Hopkins Hospital continues to undervalue the lives of its patients

By THE EDITORIAL BOARD | December 6, 2018

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When physicians take the Hippocratic Oath, they vow to do no harm and to uphold medical ethics to preserve the safety and well-being of patients in their care. Our institution is known as a leader of medical innovation, and yet it has consistently fallen short of that principle. Many of us attend Hopkins not only for the world class education it provides, but also for its prestigious status. But this reputation rests on a continued legacy of Hopkins undervaluing the lives of its patients.

When Johns Hopkins established the Johns Hopkins Hospital in 1889, he sought to provide quality healthcare and serve as an invaluable resource to the surrounding community. Yet recent reports on the conditions at the Johns Hopkins All Children’s Hospital in St. Petersburg, Fla. and the Johns Hopkins Hospital in East Baltimore illustrate an appalling failure to carry on our founder’s mission.

Before Hopkins took it over in 2011, All Children’s had been a profitable hospital with one of the best heart surgery programs in Florida. A year long investigation by The Tampa Bay Times, published last week, revealed that since 2015, All Children’s mortality rate tripled. Last year, one in 10 patients treated at All Children’s died, the state’s highest mortality rate.

What led to these alarming numbers? Human error and an inability to follow basic safety procedures. Surgeons lost needles in the chests of at least two infants. A heart transplant patient suffered a stroke after the stitching connecting his heart to his body broke; that child now can’t walk or feed himself. Another cardiac patient suffered a burst vein in her esophagus, resulting in a stroke that left her without motor function.

These were not isolated incidents. Patients at All Children’s are five times as likely to have their surgical wounds split open, three times as likely to become septic, or infected with bacteria, and take twice as long to recover from cardiac procedures.

The Times reported that when Hopkins took over All Children’s Hospital in 2011, it replaced one of the hospital’s top surgeons and redistributed the cases among remaining doctors without taking into account the level of skill each case required. And rather than retaining the cardiologists and doctors responsible for All Children’s past successes, Hopkins replaced them with its own employees. 

But it doesn’t end there. All Children’s doctors and surgeons failed to keep parents informed about the conditions of their children, even lying to them about treatment options — one physician led a child’s parents to believe that her heart condition was fatal and could not be treated. Soon after, doctors in Cincinnati successfully operated on her. In other cases, the hospital failed to inform parents when their children developed infections. Instead, the parents found out from autopsy reports. Hopkins Hospital has not refuted The Times findings and, in a statement, failed to acknowledge how its errors led to life-altering repercussions for its young patients. 

Even here in Baltimore, Hopkins has failed to protect its patients. Nurses at Hopkins Hospital have been trying to unionize over the past few months. This month, National Nurses United published several reports revealing that Hopkins has been threatening the health and safety of its patients. We acknowledge that the views in these reports may not represent those of all nurses at Hopkins Hospital, but still believe that these concerns should be addressed. Furthermore, in a statement to The News-Letter, a Hospital spokesperson did not dispute the nurses’ claims. 

The report claims that the Hospital is severely understaffed. As a result, nurses are overworked and patients are unable to get the individual attention and care that they need. Nurses go on shifts for as long as 12.5 hours, with few breaks and insufficient sleep. There is no relief for nurses when they need to rest. Nurses are also taking on tasks that would ordinarily be delegated to support staff.

Also alarming is the lack of basic equipment and attention to rudimentary safety procedures at the hospital. Nurses are not given sufficient training to protect themselves from dangerous chemical substances produced during chemotherapy. One nurse reported that while a patient was suffering a heart attack, staff had to run to another building to find an oxygen tank. Emergency units do not have enough beds or staff, and patients are forced to wait or stay in other units where they cannot get the care they need. During these waiting times, high-acuity patients are forced to wait for hours on end, during which they may vomit, bleed to the point of passing out, and suffer chest pain, seizures and cardiac arrests. According to one nurse, two patient deaths could have been prevented if they’d had enough beds in the Intensive Care Unit. 

Nurses are also struggling to overcome a hostile working environment. The overwhelming majority — 95 percent — of nurses surveyed report feeling unsafe while at work. Yet many of them are reluctant to speak up about their concerns because they don’t think their needs will be taken seriously. 50.1 percent of nurses have said that when they reported concerns about their own safety, the Hospital did nothing. Meanwhile, 37 percent of nurses have experienced workplace violence in the past year. 

Hopkins Hospital’s duty as a nonprofit medical institution is twofold: the first is to serve the Baltimore community and the second is to do its patients no harm. It has failed to do both. It has put the lives of its patients and Baltimore residents in danger, both here and at All Children’s Hospital. Hopkins has certainly done them harm.

It is hardly the first time. Hopkins Hospital has had a long history of doing harm to its patients and to our city. It did harm when it took cells from black Baltimore resident Henrietta Lacks without her consent, then profited off of them while keeping her family in the dark. It did harm when it allegedly conducted an experiment in the 1940s infecting hundreds of Guatemalans with sexually transmitted diseases, and it did harm when it intentionally exposed hundreds of black children to lead poisoning. 

There is nothing that the Hospital can do to fully compensate for the harm it has done — for communities ravaged, for lives damaged and lost. We can only hope that going forward, it will do a better job of serving its patients and our city. 

In the meantime, it’s up to us as students to carry on the mission of our founder. Many Hopkins students conduct research at the Hospital, take classes on the East Baltimore campus or volunteer with patients there. All of us — particularly those who hope to become doctors — need to remember that our actions have real human consequences. Some of us aspire to work in a hospital, and others are likely to require the services of one at some point. 

Time and time again, Hopkins has violated patient trust and failed to uphold the core principle of the Hippocratic Oath. We can’t allow these mistakes to be repeated, because they can mean the difference between life and death. The relationship between doctors and patients should be one of transparency, compassion and support. The humanity in healthcare should be found not in the drive for profit or prestige but in valuing the mental and physical well-being of patients and their families. To do otherwise is to do irreconcilable harm.

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