Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
'Wrong-Pipe' Intubation Deaths
Twelve patients in Rhode Island died over the last 3 years after emergency responders mistakenly put breathing tubes down the esophagus, .
These "never events" were discovered by a research assistant to Nick Asselin, DO -- a former firefighter and EMT himself before he became a physician. Asselin then met with resistance when trying to raise the issue with state EMS regulators.
Asselin thought data on the first 11 cases -- eight of whom were treated by advanced-level EMS providers called EMT-Cardiacs -- would speak for itself. But a proposal to prohibit these providers from performing intubations was swiftly tabled by the state's EMS board. (Rhode Island is the only state in New England that allows non-paramedics to place breathing tubes.)
The board did, however, vote to require all providers to consider less invasive measures before inserting a breathing tube.
Just days after that vote, the 12th death involving an esophageal intubation occurred, in a 38-year-old mother who suffering cardiac arrest. The case triggered an investigation that found the EMT-Cardiac never attempted to use a device to monitor the patient's exhaled carbon dioxide levels.
When the patient arrived at the emergency room, her abdomen was distended, and when the respirator bag was squeezed, "gurgling sounds" came from her stomach area.
Physician Staffing Firm Sues Patients
While hospitals and health systems have been under fire for suing poor patients, that does the same.
Southeastern Emergency Physicians filed more than 4,800 lawsuits in Shelby County General Sessions Court since 2017, the news outlets reported. In just the first 6 months of this year, it filed more lawsuits than local hospitals Methodist Le Bonheur Healthcare -- which ProPublica and MLK50 for suing poor patients -- and Baptist and Regional One combined.
The situation is noteworthy because doctors have historically avoided suing patients en masse, instead sending unpaid bills to third-party collectors or writing them off as bad debt.
After questions from reporters, the staffing firm said it would no longer sue patients and wouldn't pursue lawsuits it already filed. It also implemented a new financial assistance policy on Dec. 1, with greater discounts being offered for the uninsured population.
Southeastern's parent company is TeamHealth, bought for $6.1 billion by the private equity firm Blackstone Group in 2017. Private equity investment in healthcare has become a growing trend over the last decade.
Former TeamHealth call center agents who spoke with ProPublica and MLK50 said they were told not to mention charity care programs unless patients asked first. These employees said they developed their own workarounds, like asking patients, "Did the hospital help you?" but the 4 minutes allotted per each call wasn't enough to help patients understand their options, those employees said.
As for Methodist, the hospital said it would curb its lawsuits over unpaid debt, and has zeroed out balances owed by more than 5,100 patients and reduced bills for more than 2,200 others.
Nursing Home Evictions
Thousands of Americans are evicted from nursing homes each year, many illegally, .
Long-term care ombudsmen, who advocate for nursing home residents, received 10,610 complaints about discharges and transfers in 2017, up from 9,192 in 2015, according to the news outlet.
Advocates say nursing homes tend to evict low-income, longer-term residents on Medicaid to make room for rehabilitation patients covered by Medicare whose stays are shorter. Medicare reimburses these visits at a higher rate. For example, in California, the average Medicaid reimbursement for a nursing home is $219 per day, while Medicare might pay more than $1,000 per day for up to 20 days.
When Medicare says it will no longer pay, patients can appeal or apply for Medicaid. An AARP Foundation executive said that while some residents get discharge letters with advance notice, others are asked or pressured to leave with "no due process rights, no notice."
In one case in Los Angeles, Ronald Anderson said he was evicted in the night from Avalon Villa Care Center, where he had moved a year earlier to recover from a partial foot amputation. He was loaded into a van and dropped off on a sidewalk in downtown Los Angeles, according to a report from the California Department of Public Health.
"You're just a piece of garbage," Anderson told NBC News. "They'll kick you right out on the curb."
Preventable Psychiatric Hospital Deaths
of death certificates, coroner's reports, and hospital inspection records identified nearly 100 preventable deaths -- predominantly suicides -- over the last decade at California psychiatric facilities.
Those tragedies cut across age groups, race, and social class, with victims including a 15-year-old high schooler in marching band, a 27-year-old who spent his free time volunteering at church, and a criminology PhD student.
Although the number of inpatient deaths in California is in line with national averages, the deaths reveal serious lapses in patient safety, according to the Times. In the last 10 years, more than 50 people have killed themselves while admitted to psychiatric facilities in California, and an additional 30 have attempted suicide but survived, according to documents reviewed by the Times. Other causes of death included homicide, medical error, and negligence.
Inpatient Julian St. John, 24, who had schizophrenia, killed himself at La Casa Mental Health Rehabilitation Center in Long Beach. His mother Mia is now lobbying for the state to publicize "track records" listing how many inpatients died at a facility. She hadn't known that just 2 years earlier, a 22-year-old committed suicide at La Casa, or that facility staff hadn't monitored that patient properly given his high risk of suicide, according to a state Department of Mental Health investigation.
Despite a suicide attempt three weeks before he killed himself, La Casa staff didn't take the plastic bags out of the trash cans in Julian's room. He was found face-down with a plastic bag over his head.