SECRECY IN CALIFORNIA PUBLIC HOSPITALS

In a little more than a year, four patients have died at hospitals in Santa Clara County alone due to medical errors that could have been prevented, according to state Sen. Elaine Alquist's office. Not that anyone would know. California doesn't have an easy system for providing public information about hospital safety records. To check the records, residents must go to a state office and look through paper files. Meanwhile, state inspectors charged with enforcing safety regulations visit hospitals only once every three years.

Alquist, D-Santa Clara, says public accountability at hospitals needs to improve. She has introduced SB 1301, which would require hospitals to start reporting medical errors - such as giving a patient the wrong medication - directly to the state Department of Health Services within 48 hours after they occur. It would require the state to put the information on a public Web site. And it would require state inspectors to monitor hospitals annually. The bill would also shorten the time the state has to respond to complaints about hospital care. Right now, inspectors have six months to follow up on a complaint. Alquist wants to reduce that to 45 days.

There's been a lot of public scrutiny of whether the state does a good enough job monitoring nursing homes and non-medical facilities such as child-care centers and homes for the elderly. Now, Alquist says, it's time to focus on acute care. "My goal is not to castigate anyone," Alquist said. "My goal is simply to see that hospitals are a safe place for sick people. ... We have a lot of good people who work in hospitals who are trying to do their best, but sometimes the systems have broken down." Citing various medical studies, Alquist's office estimates that there are an average of five to 10 fatalities due to mistakes at each hospital every year. The California Hospital Association opposes the bill, but not the idea of increased public awareness.

The group, a membership organization of hospitals throughout California, would support the measure if the public data were not hospital-specific and if it could not be used as evidence in a lawsuit, said Debby Rogers, vice president for quality and patient safety at the organization. "We want to create an environment where people are willing to talk about their mistakes," she said. "There may be some that would see posting the outcomes on the Internet as not necessarily the environment we want to create." Rogers said the hospital association and other groups are already working to improve public information about hospitals - and to improve hospitals' awareness of how to prevent mistakes. "The more we look at issues, the better we can get at identifying them," she said. "We're catching things we may not have caught five years ago."

The Schwarzenegger administration has not taken an official position on the bill, said Lea Brooks, a spokeswoman for the Department of Health Services. But the administration is in the midst of improving inspections of health facilities, and has included funds to hire more than 100 inspectors for hospitals and nursing homes in the proposed budget for next year, Brooks said. The ultimate goal, Alquist said, is to reduce errors. "The public believes they are safe in hospitals," she said. "And I want them to be safe."

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FEDS CRIMP MASSACHUSETTS AIM TO GIVE FREE CARE TO ILLEGALS

Under a provision of the Deficit Reduction Act of 2005, as of July 1 all US citizens who sign up for Medicaid or renew their benefits will have to provide documentation of their citizenship. Eligibility rules for legal immigrants have not changed. Almost all of the state's poorest residents will have to show proof of US citizenship to continue getting medical care by July 1, under a little-noticed federal law that could endanger coverage for many, as Massachusetts is trying to expand access to healthcare.

Born out of ongoing efforts in Washington to clamp down on illegal immigration, the new federal requirement compels anyone seeking Medicaid coverage to provide a birth certificate, a passport, or another form of identification in order to sign up for benefits or renew them. No such proof is required now. The requirement was tucked into the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year

The measure was part of an effort to limit the skyrocketing growth of federal entitlement programs. It has surfaced as Massachusetts begins to implement its sweeping healthcare plan, which aims to bring health coverage to almost all of the state's uninsured, in part by enrolling those in Medicaid who are eligible but who have not signed up.

Healthcare specialists voiced fear that because many Medicaid recipients -- including the homeless and the mentally disabled -- won't be able to easily produce documentation of their citizenship, they will have difficultly receiving care at community health centers, hospitals, or anywhere else. ''So we've got people in nursing homes, people in the [state Department of Mental Retardation] institutions, we've got the homeless, we've got the . . . mentally ill who now will have to come up with some verification to prove that they're citizens," said Victoria Pulos, health law attorney at the Massachusetts Law Reform Institute. ''It's ironic that this is happening in the state where part of the health reform plan is to make sure that everyone who's eligible for Medicaid is enrolled."

The new federal requirement, which all states have to comply with, would apply to the vast majority of the more than 1 million people on MassHealth, the Massachusetts Medicaid program. The intent is to prevent undocumented immigrants from posing as citizens and taking advantage of taxpayer-funded healthcare benefits that are afforded only to legal residents. (Under federal law, undocumented immigrants can receive only emergency Medicaid care; Massachusetts has 40,000 on such a program, which is called MassHealth Limited.) Less than three months before the new citizenship requirement takes effect, though, Massachusetts and other states are waiting for guidance from the federal government on how it will work

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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