that Burgess' death was recorded as having occurred more than three hours after the last of the morphine injections.

Cook declined to comment for this article. Minyard said that he had not spoken with Cook during his investigation. He said that during his investigation he consulted with four pathologists who work in his office, three local experts and Dr. Michael Baden, a renowned forensic pathologist from New York.

Baden has said he has a different view of the case. In an interview several months ago, after he reviewed Burgess' records, Baden said that Burgess' death was "no question a homicide." Homicide is defined by coroners as a death caused by the action of another person. Such findings do not address the issue of intent which is critical to deciding whether a crime has been committed.

Burgess' daughter, Linette Burgess Guidi, said she had not seen the experts' determinations. She said she hoped that some sort of review board could review Cook's actions. "I understand he was under a lot of pressure," she said. "I'm not out for vengeance. I just want to know the truth, I want to know what happened." She added, "There's too many questions."

The district attorney in Orleans Parish, Leon Cannizzaro, will ultimately decide whether there will be further criminal investigation or prosecution related to Burgess' death. Minyard conducted his assessment of the Burgess case at Cannizzaro's request. In September 2009, shortly after the ProPublica report, Cannizzaro said he asked Minyard "to classify the deaths reported in" the article. Cannizzaro could not be reached immediately for comment on the coroner's decision.

In 2006, authorities arrested Dr. Anna Pou and nurses Lori Budo and Cheri Landry for alleged mercy killings at the same hospital after Katrina. A local grand jury heard evidence in the case and declined to bring charges. The nurses and Dr. Pou emphatically denied that they had murdered patients and the case prompted outrage in New Orleans where medical professionals who worked in horrific conditions after the storm were widely viewed as heroes and victims. Some close to Minyard speculated that the coroner, who recently won re-election to his 10th term, decided to postpone his determination in the case until after the election -- something Minyard denies.

Minyard, 80, said the reason he had not completed his investigation of Burgess' death before now was because his office has a great deal of work on other cases and is understaffed. "I've just got too much going," he said when contacted last December. "I just want to make sure when I do it that I have it right."

Update: Minyard's press conference has happened. For more on the conference, go to the New Orleans Times-Picayune.

The District Attorney's office has just released this statement: "Since it is the Coroner's opinion that this victim did not die as a result of being administered a lethal dose of narcotics, I cannot pursue a homicide charge at this time."

Reporting Recipe: How You Can Investigate Your State’s Oversight of Its Nurses

2010-03-03T17:38:44-05:00

by Charles Ornstein and Tracy Weber, ProPublica -

Nursing boards – and other agencies that oversee such professionals as pharmacists, dentists and mortgage brokers – do not get nearly enough scrutiny. These boards are charged with protecting consumers from unscrupulous or incompetent professionals, but some provide almost no public information about what they do or how they're run. They are sometimes led by ill-qualified political appointees and lack sufficient personnel. But should these boring bureaucracies fail, the implications for your health, finances, and home can be dire.

We realize that many newsrooms face competing priorities and limited resources, so we’re making our reporting recipe public.

Visit our special site with our complete how-to investigation guide, with information on all 50 states.

Feds Reassign Heads of Troubled Caregivers Database

2010-03-01T21:41:33-05:00

by Charles Ornstein and Tracy Weber, ProPublica -

Federal officials have removed the management team overseeing a national database of dangerous or incompetent caregivers after questions were raised by ProPublica about its accuracy.

The reassignments of the division director and four managers came in response to our story last month that found the repository was likely missing thousands of serious disciplinary cases against health providers.

Congress ordered up the database more than 20 years ago. It was supposed to provide an alert system for hospitals, flagging them to disciplinary actions taken in any state against nurses, therapists, pharmacists and other licensed health professionals.

It finally became available to hospitals Monday. But it comes with a warning: Federal officials are "currently reviewing the completeness and accuracy of state licensure information."

The Health Resources and Services Administration (HRSA) declined Monday to make its administrator and the new director overseeing the database available for interviews. The agency also wouldn’t comment on the personnel changes.

