Above photo: As the Swedish Neuroscience Institute was shifting toward a high-volume practice, Providence recruited Dr. Johnny Delashaw, a star surgeon known around the West Coast as a top producer. By Bill Wagner/The Daily News (from the Seattle Times article)

By Margaret Flowers

This excellent series of articles, called “Quantity of Care”, by Mike Baker and Justin Mayo was recently printed in the Seattle Times. The series looks at a recent change in the way that neurosurgery is done at Swedish-Cherry Hill Hospital in which attending surgeons book multiple operations at once and are overwhelming the staff at the hospital so that they are unable to care for patients adequately. In addition, there is evidence that one of the most notable neurosurgeons at the hospital is not informing patients about less invasive solutions and ignores signs of dangerous post-operative complications.

The first article in the series, “A Lost Voice,” tells the heart-breaking story of 23-year-old Talia Goldenberg. It is long, but it gives a real insight to the experiences of patients and families in hospitals in the United States.

I started medical school in 1986, a time when the privatization wave was just beginning in earnest in the US. I was confused when we were urged to call patients clients or consumers and to think about the business aspects of medicine. I remember saying as a student that doctors weren’t supposed to be business people. Our role was to care for patients.

After I completed my residency, I saw how hospitals brought business consultants in to solve problems rather than discussing issues with the staff. As head of a pediatric hospitalist program at a rural hospital that was rapidly increasing the number of deliveries each year, I had to fight for a dedicated space for newborns who developed complications or were born prematurely. We also had to fight to make sure that maternity unit nurses were not given too many patients to care for adequately.

I now hear regularly from people who have been hospitalized or who had a family member hospitalized that they felt like they had to watch over everything and make sure that appropriate care was given. This is added stress that patients and families shouldn’t have, but it is a by-product of a for-profit system in which staff are pushed to their limits to “produce.”

The second article in the series, “High Volume, Big Dollars, Rising Tension,” describes what is going on at Swedish-Cherry Hill hospital from a larger viewpoint.

The authors write:

“A steady churn of high-risk patients undergoing invasive brain and spine procedures allowed Cherry Hill to generate half a billion dollars in net operating revenue in 2015 — a 39 percent increase from just three years prior. It also had the highest Medicare reimbursements per inpatient visit of any U.S. hospital with at least 150 beds.

By those metrics, Providence’s acquisition of Cherry Hill has been a rousing success story.

But the aggressive pursuit of more patients, more surgeries and more dollars has undermined Providence’s values — rooted in the nonprofit’s founding as a humble home where nuns served the poor — and placed patient care in jeopardy, a Seattle Times investigation has found.”

It is long, but an excellent portrayal of the problems of a for-profit system. I suspect that many other hospitals are facing similar pressures to produce profits.

This is why we fight for health over profit for everyone through a National Improved Medicare for All system. When health is the bottom line, it fundamentally changes the way that health care is delivered. I believe that we can’t improved health outcomes in a significant way until we get the profit-making out of the system. It is the poison that taints our health care, what many call a ‘sick care,’ system.

A key provision of the legislation in Congress, HR 676: The Expanded and Improved Medicare for All Act, is to get rid of investor-owned for-profit facilities. They are shown to have worse health outcomes and to be more expensive than non-profit. Although, these days, even non-profits are forced to behave like the for-profit institutions in order to compete.

Once we win National Improved Medicare for All, more will need to be done to make sure that everyone has access to high-quality comprehensive and appropriate care. However, this is the critical, first and most basic step towards that goal.


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