Health Perspectives Vol. I No. 8 November-December 1974


Using the example of special interest success in presenting a view that is not challenged, this issue started with “In the United States today, conditioned as we are by television’s Marcus Welby and Medical Center, we think….”. Marcus Welby and Medical Center were the then current popular medical shows that depicted the American medical care dream. Handsome doctors, white patients, superbly trained and always helpful nurses, clean even immaculate overstaffed hospitals, wonderful results and barely any mention of expenses. These shows followed on the heels of City Hospital, The Doctor, Medic, Dr. Kildare, Ben Casey, The Doctors, General Hospital, and The Nurses; which in turn led the way for another 50 medical shows including the currently running House, M.D. , Private Practice, The Listener,  Royal Pains, HawthoRNe, Nurse Jackie, and Grey’s Anatomy. America’s insatiable fascination with miraculous medical care and an incredible to deny its failures are important subjects as is the subject of this issue of Health Perspectives. America’s fascination as now extends to showcasing pathologists (albeit forensic) in a variety of shows dedicated to solving hot and cold murder cases.

What this has to do with hospital inspection is a good question unless you understand that these shows, even the more realistic ones, still have a lasting impression on the public’s sense that medical doctors working in hospitals and morgues have an ability to solve and resolve all that ails America dead or alive. What is not mentioned, certainly not in any manner except in passing, is that medical care received is in the top five killers in America each and every year. One major contributor to that horrific researched and understood fact is the failure to maintain standards that promote wellness and health not accept medical care that kills. Standards once set should be honored by routine in house compliance programs, continuing education and training, safety procedures, and methods to eliminate obvious potential error and avoidable communication of vectors of disease.

But none of that is going to happen in hospitals which are not in compliance with building and operational codes mandated to protect people who are most vulnerable as patients. But even inspection programs undertaken to ensure that hospitals meet standards, minimum as they always seem to be, they have to be done with a maximum degree of professionalism, competence and independence. In most situations the inspections were not conducted as in this manner. The inspectors often act as if they are beholden to those they have the legal authority to hold accountable. And when the government agencies acted to uphold the codes and regulations the hospital industry had the clout to circumvent government efforts by the use of organizations they owned or controlled.

So with too much pressure the industry would seek new codes and regulations; dismantling of government responsibility to conduct inspections; crippling government efforts by use of appeal processes; reducing the inspection agency’s funding and staff; transferring inspection to other more industry friendly government agencies; etc. It is a loss-loss situation yet the disclosure by CCAHS of the failures and reproducing inspection findings made a splash in the media. That splash, almost a ripple in a tidal basin, brought forth demands for tighter inspections. As a result of the disclosures many hospitals in New York State were forced to comply with recommendations for changes.

The interlocking issues of disclosure, consumer rights and hospital inspections became apparent as the industry demanded that inspection findings be keep confidential. The reasons for this position included the failures of the inspection process itself, the ability to misread or misunderstand the findings, the failure to include changes made to correct specific deficiencies and the cost to make some changes.

In the 1970’s when CCAHS reported on this issue until the present, the hospital industry has failed to initiate successful internal programs to avoid the failures that were avoidable. These failures included operations on the wrong patient or wrong body part on the correct patient; drug errors; and transmission of avoidable communicable disease. The latter was due in large part to a total disregard of the proven fact that hands needed to be washed between patients and sometimes between procedures on the same patient. Only in the first decade of the 21st century and the appearance of MRSA and other rampant spread of infections that once responded to standard antibiotics did the public pressure the professionals and hospitals to encourage and enforce ‘hand washing’ procedures known to avoid disease for over 100 years.

Hand washing was advocated in 1843 by Dr. Oliver Wendell Holmes. Most of his ideas about self monitoring and discipline were greeted with disdain by many of his peers. Dr. Ignaz Semmelweis ordered medical students in Vienna to wash their hands to reduce maternal infections and deaths. The mortality rates dropped to less than one percent. But for the most part his dictums and the results were ignored elsewhere. Improved plumbing, research and education and other scientific advances should have made this problem of disease transmission a non-issue in America. But the massive misuse of antibiotics and ingrain resistance to hand washing, a fundamental infection control practice, led to a major initiative to “wash hands” in the first decade of the 21st Century.

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