But in an internal e-mail sent last week, Mark S. Pincus, the newly named acting director of the Division of Practitioner Data Banks, confirmed the reassignments. Pincus had previously led the program from 2004 to 2007. HRSA officials would not comment about why Pincus was chosen given the gaps in the database during his previous tenure.

Pincus replaces Darryl A. Gray, who told reporters last month that his staff "constantly" monitored state regulators' Web sites to ensure the federal database was complete. Gray did not respond to an e-mail seeking comment Monday.

ProPublica’s own review found that at least 20 states, including California, Illinois and Tennessee, failed to adequately report the sanctions they took as required by federal law.

After reviewing these findings, Mary Wakefield, HRSA’s administrator, conceded that the database was incomplete. She ordered an audit, offered technical assistance to states and sent letters to every governor requesting their help. In the letters, she wrote that agencies that did not report disciplinary actions to the database would be publicized.

State officials say they are taking steps to ensure that their records are complete. Many said the federal government had never questioned them about their missing records.

In California, for example, the executive officers of the agencies overseeing psychiatric technicians and occupational therapists hadn’t reported any disciplinary actions. In the last two years, dozens of psych techs had their licenses restricted or taken away after serious misconduct. Both agencies said they plan to report in the future.

In Tennessee, certified nurse aides weren’t reported. And in Illinois, emergency medical technicians were left out.

In addition, many state regulators said reporting to the database is cumbersome and often confusing, making it difficult to meet the federal mandate. One state nursing regulator said she often had a staffer working full time to sort out discrepancies.

Hospitals began using the National Practitioner Data Bank in 1990 to research doctors and dentists. But a series of problems delayed its expansion to other health providers until now. On Monday, hospitals were finally able to access data on about 280,000 nurses and other practitioners who have been disciplined by states. Federal officials are still assessing how many more will be added once the gaps are filled. The database is not open to the public.

Judge Strikes Complaint in Libel Suit Against ProPublica

2010-02-24T21:21:39-05:00

by Robin Fields, ProPublica -

A ruling (PDF) issued Wednesday by a federal judge in Louisiana will effectively result in the dismissal of a libel lawsuit filed last year against ProPublica and the New York Times.

The case concerned "The Deadly Choices at Memorial," an article written by ProPublica's Sheri Fink and published in August in The New York Times Magazine.

The story reported how, in the chaos following Hurricane Katrina, some health professionals at Memorial Medical Center in New Orleans injected severely ill patients -- more patients than had previously been known -- with lethal doses of drugs.

Dr. William Armington, a neuroradiologist mentioned in two paragraphs of the 13,000-word article, filed the suit in October, claiming the story falsely suggested he had known patients were being euthanized and did not act to prevent it.

In Wednesday's ruling, U.S. District Court Judge Martin L.C. Feldman wrote that the story did not indicate Armington had been among those involved in injecting patients. The judge concluded the article had not defamed Armington and that Armington had not shown anything in it to be false.

"Dr. Armington," the court found, "is portrayed as a doctor who, while suspecting euthanasia might occur, renewed his efforts to evacuate all of the patients."

The judge ordered Armington to pay the defendants' attorneys fees and costs, in accordance with Louisiana law.

Maxwell Kennerly, Armington's attorney, noted in an e-mail that the judge had conveyed distaste for the story in his opinion.

"The Court believed that the article 'selfishly resurrects melodrama to an old and sad story,' but nonetheless held that the article did not 'directly accuse Dr. Armington of engaging in euthanasia,'" Kennerly wrote. "We respectfully disagree with the latter."

David McCraw, the Times' assistant general counsel, said he was pleased the court had moved quickly and decisively on the matter.

"While the judge expressed some disagreement with our decision to publish the story," McCraw said, "he recognized that the article was in the public interest, that it portrayed Dr. Armington as a doctor who worked hard to evacuate patients, and that nothing about the article defamed Dr. Armington."

Richard Tofel, general manager of ProPublica, said, "We're very pleased with the court's opinion, and continue to be enormously proud of Sheri Fink's extraordinary work of journalism."

