Surprise: NYT Discovers Spending Money on Frail Elderly Not Always Useless
After months of Times stories pushing the need for limits on end-of-life care in the name of universal health care, reporter Reed Abelson looks at the other side and makes a shocking discovery: "the hospitals that spend the most seem to save the most lives."
Published: 12/28/2009 11:15 AM ET
After a year of front-page stories pushing not so subtly for reductions in "costly" end of life care for the old and "frail" (as a precursor for the kind of universal health care the editors favor) reporter Reed Abelson looked at the other side of the debate in a December 23 front-page piece from Los Angeles, an entry in the paper's new "Months to Live" series: "U.C.L.A. Medical Center at Heart of End-of-Life Debate."
The Ronald Reagan U.C.L.A. Medical Center, one of the nation's most highly regarded academic hospitals, has earned a reputation as a place where doctors will go to virtually any length and expense to try to save a patient's life.
"If you come into this hospital, we're not going to let you die," said Dr. David T. Feinberg, the hospital system's chief executive.
Yet that ethos has made the medical center a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.
Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.'s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.
That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive.
Take the case of Salah Putrus, who at age 71 had a long history of heart failure.
After repeated visits to his local hospital near Burbank, Calif., Mr. Putrus was referred to U.C.L.A. this year to be evaluated for a heart transplant.
Some other medical centers might have considered Mr. Putrus too old for the surgery. But U.C.L.A.'s attitude was "let's see what we can do for him," said his physician there, Dr. Tamara Horwich.One certainly doesn't see admissions like this in the Times very often:
Indeed, Mr. Putrus recalled, Dr. Horwich and her colleagues "did every test." They changed his medicines to reduce the amount of water he was retaining. They even removed some teeth that could be a potential source of infection.
His condition improved so much that more than six months later, Mr. Putrus has remained out of the hospital and is no longer considered in active need of a transplant.
Indeed, U.C.L.A. and five other big California medical centers recently published their own research results with a striking conclusion: for heart failure patients, the hospitals that spend the most seem to save the most lives.