Canary in the mine?

After receiving nearly a dozen alerts of extraordinarily high rates of patient deaths, the Healthcare Commission launched an independent investigation of Stafford Hospital. It just released the report of its findings. It and the reports from thousands of patients and families in UK paint a disturbing picture of what is being described as “Third World” conditions in the hospital.

Sir Ian Kennedy, chairman of the Healthcare Commission, told the press that the full extent of the hospital’s failures is not known, but that its findings included deficiencies at nearly every stage of caring for emergency patients, equipment in disrepair — including nonfunctioning defibrillators, and patients dumped so that the hospital’s “waiting time” performance measures were lowered and it looked good on paper.

The commission said the leadership were more focused on money, performance targets and getting foundation trust status, as well as a desire to save £10million. “The hospital board was so focused on hitting financial and performance targets to achieve foundation status that it ignored issues of patient safety,” reported the Independent.

Health Secretary Alan Johnson said “it was a failure of management.” Sir Bruce Keogh, medical director of the NHS, was quoted saying there had been a “gross and terrible breach of trust” of patients and a “complete failure of leadership.”

The 382-bed hospital had so few nurses that receptionists and people with no medical qualifications at all were assessing and triaging emergency room patients, and nurses without understanding of cardiac monitors simply turning them off. “In one ward, 55 percent of patients were found to have pressure sores when only 10 percent had sores on arrival,” the report found.

Death rates in the hospital had ranged from 27 to 45 percent above average since at least the year 2000, but nothing had been done. The investigation estimates that 400 to 1,200 excessive deaths occurred during a three-year period. NHS inspectorate is now looking into the warning systems of every NHS hospital to assess the extent of the problems.

You can probably find horror tales from patients and families from just about anywhere, but the sheer volume and consistency of the ones from UK have stunned much of the world. Single-payer systems apply the drawbacks of monopolies to people’s lives — by eliminating the need for competition and incentives for continual improvement in quality and efficiency, and the checks and balances to help contain corruption. The reality can be in stark contrast to what we might hope.

Massachusetts’ experiment saw growing shortages of doctors within the first year and began rationing and cutting services, as it faced insolvency. In New Mexico, where the administration’s push for a similar system is especially intense, hospitals are already so short of young nurses, that Presbyterian Hospital recently introduced a new program to pay entry-level employees with no medical background to take an online associated degree course and get their nursing degrees by next May. The hospital hopes to fill 350 nursing vacancies. Reducing education standards for medical professionals will put warm bodies on the floors. Will they know what the squiggly lines on the cardiac monitors mean, either?