Introducing Our State-by-State Guide to Dangerous Nurses

2010-02-22T10:04:43-05:00

by Charles Ornstein, ProPublica -

Our ongoing investigation of gaps in the federal government’s database of sanctioned caregivers has turned up additional problems. In a story published this morning in the Chicago Tribune, we detail how the state of Illinois hasn’t reported a single emergency medical technician whose license was revoked or suspended.

Other states, including California, Ohio, Indiana and Tennessee, also have failed to completely report to the feds on disciplinary actions against nurses, pharmacists, psychologists, therapists or other health professionals.

With this in mind, we’ve created our own easy-to-use guide to verifying nurses’ licenses in every state. You can see which states let you look up nursing licenses for free online and which provide Web access to disciplinary documents.

We hope the guide helps not only the public, but health employers and journalists who want to check on how well their states regulate nurses.

Last year, when we looked at California’s Board of Registered Nursing, we found a system plagued by delays that allowed nurses to move from hospital to hospital, amassing complaints, before they were disciplined.

Our story in today’s Tribune, along with one last week in the Los Angeles Times, follows up by focusing on the federal government’s effort to expand its National Practitioners Data Bank beyond just physicians and dentists.

The database is meant to be a clearinghouse that employers can use to make sure dangerous health workers aren’t hopscotching undetected from state to state. But we found that many states haven’t been reporting disciplinary actions to the feds. Our review suggests that thousands of cases might be missing.

They include a Chicago EMT who lost her license in 2000 after she repeatedly failed to provide proper emergency care to patients. Her license was revoked again last year – after regulators discovered she'd lied to get a new one.

A spokeswoman for Illinois’ Department of Public Health, which oversees EMTs, told us officials hadn’t been aware of the federal database or the need to report sanctions to it.

After we began asking questions, federal officials said they would increase their oversight and conduct an audit to determine what is wrong and how to fix it. And they sent a letter to governors asking for help filling gaps.

GE and Muzzled Radiologist End UK Libel Case

2010-02-18T14:29:04-05:00

by Jeff Gerth, ProPublica -

GE Healthcare has settled its libel lawsuit against Henrik Thomsen, the Danish radiologist who had raised questions about the safety of one of the company’s drugs used for magnetic resonance scans.

The two-year-old suit in London involved a 2007 presentation Thomsen made in Oxford and statements in an article published in his name by a European scientific journal in February 2008. Both contained descriptions of his experiences at a Copenhagen hospital in 2006, when 20 kidney patients, all of whom had been injected with the GE Healthcare drug, Omniscan, developed a crippling and sometimes deadly disease. The rare condition is called nephrogenic systemic fibrosis, or NSF.

The libel suit was first disclosed two months ago by ProPublica and The Sunday Times. The case quickly became a key exhibit in a running debate about whether England’s libel laws are so restrictive that they impede free speech, including the open exchange of scientific information.

Neither the company, a subsidiary of General Electric, nor Thomsen, who is director of diagnostic sciences at the University of Copenhagen, disclosed the terms of the settlement.

Dr. Lynne Gailey, the company’s spokeswoman, said in a statement (PDF) issued jointly with Thomsen that GE Healthcare never intended "to stifle academic debate" but objected to statements by Thomsen "which it interpreted as suggesting that it had known from the outset that Omniscan caused NSF." The company now believes Thomsen’s "concerns were expressed in good faith" and "regrets that these proceedings were necessary to reach the common understanding described in the statement."

Thomsen said in the statement that he had not intended "to suggest that on the basis of the evidence then available to me that GE Healthcare had marketed Omniscan knowing that it might cause NSF." The statement said his comments had been based on statements by other experts, including some at a Berlin conference in May 2007, "which indicated that it had been known for many years that there was a specific risk arising from the formulation of gadodiamide" – a uniquely structured chemical compound found only in Omniscan.

Omniscan is one of several contrast agents containing the metal gadolinium. Some of the gadolinium- based agents have been linked to NSF in patients with severe kidney disease. Some 500 lawsuits over gadolinium-based agents have been filed in U.S. federal courts by patients who contracted NSF; most involve Omniscan.

