As Hurricane Bonnie battered the North Carolina coast last month, it wreaked havoc on patient care at a small community hospital in Supply.
Bonnie peeled the roof off 56-bed Columbia Brunswick Hospital, forcing the evacuation of 31 patients to nearby Grand Strand Regional Medical Center in Myrtle Beach, S.C. Both hospitals are managed by Nashville-based Columbia/HCA Healthcare Corp.
"It was quite an effort to get the ambulances up there," says Jeff Prescott, a Columbia spokesman. "There were some heroic efforts involved." With the National Guard's assistance, workers from Wilmington-based New Hanover Regional Medical Center, some 40 miles to the south, plowed through flooded roads in a Humvee, picking up six Brunswick patients.There were no reported injuries, Prescott says.
Bonnie's 115-mph winds pulled a 1-ton air conditioning unit off the hospital roof, opening a gaping hole over the maternity ward (See photo). Prescott says there was "tons of damage" to the hospital, which was closed for repairs Aug. 27.
But the move to close the hospital drew fire from some local officials, the Wilmington (N.C.) Morning Star reported.
Huey Marshall, attorney for Brunswick County, complained to the paper: "The (county) commissioners are wondering why they don't have an emergency room as specified in the hospital contract (between Columbia and the county)."
There's an irony here. Columbia/HCA Healthcare Corp., which leases Brunswick Hospital, recently backed off plans to sell the facility to New Hanover Regional. County commissioners, angered about not being consulted prior to the agreement, gave Columbia an ultimatum: Keep the hospital and expand the ER or fork over some of the proceeds from the sale.
Reach out and pitch someone. Even when President Clinton goes on vacation, activists have to remain creative to get their message to him and the national media.
The Paralyzed Veterans of America last month announced that they don't want Kenneth Kizer, M.D., to be appointed to another four-year term as head of the Department of Veterans Affairs healthcare system. They say reforms under Kizer's leadership have resulted in reduced access and quality of care for veterans with spinal-cord injuries.
Their choice to reach Clinton: an advertisement in the form of an "open letter" asking for a new appointee. But instead of publishing it in one of the powerful national dailies like the Washington Post, New York Times or Wall Street Journal, the PVA chose the tiny Vineyard Gazette, a twice-weekly newspaper on Martha's Vineyard, where Clinton vacations every year.
"We call on you to deny Dr. Kizer an additional four years and, instead, bring new leadership to veterans' healthcare," the advertisement said.
The PVA is fortunate they chose to oppose Kizer before Clinton ended his vacation. To reach the globe-trotting president last week would have required the PVA to take out ads in a Russian newspaper.
Complain by the numbers. Consumers can now purchase a booklet that offers the inside scoop on how to gripe effectively about hospital services.
The 37-page Multi-step Hospital Complaint Process gives step-by-step instructions on how to protest such things as long waits for pain medication or a dirty bathroom.
It's being sold for $14.95 plus $3 for shipping by a Scranton, Pa., outfit called Hospital Complaints of America. Vice President John Manlie says the booklet has been advertised mainly in Catholic publications in New Jersey and has sold about 100 copies since its printing in June.
Manlie says he's been on both sides of the fence, having worked as a midlevel healthcare administrator and having a wife with a chronic illness. He says patient complaints often are ignored because they are "too emotional" and not addressed to the proper parties.
The booklet encourages patients to ask first for a "patient representative" or "risk manager." If that doesn't work, it provides sample letters to hospital CEOs, the Joint Commission, state health departments, HCFA and finally Congress. Addresses are also included.
"Many patients haven't ever heard the words `risk manager,' and hospitals don't tell you about them," says Manlie, who declines to specify his healthcare work experience. "I think citizens have a right to know how to go about this."
The schmooze factor. A recent study financed by the Agency for Health Care Policy and Research sought to discover why sicker patients are less satisfied with their medical care than healthier patients. That search led to the conclusion that patients in better health got more social conversation from the doctor, prompting them to give the physician a higher rating on bedside manners and making the patients more satisfied.
This, obviously, puts HMOs in a tough spot. In the name of economic efficiency they're limiting the number of minutes patients can spend with doctors. At the same time they have to boost their patient-satisfaction results, which are being analyzed by everyone from purchasers to accreditors to self-appointed quality watchdogs.
Rate Controls, a newsletter published in Phoenix, suggests, with tongue firmly in cheek, that the trend toward specialization in medicine could naturally lead to the emergence of a new subspecialty: the designated "chatterbox" physician, who would be responsible for "management of social discourse."
Doc$. What's a doctor worth? It seems the answer depends on the experience, or perhaps simply the age, of the practitioner.
According to a recent survey by Medical Economics, physicians younger than 39 have a median net worth of $250,000, while those over 60 average $1.5 million. More than 20% of those surveyed were worth $2 million or more. About a quarter of physician households enjoyed family income of more than $300,000 in 1997.
The number of employed physicians over 40 is rising. In 1992 it was 16%. By 1997 it was 24%.