The Truth About Hospitals That `Exist To Make Money'

On this page recently, columnist Matthew Miller defended profit-oriented medical care, arguing that for-profit hospitals such as Columbia/HCA are actually beneficial to the public's health. That's kind of like saying that McDonald's exists for good nutrition.

What's beneficial about for-profit hospitals that consider unprofitable patients and services a financial drain?

Take it from a former executive of the largest hospital in the world's largest for-profit hospital chain, Columbia/HCA. "Columbia exists to make money - period," Mark Gardner told the Wall Street Journal, adding that as vice president of mammoth Columbia Sunrise Hospital in Las Vegas, "I committed felonies every day." Media reports say the chain is currently the target of a multistate Medicare fraud investigation.

Miller's comeback is that nonprofit hospitals are just mad now that for-profits are making the big bucks. Of course, many nonprofit hospitals have made a "profit" (they call it margin) and allow excessive administrative expenses. Some nonprofit hospital executives have excessive compensation packages, and some nonprofit hospitals - frequently in response to new market players like Columbia - have embarked on dangerous cost-cutting strategies.

But for-profit chains like Columbia/HCA are leading the way to lower patient-care standards. Columbia executives like to call their company the Wal-Mart of health care. (Not a healing thought!)

By definition, profits come first at for-profit hospitals like Columbia/HCA. The chain follows a well-established strategy, moving into a state and hiring lobbyists. Columbia buys for-profit hospitals and secures nonprofit hospitals through secret negotiations, frequently paying artificially deflated prices. Hospitals and services that don't make money are closed. Hospitals that remain open are expected to meet the company's high profit goals. Skilled staff are cut, substandard equipment is purchased, and "just in time inventory" is imposed, creating constant shortages of blood tubing, gloves, IV poles and pumps, and other basics.

To document for the first time exactly how Columbia/HCA lowers patient-care standards after acquiring a facility, the Service Employees International Union (SEIU) has just begun releasing a series of reports on Columbia Sunrise in Las Vegas.

The first report, released on June 26, showed how the staffing ratio has declined across the hospital. From 1994 to 1996, adjusted admissions increased 17 percent , adjusted patient days increased 4 percent, but total staffing increased just 1 percent. The study went on to show that understaffing results in delays in critical blood tests and failure to give prescribed respiratory treatments.

One respiratory therapist told researchers that, because of understaffing, Columbia Sunrise failed to give as many as 100 prescribed treatments a day during the busy winter months. Another respiratory therapist said that out of every 10 patients admitted for respiratory treatment, "maybe (two or three) of them get worse instead of better during their stay" at Sunrise. The State Bureau of Licensing issued a deficiency report documenting that on 11 separate days over a several-week hospital stay, a patient had not received the number of breathing treatments ordered by her doctor.

Understaffing in the Columbia Sunrise lab means that nurses and patients in critical-care units must wait hours for stat (urgent) test results. In a single three-day period in early June, intensive-care nurses documented seven lab delays. On June 3, a registered nurse ordered a stat blood test on coagulants for a heart patient. The test should have been done in minutes. The nurse waited 6 1/2 hours for the results.

In an October 1996 poll of more than 500 Columbia Sunrise workers, 60 percent reported potentially dangerous delays in nursing response; 44 percent reported medication errors; and 4 percent reported patient deaths - all due to understaffing. Seventy-three percent reported that the quality of supplies and equipment had declined since Sunrise was acquired by Columbia. Workers said that 70 percent of the time, patients are discharged before they are ready to go home.

Lowering patient-care standards isn't the only reason Columbia has gained such notoriety. The Colorado Hospital Association says Columbia/HCA's Northern Suburban Medical Center in Colorado dropped its charity care to $42,000 in 1995, from $7.75 million in 1993. In Florida, a Columbia hospital agreed to relinquish its license and pay a fine after it refused to treat a patient who later died.

Of course, things like this can happen in a nonprofit hospital. But at Columbia, these policies are hardwired into the system. That's why legislatures, attorneys general, and regulators have recently blocked Columbia from expanding in California, Rhode Island and Ohio.

The last thing we need in Washington state is the growth of a for-profit hospital chain like Columbia/HCA. It won't be beneficial. We've got our hands full right now with health-care priorities that allow excessive administrative and marketing expenses to keep going up, while the number of insured children and adults goes down. We can learn from consumers in Nevada, California, Rhode Island and Ohio. Columbia/HCA's for-profit business practices are not healthy for Washingtonians.

Diane Sosne, RN, MN, is president of District 1199NW, Hospital & Health Care Employees Union, SEIU. District 1199NW is a statewide health-care union representing workers in both the public and private sector.