Council report tags four area hospitals

Four area hospitals had high death rates in some treatment areas in 2011, according to a report published recently by the Pennsylvania Health Care Cost Containment Council.

But the hospitals said many of those who died had do-not-resuscitate orders or other issues.

Nason Hospital had high-death rates in three treatment areas – colorectal procedures, congestive heart failure and hypotension and fainting, according to PHC4’s latest Hospital Performance Report.

Tyrone Hospital had a high death rate for kidney and urinary tract infections, Clearfield for hypotension and fainting and Mount Nittany for chronic obstructive pulmonary disease, according to the report.

Nason explained its high-death rate findings by pointing out in a letter to the council that a high percentage of the deaths were to be expected.

Two of the three deaths from colorectal procedures – there were 46 patients in all – had do-not-resuscitate orders. All were old and had “co-morbid conditions,” the hospital pointed out.

The same issues existed for eight of the 10 deaths from congestive heart failure. Nason had 106 patients with congestive heart failure.

The single death of a patient with hypotension and fainting – there were only two of those patients altogether – actually resulted from lymphoma, according to Nason.

The Nason argument is a common one for hospitals flagged for high death rates.

“By and large, patients with do-not-resuscitate orders are sicker than most patients and older than most,” said council Executive Director Joe Martin. “But our system does account for that, and if hospitals are truly treating sicker and older patients, they get credit.”

Over the years, the council has debated whether to exclude do-not-resuscitate cases, Martin said. But most clinical advisers oppose it.

The conditions for imposing do-not-resuscitate orders vary from hospital to hospital, so eliminating those cases would actually create an avenue for unfairness, according to Martin.

In response to the finding against Tyrone, hospital Director of Performance Improvement Amy Vereshack said: “Mortality was not an unexpected outcome, as the patients were chronically ill and had elected either do-not-resuscitate status or received comfort care measures.”

Clearfield Hospital Quality Director Catherine Civiello said the single patient’s death that led to the finding was actually not from hypotension and fainting – the diagnosis category that created the basis for the finding, in response to the report.

Mount Nittany Hospital Vice President for Quality Gail Miller said all patients whose deaths led to the finding had do-not-resuscitate or palliative care orders.

The hospital supports the use of reports like PHC4’s “in identifying opportunities for improvement,” Miller said.

The latest report analyzes hospital performance for 12 treatment areas.

For its performance reports, the state agency uses data submitted by all hospitals in Pennsylvania through a risk-adjustment analysis to identify abnormal patterns.

It publishes the results to “empower purchasers of health care benefits, such as employers or labor union health and welfare funds, with information they can use to improve quality and restrain costs,” according to the performance report.

Mirror Staff Writer William Kibler is at 949-7038.