The Patients' Perils

Though New York City has an abundance of doctors and an unusually strict hospital code, publication last week of a searching two-year survey by acknowledged medical experts showed that many of the city's residents still get incompetent care and are subjected to unnecessary surgery. After studying the medical records of Teamsters Union members and their families admitted to 101 hospitals, a team Headed by Columbia University's Dr. Ray E. Trussell* concluded that:

> Overall, only 57% of the patients received good or excellent care; for 20% care was fair, and for 23% it was poor.

> Patients fared best in nonprofit hospitals where medical and surgical services are supervised by medical school faculties (which includes most of the city's largest hospitals); in hospitals run for profit, the care was good or excellent for only 39% and poor for 43%.

> One-fifth of hospital admissions were unnecessary.

> Among 60 cases in which the uterus was removed, there were 20 in which the operation should not have been done; five more were questionable.

Doctors rarely criticize one another's work, but the experts' report was studded with such angry comments as: "Bad medicine," "completely unjustified surgery," "appalling,"' "scandalous," "a shocking case--a gross violation of medical ethics." Ironically, 80% of the patients had thought they were getting the best of care. It was ironic, too, that the study was started because of concern over the high costs of medical care, and ended in far more shocking observations about low quality.

The Columbia group made the $60,000 investigation for a trust fund representing both labor (165,000 teamsters) and management (which pays for the insurance that covers the teamsters' hospitalization and most of their physicians' and surgeons' fees). The types of cases studied were carefully restricted to those on which good doctors rarely disagree about what treatment is proper and best. This left little room for argument. And there could be no argument at all in cases of unnecessary Caesarean deliveries, or of Caesareans poorly performed. Some patients, the study group found, underwent drastic surgery without even having had necessary laboratory tests beforehand. Others, after admission to a hospital, waited longer for their operations than they should have.

Unnecessary operations, which are profitable to the hospital and doctors but not to the patient, were more common in the profit-making hospitals. One of the first results of the report was that Commissioner Trussell tightened the city's already close rein on profit hospitals: now they will get only month-to-month licenses, which means far more frequent inspections. Though no such penetrating study has yet been made outside New York City, medical experts noted that across the country hospital codes are generally looser. Nationwide hospital treatment is generally no better than it is in New York, and in many places, worse.

*Director of Columbia's School of Public Health, now on leave to do a cleanup job as Mayor Robert F. Wagner's commissioner of hospitals.

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