Syracuse - In March 2004, Sharon Yacketta walked into University Hospital here for an operation to help control her incontinence.
But her doctor, Robert S. Lai, botched the procedure, causing urine to leak into her abdomen. A month later, Dr. Lai and a second surgeon perforated her colon during a follow-up operation at University. Four years and 20 operations later, Ms. Yacketta has lost most of her colon and is still incontinent.
“They messed my life up,” Ms. Yacketta said of her surgeons. “I hope those doctors rot.”
Dr. Lai, who has left University and now practices outside Chicago, acknowledged that he and his surgical team had accidentally injured Ms. Yacketta but said he had not been negligent.
Mistakes happen even at good hospitals, of course. But evidence shows that University, which is owned by the State University of New York system, is not a good hospital. In fact, in late 2006 a state commission recommended that it be scaled back and merged with another hospital.
The state’s inability to follow through on that plan for University provides a stark example of how hard it can be — not just in New York, but around the nation — to close or shrink hospitals, even when there is evidence they are providing costly and below-average care.
Certainly the evidence against University Hospital was strong. In 2006, patients at University were three times as likely to develop infections stemming from hospitals as were patients at the average New York hospital. HealthGrades, a company that rates hospitals using data from Medicare, ranks University among the least safe hospitals in the United States — although the hospital’s executives strongly dispute that assertion. University, meanwhile, is expensive to run.
Yet, today, University remains under state ownership. And far from shrinking, University is expanding.
Unlike some other nations, including France, the United States has no federal agency charged with hospital oversight. Instead, it relies on a patchwork of state health departments and a nonprofit group called the Joint Commission that sets basic quality standards for the nation. Hospitals are rarely closed or hit with significant financial penalties for hurting patients.
One of the reasons is that even troubled hospitals are major employers, and communities generally rally behind them when they face the threat of cuts, as Syracuse did for University.
“We haven’t been forthright about the dirty little secret, the huge variation of quality and safety in the system,” said Arthur Aaron Levin, director of the Center for Medical Consumers, a nonprofit patient advocacy group. Nearly a decade after the Institute of Medicine report, preventable errors remain shockingly common, said Mr. Levin, who was a member of the commission that wrote the report.
“It’s nine years later, and we can’t even tell you if it’s better,” Mr. Levin said. “How is that permissible?”
Any effort to maintain national standards is left largely to Medicare and the Joint Commission, a nonprofit group based in Oakbrook Terrace, Ill., which along with state health departments certifies that hospitals are operating safely.
But the commission lacks the heft and enforcement powers of a federal regulator. With fewer than 1,000 employees, it accredits and sets patient safety goals for 17,000 hospitals, nursing homes and assisted-living providers nationally. A typical survey lasts less than a week and involves fewer than a half-dozen examiners, said Dr. Mark R. Chassin, the president of the Joint Commission.
Hospitals account for the largest single slice of the nation’s medical spending, 31 percent, or about $650 billion in 2007, according to Medicare. Despite that enormous bill, hospital care is uneven, and often deadly. In 1999, a report from the Institute of Medicine found that hospital errors caused as many as 98,000 deaths a year in the United States.
Medicare is pressing for quality improvements, using as leverage the $155 billion it spends on hospital care annually. But Herb Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, said hospitals would not make patient safety their top priority until Medicare changed its reimbursement system.
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