Blood Clot Mystery; Emergency Docs Fight Envision; Hospital Police Forces

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Mystery Diagnosis: Shortness of Breath After Blood Clot Treatment

An avid skier and father from Idaho had developed a swollen and painful right calf, and was increasingly short of breath. His doctor discovered two serious blood clots — one in the leg and another between his lungs — that had almost killed him, but the emergency treatment was a success. Still, 7 months later, Mark Porter was fatigued and had to stop to catch his breath frequently, the Washington Post reported.

Worried about offending his primary care doctor, Porter accepted his reassurance that nothing was wrong, and tests found no new clots. But when his doctor was away, he saw another who referred him to a cardiologist, who then sent him to a lung specialist. That’s when the truth of his condition emerged.

All of Porter’s symptoms pointed to chronic thromboembolic pulmonary hypertension (CTEPH), a rare condition and a kind of pulmonary hypertension where blood clots that clog arteries lead to build-up of scar tissue in the blood vessels of the lungs and restricts blood flow. Porter decided to undergo an intensive, day-long procedure where surgeons would bypass his heart and lungs with a machine, cool his body to 68 degrees, and painstakingly remove the clots.

After a long recovery, Porter can exercise without shortness of breath or chest pain. He told the Washington Post that in trying not to offend his primary care physician by foregoing a second opinion for so long, “I probably waited too long to fight for myself.”

Emergency Docs Continue Fight Against Envision

Envision Healthcare, one of the biggest private equity-backed healthcare companies, is filing for bankruptcy — but emergency physicians are seeking permission to continue a lawsuit against Envision, whose practices they say are unlawful, KFF Health News reported.

Instead of monetary damages, the American Academy of Emergency Medicine (AAEM) Physician Group wants a declaration from a court that Envision’s strategy of using shell companies to maintain control of emergency staffing groups is illegal. This, they believe, might stop the practice in California, where they claim Envision is breaking laws.

Most states have laws against the corporate practice of medicine, to prevent non-doctors from owning and controlling medical practices. But Envision, according to KFF Health News, runs 467 emergency departments, using their ownership of emergency doctors’ staffing companies to maintain control.

Envision had about $8 billion in debt, massively overshadowing its earnings in 2022, KFF Health News reported. Envision’s revenue has been hit by the No Surprises Act, which curbs out-of-network bills they can collect on, staffing shortages and high labor costs driven by pandemic burnout, and a lawsuit with insurance company UnitedHealthcare. Envision filed for bankruptcy on Monday, and a trial over the physician group case in San Francisco has been postponed from January.

Hospitals Install Their Own Police Departments

With a growing awareness of the violence healthcare workers face every day, some hospitals are making their own independent police forces, KFF Health News reported. Earlier this month, Georgia’s governor signed a law that will create harsher criminal penalties for assaulting a hospital worker and allow healthcare systems to create their own police forces. In 29 other states, laws have either passed or are in the works to allow the same.

One co-sponsor of the bill in Georgia told KFF Health News, “If you have a specialized police department, they are more in tune with the needs of the facility” because they can get to know the space and the staff.

These police officers are usually allowed to carry guns and make arrests and receive more training than hospital security guards. Some nursing and hospital groups commend the effort to reduce workplace violence, but others are more critical. Ji Seon Song, a University of California-Irvine law professor, told KFF Health News, “You can see where there might be a lot of problems,” she said, “especially if the patient is African American, undocumented, Latino — something that makes them prone to being criminalized.”

KFF Health News noted a lack of data on whether or not these police forces prevent violence in hospitals, and cited a study that found that in emergency department shootings, 23% involved the shooter taking a gun from a security officer.

Elinore Kaufman, MD, a trauma surgeon at the University of Pennsylvania, told KFF Health News, “Our primary lens shouldn’t be that our patients are a danger to us. It’s a harmful lens and a racist one. We should develop safe and healthy workplaces through other ways.” CMS, for example, has recommended boosting hospital staffing, improving training and education for staffers, and developing more patient risk assessment strategies.