Thomsen’s statement said he continues to "stand by" his publicly expressed opinion that "there is an association between the chemical formulation of gadolinium-based contrast agents and NSF."

GE Healthcare, in its statement, repeated its long standing position that it is cooperating with authorities around the world as part of an effort to look at the safety of these agents "based on evidence and science." The company has previously said evidence isn’t sufficient to show (PDF) that the risks of NSF are greater for patients using Omniscan than for competing drugs.

GE is the only manufacturer that has not settled NSF lawsuits in federal courts. The first of those cases is scheduled to go to trial later this spring.

Thomsen's and GE’s statement (PDF).

Read our complete coverage of GE and Omniscan.

Dangerous Caregivers Missing From Federal Database

2010-02-15T03:04:56-05:00

by Tracy Weber and Charles Ornstein, ProPublica -

This story was co-published with the Los Angeles Times.

More than two decades ago, Congress set out to stop dangerous or incompetent caregivers from crossing state lines and landing in trouble again.

It ordered up a national database allowing hospitals to check for disciplinary actions taken anywhere in the country against nurses, pharmacists, psychologists and other licensed health professionals.

On March 1 – 22 years later – the federal government finally plans to let hospitals use it. But the long-awaited repository is missing serious disciplinary actions against what are probably thousands of health providers, according to an investigation by ProPublica in collaboration with the Los Angeles Times.

Some of the missing cases involve providers who have harmed patients – a nurse, for instance, whose license was pulled after she injected a patient with painkillers in a drugstore parking lot and improperly prescribed methadone to an addict who later died of an overdose.

The omissions took federal health officials by surprise. Only last month, a spokesman for the agency that oversees the database told reporters that "no data is missing." Another official said the agency had been "constantly" checking its data against state licensing board Web sites.

But Friday, the head of the Health Resources and Services Administration (HRSA) acknowledged that records were missing. She said her agency had launched a "full and complete" review to determine what is wrong and how to fix it.

"We take this very seriously," administrator Mary Wakefield said.

The new information will still go online as planned – but with a warning that it is incomplete, she said.

Wakefield and Health and Human Services Secretary Kathleen Sebelius sent a letter Friday to the nation's governors asking for their immediate help fixing gaps in the database. It was a matter of "protecting the safety of patients across this country," they wrote.

This summer, the letter said, the federal government will begin publicly listing any state agencies that do not report properly. Wakefield's agency also plans to hold training sessions for state officials and conduct audits to help ensure compliance.

The government for two decades has kept a database of disciplinary actions against doctors and dentists. In 1999, state boards were required to begin filing reports on all other health professionals whose licenses were revoked or restricted.

Yet many states have filed sporadically, if at all. They've faced no penalties.

Reporters compared the total number of disciplinary actions that various states reported to the federal government – detailed on the HRSA Web site – to the states' own records, some of which were posted online. The discrepancies were glaring.

The federal government's site does not include a single report of discipline against any of the thousands of psychiatric technicians or occupational therapists in California.

Yet the Web site for the California board overseeing psychiatric technicians cites 84 who received severe sanctions in the last two years alone. Among them are two who surrendered their licenses after failing to help a woman who was choking to death on a paper towel and a third convicted of possessing child pornography.

Similarly, the occupational therapy board lists 40 disciplinary actions over five years.

Leaders of both state boards acknowledged that they hadn't been reporting disciplinary cases to the federal government but said they intended to do so in the future.

Judging from the federal numbers, no pharmacist has been disciplined in South Dakota or New Hampshire, and only one each in Alabama, Delaware, Ohio and Tennessee. But a search of those states' Web sites showed hundreds of sanctions.

Reporters found at least nine states that appear to have submitted incomplete records on registered nurses.

Indiana didn't report hundreds of disciplinary actions in 2004 and 2005 – including the nearly 100 nurses who were indefinitely barred from caring for patients. In one case, a nurse had put a knife to a co-worker's throat.

