The story behind the story

(Authors note: This is one in a series of blog posts related to business reporting class assignments.  While interesting (I hope!) they will likely not have much to do with municipal finance.)

“Among life’s core assumptions is that hospitals bring healing. But sometimes they bring harm.”

That’s the lede of the first story of “Do No Harm: Hospital Care in Las Vegas,” an award-winning special report published last year by the Las Vegas Sun.

As an aspiring investigative reporter, I Recently, I was able to sit down with one of the project’s two reporters to find out the story behind the story.

The reporter: Marshall Allen, now a reporter at investigative news nonprofit ProPublica

Allen came to the Las Vegas Sun in 2006 after stints at several community newspapers in the Los Angeles region. Shortly after starting at the Sun, he was tasked with covering the Las Vegas healthcare system — an entirely new beat for him.

“I had never covered healthcare. I didn’t really want to cover health care,” he said.

So Allen decided to take the beat and report it from the patient’s point of view within the tangled world of health care special interests.  And he quickly realized how many untold stories there were to tell to his readers.

“The patient has no voice in this world,” he said.  “So that’s me, that’s my job. I’m the guy who is going to represent the patient.”

The story:  The series spanned more than two dozen articles of roughly 30,000 words and an interactive web component where readers could view the data and see how their hospital had fared.

It is based on an analysis of nearly hundreds of thousands of patient billing records requested from state hospital regulators and showed that in 2008 and 2009, there were 3,689 instances where patients suffered preventable injury, infection or other harm in a Las Vegas hospital.

The Sun was the first organization in the state to provide such a break-down of hospital-acquired patient harm on a facility-by-facility basis.

The series explores a number of themes, including how the incidents of harm revealed could be prevented, the under-reporting of these incidents and the significant amount of money that hospitals had spent on lobbying efforts to keep the data private.

It also put a face on many of the instances, telling the stories of patients personal hospital nightmares.

The idea: After several years of covering the Las Vegas healthcare system, Allen had written his fair share of “crazy stories about people getting harmed in the hospital.”

At the beginning of 2008, his boss tasked him with answering one big picture question — “Find out if it is really as bad as everyone says it is.”

The reporting: Allen spent roughly two years reporting the story, which had two big reporting components — human interviews and the analysis of millions of hospital data billing records.

In the two years, Allen conducted roughly 300 interviews with doctors, nurses, patients and their family members, former hospital officials, state regulators, healthcare advocates and other sources.

The Sun has a fairly small staff so during much of his time reporting the story, Allen was also producing regular beat work. During the first year, whenever he did an interview with anyone involved with the healthcare industry, he would ask them the question he was looking to answer.

“I would say, what do you think about health care in Vegas?’” he said. “’Is it really as bad as everyone says it is? Why is it bad? What are the good things? What are the themes?’”

At the same time, Allen was working with the Sun’s computer-assisted reporting expert Alex Richards to try to find a set of data that would help answer the question as well.

“I had to quantify this somehow,” Allen said. “I can’t just do a bunch of anecdotal sob stories from patients. I needed somehow to get some real data behind this that measures it some way.”

Allen and Richards eventually zeroed in on inpatient hospital billing records that Nevada state regulators were “starting to use but hadn’t really used effectively,” according to Allen.

They filed a public records request and received the massive data set in April 2009. Richards then set to work using CAR tools to analyze the data using billing codes that indicated instances of hospital-acquired injury, infection or surgical errors.

While Richards analyzed the data and created the series’ multimedia components, Allen continued interviewing a variety of sources, adding to his extensive file of interviews.

The first part of the series ran in June 2010, and Allen continued reporting the series, including reactions to it, through the final part, which ran in December 2010.

Roadblocks: The series encountered a few roadblocks, but nothing to the level of threatening it from reaching print.

When the newspaper filed the public records request with the state, they were first told they would have to pay a high fee to cover the cost of producing the data so the newspaper had to negotiate to bring that cost down.

Only one of the 13 hospitals mentioned in the series commented, which Allen said would have been a bigger roadblock if the stories did not rest on non-disputable data.

“I want them to respond, but if they don’t, they can’t stop us,” he said. “So it’s so empowering to use the data in a story.”

The writing: Allen and Richards and their editors eventually decided to spread the five parts over a matter of months, which would allow Allen continue to work on the project, even after its launch.

“It was too much information to do, for example, in a one-week series,” he said. “I couldn’t have gotten all that information prepared in advance.”

The series is broken up into more than two-dozen articles, which Allen wrote in five parts.

  • Preventable Injuries: a look at instances of preventable injuries and other harmful instances and the hospitals’ efforts to block transparency
  • Hospital-acquired infections: a look at the “proliferation of ‘superbugs’ in Las Vegas hospitals
  • Punctures and lacerations: a look at surgical errors
  • Systemic Failure: an exploration of the problem’s causes, including staffing issues and poor oversight
  • The Way Forward: an exploration of the possible solutions to the problems, including proposals from other states

Allen says that with the article component of the series, he wanted to put a human face on the story that the data was telling — the fundamental fact that some Las Vegas patients were entering hospitals worse off than when they entered.

Much of the package’s 30,000 words are in the form of short profiles. Profiles of patients who had been injured in the hospital. Profiles of those who had lost loved ones to allegedly bad hospital care.

Other pieces look at the associated policy and political implications and how the Las Vegas healthcare system could improve.

Reaction/Awards: The series triggered a variety of reactions, including a state probe to determine if Las Vegas hospitals were breaking the law by fairly to accurately report instances of hospital-sustained infection or injury.

Some hospital executives lashed out against the newspaper, running full-page ads in the rival newspaper speaking out against the newspaper’s reporting as “flawed” and “reckless,” Allen said.

Other hospitals began to voluntarily post patient care data that hadn’t been previously disclosed. Nevada legislators also passed bills that would force hospitals to be more transparent about hospital.

The series won a long list of regional and national journalism awards, including the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting, the National Headliners Awards “Best of show” award. It was also named a 2011 Pulitzer finalist for local reporting.

Allen credits the Sun’s owner Brian Greenspun for having the guts to support important investigative work, regardless of the backlash.

“I’ve had other journalists around the country who write about healthcare say my newspaper would never let me do that story because hospitals are too big of advertisers in our community.”

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One Response to The story behind the story

  1. Bella Silverstein says:

    Kudos to Marshall Allen. He bested my city’s paper, the Los Angeles Times. I only wish my paper had the guts to do a report like this.

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