Courier Journal exam of Ky. hospitals' childbirth-complication rates show some ARH hospitals fare poorly; Harlan off the chart

"Where a woman delivers her baby in Kentucky can determine whether she is seriously injured in childbirth, and even whether she lives or dies," Laura Ungar reports for the Louisville Courier Journal and USA Today.

Harlan Appalachian Regional Healthcare Hospital

Kentucky's highest rate of childbirth complications is at Harlan ARH Hospital, owned by Appalachian Regional Healthcare. Almost 10 percent of women who delivered there in recent years "suffered severe childbirth complications that in some cases could have killed them," Ungar writes. The rate is "about seven times the state and national norm of 1.4 percent."

Ungar reports that the hospital wouldn't answer her questions "despite repeated requests . . . so it's unclear why Harlan ARH Hospital's rate of 9.7 percent is so much higher than other hospitals in Kentucky, including those within the company."

In an adjoining county, Hazard ARH Hospital has a complication rate of 1.5 percent, "around the state average," Ungar notes. Poverty rates are lower in Perry County, where Hazard is located — 26 percent compared with 42 percent in Harlan County," but they have about the same share of mothers on Medicaid. For the Hazard hospital's broader dataset, click here; for Harlan's, click here.

"One big difference is that Harlan's first-time cesarean section rate is much higher — 32 percent compared with 13 percent in Hazard," Ungar writs. "When subsequent C-sections are factored in, Harlan's rate shoots to 48 percent and Hazard's to 24 percent. C-sections put women at greater risk for bleeding, infection and other complications."

In the other Kentucky counties adjoining Harlan that have hospitals with maternity units, Whitesburg ARH Hospital and Middlesboro ARH Hospital had respective complication rates of 2.7 and 2.9 percent, about double the state average.

Other Kentucky hospitals with rates double the state average or higher were Taylor Regional Hospital in Campbellsville, 3.3 percent; University of Louisville Hospital, 3 percent; and Pikeville Medical Center, 2.9 percent.

The lowest rate in the Kentucky database, 0.2 percent, was at Owensboro Health Regional Hospital. It was 0.3 percent at Baptist Health Lexington and Hardin Memorial Hospital in Elizabethtown, 0.4 percent at Norton Women's and Children's Hospital in Louisville, which has more than 21,000 deliveries in 2014-17, more than any other Kentucky hospital.

The numbers are part of a 13-state database that USA Today built from billing data that is usually "a well-guarded secret," John Kelly and Alison Young reported for the newspaper last fall. "Many hospitals know them. So do many state health agencies, insurance companies and researchers. But they fear the complication rates are too complex for regular folks to understand."

The paper notes potential pitfalls in using the data: "Some hospitals are more likely to treat patients with health problems, so childbirth complication rates are difficult to compare. Some of the best-equipped hospitals in the country may have higher complication rates because mothers who are very sick get referred there. Because of that, hospitals and others in the health-care industry have argued against releasing complication rates, saying they are unfair and could lead women to make bad choices."

"Hospitals have blamed rising maternal deaths and injuries on problems beyond their control," USA Today reported. "Almost universally, they’ve pointed to poverty and pre-existing medical conditions as the driving factors in making America the most dangerous place in the developed world to give birth. That narrative shifts the focus away from examining how doctors and nurses perform in maternity units. . . . Every year, thousands of women suffer life-altering injuries or die during childbirth because hospitals and medical workers skip safety practices known to head off disaster."

Alison Young of USA Today wrote, "Hospitals know how to protect mothers. They just aren't doing it. . . . Doctors and nurses should be weighing bloody pads to track blood loss so they recognize the danger sooner. They should be giving medication within an hour of spotting dangerously high blood pressure to fend off strokes. These are not complicated procedures requiring expensive technology. They are among basic tasks that experts have recommended for years because they can save mothers’ lives. Yet hospitals, doctors and nurses across the country continue to ignore them."

The USA Today stories also examined the role of state regulation, including review panels that examine deaths of mothers and babies. Kevin Kavanagh of Somerset, a retired physician who runs the watchdog group Health Watch USA, noted that Kentucky's panel is run my the Kentucky Medical Association, not the state. "It’s a conflict of interest, he said, because the profession is in effect policing itself and might not want to recommend changes that could affect doctors. Physician Stanley Gall, longtime chairman of Kentucky’s panel, said his group considers the facts of each case without bias."

Gall's panel "never had a chance to examine Jessica Butler’s case. The death of the Louisville woman and her baby was never discovered by the state panel. No one is sure why," Ungar writes. "A host of problems, including death certificate inaccuracies, computer problems and doctors forgetting to note that their patients were recently pregnant, has kept cases from being flagged, said Gall."

Butler, 27, told a nurse that her pain was “worse than childbirth,” but she was sent home without seeing a doctor, her family claimed in a lawsuit. Ungar writes:

"The next morning, Nate Butler found his pregnant wife vomiting and crawling across their kitchen floor. He rushed her back to the hospital. Doctors discovered a spreading kidney infection – one just like she experienced in a prior pregnancy. . . . The infection spread to Jessica’s blood, and her heart stopped during surgery. The baby girl inside her died. Jessica lingered on life support for three days before Nate let her go. . . .

"Witnesses disagreed about her care. An expert testifying for the family said the hospital should have admitted Jessica immediately and started IV antibiotics. A defense expert said her urine test and abdominal pain suggested a common urinary tract infection. Baptist Hospital denied liability and settled the lawsuit for an undisclosed amount, but it would not discuss details. The obstetrician’s lawyer defended his client’s care, but a jury found the doctor and the hospital were at fault and awarded a $7.4 million verdict to the family."