It's difficult to quantify how much data is missing. In each state, multiple boards oversee various health practitioners. Each has different rules and methods for meting out discipline. Some don't make the information public, and others said they didn't know the number of actions they'd taken.

Troubled professionals can have licenses in multiple states, so checking with just one state's board might not turn up disciplinary actions elsewhere. Moreover, state regulators can be slow to share information with one another, and some professionals hide past sanctions.

Several directors of state licensing agencies said they had assumed that their cases were being reported to the federal government.

Sean Gorman, the director of Indiana's nursing board, learned from reporters that hundreds of his state's actions against nurses had not been. That prompted Indiana to audit compliance by all of the state's health boards.

In Ohio, William T. Winsley, executive director of the pharmacy board, said he had no idea that only one of his state's pharmacist cases had been reported. At his board's November 2009 meeting alone, it pulled the licenses of five, including one who ran an Internet pill mill that dispensed nearly 1.5 million drug doses without valid prescriptions.

The database has had a long and fitful history.

In 1986, amid concerns that doctors were racking up malpractice accusations and then moving freely to other states, Congress called for a central repository of disciplinary actions against them. The next year, lawmakers expanded the requirement to include all health care workers.

The idea was to create a one-stop clearinghouse that hospitals and other eligible employers could check. The National Practitioner Data Bank was up and running quickly on doctors and dentists, but a series of logistical, technological and financial hurdles delayed its expansion. Some 280,000 nurses and other practitioners are to be added March 1.

Federal officials predict that the new information will be searched more than 123,000 times annually by health employers and others. The database is not open to the public.

Hospital industry officials said they welcomed the database but emphasized that it's just one tool for screening potential hires, along with criminal checks, drug tests and reference calls.

With an incomplete database, however, employers could be given "a false sense of security that somebody who may be really dangerous isn't, because their name isn't there," said Dr. Sidney M. Wolfe, director of Public Citizen's Health Research Group.

The federal government has had plenty of time to make it right, said Wolfe, whose Washington-based group advocates for patient safety. "It's really just embarrassing."

Haitians Under U.S. Treatment Are Often Separated From Families

2010-02-02T12:50:08-05:00

by Sheri Fink, Special to ProPublica -

PORT-AU-PRINCE, Haiti – In turning tents into sophisticated operating theaters and deploying a gleaming hospital ship, the USNS Comfort, to the coast of Port-au-Prince, the U.S. government has brought needed medical services to thousands of Haitian earthquake survivors.

But after top U.S. doctors operate on severe injuries and treat infections, it is up to Haitian family members to see their loved ones through the long process of healing.

The ability of the U.S. system to connect with these family members nearly three weeks after the Jan. 12 disaster remains uncertain at best.

Navy helicopters often whisk the ill and injured from one medical site to another without documentation, leaving family members behind. As of last week there was no phone number for relatives to call to check on hundreds of patients being treated aboard the Comfort.

"Patients actually die from that, when they’re left alone with no family," said Nick Goldsberry, a registered nurse working at a tent hospital in Port-au-Prince with San Diego-based International Relief Teams.

Kevin Tweedy, a public information officer for a different field hospital in Port-au-Prince run by the U.S. National Disaster Medical System, struggled to find information for concerned relatives last week. On Tuesday he gripped a small cell phone to his ear. "People are getting upset," he told Keziah Furth, an American nurse volunteering as a liaison officer for the Comfort. "They’re beating on the gates. They want to know where their family member is."

The family of one of those patients spent last week in anguish. Gerd Belizaire, a 35-year-old engineer, was buried under rubble after the earthquake. Days after being rescued, he developed difficulty breathing, and the oxygen level in his blood dipped dangerously low. Doctors at the U.S. government field hospital put a tube in his throat to help him breathe, and one of Belizaire’s brothers, Ketler, scoured the city for a tank of oxygen.

Belizaire remained in critical condition, and a week ago Saturday the American doctors arranged urgent transport to the Comfort for intensive care. His wife, mother and brother bid him emotional goodbyes.

All week the family was unable to find out what happened to him. On Wednesday, a relative in the United States said he had reached someone by phone who informed him that Belizaire had died.

