Advocates push Public Health to improve on data

Over the holidays, the California Department of Public Health released a report that found that thousands of Californians continue to die every year from infections they catch in hospitals.

One of those people was Carole Moss’ son Nile. In 2006, the 15-year-old succumbed to a methicillin-resistant staphylococcus aureus (MRSA) infection he caught at Children’s Hospital of Orange County. Nile suffered from a brain condition that required frequent hospitalizations.

CDPH Director Mark Horton didn’t come onto the job until 2007. But Moss thinks he should be held responsible for not pushing hard enough for hospitals to report their infection data in the new report, and for not acting on a set of 2005 recommendations from the California Department of Health Services.

“He and several of the people that report to him are not doing their jobs,” said Moss, a board member on the Healthcare Associated Infection Advisory Committee. “There are people in this department who are supposed to be protecting the public but are doing everything they can do to not protect the public, and everything they can do to not disclose information.”
CDPH counters that they have been doing the best they can with limited resources, and says the next round of data will be better.

“The department was not able to start up the program to do some hiring late in 2009,” said Kevin Reilly, chief deputy director of policy and programs at CDPH. “Once we were able to hire those staff, we’ve done a lot.”

With the help of federal money, Reilly said CDPH has been able to add nine people in recent months to track data such as hospital infections. In earlier years, he said, the department had only been able to employ one public health doctor for this type of work, and he also had other duties.

The December report was the first delivered under Nile’s Law, SB 1058 by Sen. Elaine Alquist, D-Santa Clara, in 2008. It requires hospitals to track and report on “healthcare associated infections,” or HAIs, in California and send this data to the federal Centers for Disease Control and Prevention and the CDPH. A companion bill, SB 158 by then-Sen. Dean Florez, set out guidelines for hospitals to avoid infections and established the Hospital Infectious Disease Control Program.

According to data released by the department in late December, about 12,000 people die in California every year from HAIs. This may not sound like a lot compared to a population of 39 million — but it is four times the 3,081 traffic deaths recorded in California in 2009. The report also found that 200,000 people, or one in every 20 who were admitted, got an infection of some sort in a hospital.

The part that has some health care advocates concerned is that only two-thirds of hospitals in the state fully reported the data that was required of them. Nineteen didn’t report any data at all.

The first report covers the period between January 2009 and March 2010. The next report is due at the end of this year.

“This is really a first step,” Reilly said. “It’s a snapshot illustrating that health care born infections are an important issue in California. The reporting for the 2011 timeframe will be much improved.”

But this lack of data has gotten the attention of a pair of other health care advocates: Betsy Imholz, director of special projects for Consumers Union, and Health Access lobbyist Beth Capell. Imholz said she plans to raise the reporting issue when she meets next week with Diane Dooley, Gov. Jerry Brown’s newly-appointed secretary of Health and Human Services.

Neither is asking for Horton to step down. But both want him to step up and get more assertive with hospitals that aren’t meeting the requirements.

“Hospitals that hadn’t turned in their data should be named and shamed,” Capell said. She added, “Part of the process of public reporting is embarrassing people into doing a better job of providing the data.”

Capell’s group spent years clashing with the Schwarzenegger administration over health care cuts and other issues. But she praised the outgoing administration and another state agency, the Office of Statewide Health Planning and Development (OSHPD). OSHPD also released a pair of controversial reports Dec. 28, the same day DPH put out its data, covering patient mortality and preventable hospitalizations.

“There was real commitment at the Horseshoe level to putting out a lot of this data,” said Capell, whose group advocates for better health accessibility for middle and lower income people.

The OSHPD data received media attention up and down the state, with many media outlets looking at how their local hospitals were doing. But the media coverage of the CDPH infection data may have been confusing for some, with Horton and his spokespeople calling it incomplete and saying the listings shouldn’t be used to compare one hospital to another.

Imholz said that she is planning on talking to Dooley about “a wide range of issues.”

“We’re not out to get Mark Horton,” said Imholz. “We just want to see a strong, proactive role by the department.”

She also echoed the idea that the way CDPH has approached the data has made “the perfect the enemy of the good.” She pointed to Pennsylvania and Oregon as two states that have been pioneers in terms of ensuring reporting and making the data available and usable.

But Moss said the problems go deeper than the data. She said DPH has been aware of hospital infections, and how to prevent them, for a long time. Moss pointed to a 2005 California Department of Healthcare Service report that found nearly a quarter-million HAIs in the state annually. That report included numerous recommendations for preventing infections – routinely screening incoming patients to make sure they don’t infect others with some of the most common types of HAIs, hiring specialists to track infections and run prevention programs, expanding education on infections for healthcare professionals, and increasing lab capabilities to detect and isolate outbreaks.

Before that was the 2003 report from the Society for Healthcare Epidemiology of America. The so-called SHEA Guidelines laid out a program of hygiene and surveillance for reducing infections. She said CDPH has been dragging their feet, partly because of what the data shows about how little the state has done in recent years.

“The fact of the matter is they did not think they were actually going to have to post the data,” Moss said. “So they waited a long time to do the job.”