But Belizaire’s brothers and wife in Haiti were unable to confirm that information, even when I tried to help them navigate the bureaucratic labyrinth. They made daily visits back to the field hospital, and we placed phone calls to at least a half-dozen phone numbers on the Comfort. "It’s killing me," Belizaire’s wife, Giovanni, said on Wednesday.

On Sunday a relative, Dashley Beaubrun, said in an e-mail that the family had been told Thursday that Belizaire was alive, but had received no information since that time. A brother, Vladimir Gousse, said by phone that he was still awaiting news.

But a final call to a military public affairs officer on Sunday night revealed the worst. A patient matching Belizaire’s age, last name and with a similar first name, "Gend," had been recorded as deceased.

He had been dead on arrival to the Comfort, a day after he was picked up for urgent transport. Where he spent the intervening hours was unknown. According to the ship’s public information office, Belizaire’s body was released to the Haitian Ministry of Health more than a week ago. But the family has been unable to locate him.

"We looked at all the bodies, all the files, we can’t find his name," Belizaire’s wife said Monday. "I don’t know what to do. If he’s dead, where’s the body?"

The reasons for the bureaucratic tangle are unclear. Patients who arrive on the Comfort are immediately entered into an electronic record-keeping system. Tracking them should be a matter of a few mouse clicks. The hospital ship has supported numerous international relief efforts for years, so the need to provide answers to families should not have been a surprise. The Comfort had been deployed to Haiti before, as recently as last spring.

To be sure, the massive scale of the disaster, the deaths of Haitian officials and destruction of infrastructure have posed numerous challenges to coordination and communication. Last week, public affairs officers with the U.S. Joint Information Center for Haiti could not provide an explanation for the delay in making patient information available to families, except to say that the Comfort was working with non-governmental organizations to come up with a solution. "It’s very, very important to us," said one officer. "As soon as we can get that information out, we’ll let everybody know."

Lt. David Shark, a Navy assistant public affairs officer working on the Comfort, said on Sunday that a patient hot line for the ship was established on Saturday. However, he did not have the number and did not provide it after several requests. He also said that family members are allowed to travel to the ship with patients, and some have done so. But many field hospital personnel had been unaware of that.

Medical transports with unaccompanied children have been another disturbing problem. Last week, a U.S. Navy helicopter hovered over the American field hospital. A soldier descended a zip line carrying a baby whose head was grossly enlarged. The only information the hospital was given was that the baby had "water on the brain." The helicopter's propeller wash sprayed debris into the eyes of two medical workers and wreaked havoc in an adjacent "tent city" where thousands huddled under sheets propped up by tree branches.

Roughly a dozen other children were delivered to the American field hospital in recent days without family members, documents or even minimal information on where the children were being transported from.

Vanessa Rouzier, a pediatrician at a Haitian medical clinic, Gheskio, that is hosting the American field hospital, was outraged by the practice. "To me it’s shocking and unethical," she said. "It has to stop. You end up with orphans who may not be orphans."

Rouzier said rumors were flying among Haitians that foreigners were abducting children or stealing patients’ organs. (On Sunday, 10 members of the Central Valley Baptist Church in Idaho were arrested in Haiti amid accusations that they tried to spirit children out of the country to the Dominican Republic.)

"Many people are getting offended," Rouzier said. "‘How can you take my sister for five days now and not even tell me if she’s alive or dead?’ That would be a scandal in the U.S. Then they take minors without parents for amputations."

Staff at the American field hospital began making arrangements for a nearby orphanage to accept the unaccompanied children after they were treated. In the meantime, the Americans turned the hospital’s post-operative tent into a nursery and assigned staff to provide comfort and care. Some bonded with the children and began asking whether adoption might be possible.

Ultimately Rouzier and her colleagues located close relatives of nearly all of the children.

She and other Haitians said they were impressed and overwhelmed by America’s generosity, even as they were concerned by the missteps.

Doing good, Rouzier said, needs to be done the right way.

"When they leave, who’s going to stay behind to pay the price for it?" she asked. "Us."