As part of a campaign by a branch of the Service Employees International Union (SEIU), an advertisement criticizing the Stanford Health Care (SHC) system is currently being broadcast on radio stations across the Bay Area. The ad primarily discusses above-average rates of patient infection at Stanford Hospital, although the larger campaign also addresses working conditions at the Hospital.

“Stanford Health Care has been a trusted institution in the Bay Area,” the minute-long ad says. “But as they’ve expanded, they’ve lost track of the basics.”

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SEIU is a two million-member organization focused on workers’ rights. Within the larger organization is United Healthcare Workers West (SEIU-UHW), which describes itself as “one of the largest unions of hospital workers in the western United States” and reports having more than 93,000 members.

In addition to its work around healthcare worker rights, SEIU-UHW says it also seeks better conditions for patients.

It is that latter aim that the union’s radio campaign focuses on, with Stanford Hospital’s patient infection rates and high prices the main criticisms.

“For the third year in a row, Stanford Hospital has had one of the highest rates of patient infections in the country, all while Stanford is charging some of the highest prices in the state,” the campaign says.

According to Sean Wherley, senior communications specialist for media relations at SEIU-UHW, the spot is currently playing on 11 Bay Area stations.

“We’re trying to raise awareness in the community about the patient infections that are happening at Stanford and the fact that [those run] counter to the hospital’s reputation,” Wherley said. “They depict themselves as a world-class institution yet they’re having serious problems getting patient infections under control.”

Management has been “not as responsive as workers would like,” he added.

SHC, for its part, disputes the claims that it has disproportionately high patient infection rates and that it does not offer safe working conditions to employees.

“As one of the nation’s top-ranked hospitals for quality measures such as high patient survival and low infection rates, our quality and the safety of our patients and employees are our top priorities,” wrote Patrick Bartosch, SHC corporate communications and media relations lead, in an email to The Daily. “Our rankings are a testament to our dedicated employees and their commitment to quality care and ongoing improvement efforts. We feel it is unfortunate and disrespectful to our employees and the community that SEIU-UHW continues to distort the facts.”

Patient infections at Stanford Hospital

The SEIU-UHW ad directs listeners to a website, run by the union’s Political Issues Committee, that goes into more detail about the statistics behind the group’s claims. At the basis of their claim about patient infection rates, the site explains, is a federal policy that went into place in 2014 wherein the Centers for Medicare and Medicaid Services (CMS) reduces Medicare payments to the worst-performing quartile of hospitals based on their rate of hospital-acquired conditions (HACs).

Based on the prevalence of different types of injuries and infections that hospital patients can get while at a hospital — such as bloodstream and urinary tract infections, or bacteria like methicillin-resistant Staphylococcus aureus and Clostridium difficile (C. diff) — “hospitals with a Total HAC Score greater than the 75th percentile of the Total HAC Score distribution will be subject to a payment reduction,” Medicare.gov explains.

SHC has been in that bottom quartile for the last three years, and has thus been subject to a one percent reduction in Medicare funds each time.

It has performed particularly poorly with regards to the frequency of clostridium difficile infections.

“The CMS [rated] SHC as performing ‘worse than the national benchmark’ on the [C. diff] measure for over four years in a row,” SEIU-UHW writes. “Stanford also was rated as performing ‘worse than the national benchmark’ on two other [healthcare-associated infections] measures during the most recent reporting period.”

The majority of C. diff cases occur during or after time spent in a healthcare facility, including a hospital. Symptoms can range from diarrhea and abdominal cramping to kidney failure and even death.

“It’s very serious, [and] there have been 700 incidences of it over a four-year period at the hospital, making it one of the worst in the country,” Wherley said. “And the hospital may claim that it’s got everything under control, but this has been a problem year after year, and it’s not what you expect of a hospital with that kind of status.”

The SEIU-UHW campaign also looked at California state data from the Office of Statewide Health Planning and Development (OSHPD) to see how many infections hospital patients left with were not present upon their admittance to the hospital. According to them, Stanford ranked near the top of the list, with 31 percent of recorded infections “Not Present on Admission.”

For SEIU-UHW, this is a problem for both workers and patients.

“The workers want to be safe on the job, they want to have proper staffing and training, but they also don’t want to be infected,” Wherley said. “They don’t want to bring something home, they don’t want any patients to take something home like that.”

SHC, however, argued that Stanford Hospital actually “exceeds the industry benchmark at preventing infections.”

“We are extremely proud of our overall quality rating, which summarizes up to 57 quality measures and provides a hospital performance rating between 1-5 stars,” Bartosch wrote. “Stanford Health Care’s current quality score on the Hospital Compare website is 4 stars, and only 22.4 percent of the more than 4,500 hospitals rated achieved 4 or 5 stars.”

Medicare.gov also gave SHC a rating of four out of five stars. But for SEIU-UHW, that’s a distraction from the main issue.

“When they talk about things other than C. diff… they are ignoring the real issue here, which is, why does this infection continue to be a problem?” Wherley said.

He added, “No matter what other scores they want to trot out, the one that matters is this infectious disease that people get far too often, and it should not be persisting like it is.”

A long-standing issue

The question of health and labor conditions in Stanford Hospital is not a new one. In 2012 and 2013, data from the California Department of Public Health showed that the facility has “significantly higher” rates of hospital-onset C. diff than comparable peers, and in December 2015 Medicare announced that SHC would be penalized for its high rate of conditions including blood clots, falls and sepsis.

Last year, SHC workers brought their concerns forward to management. However, Wherley said, “It’s not clear that those problems have been addressed,” and so they pursued other methods like the radio campaign.

“[The union members] want to put it out forward for the larger community to learn and ask the same questions,” he added. “Why is this happening? What’s being done to get it under control?”

In the past, SHC has described the problem as one of academic versus community medical centers. In late 2017, they told Kaiser Health News that “academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections… [and so] hospitals with a high rate of immunocompromised patients will always seem to have higher” rates of infection.

However, SEIU-UHW contests that explanation, instead asserting that the OSHPD data reveals that Stanford has a disproportionate rate of in-hospital infections compared to that of other academic hospitals.

“When compared with other teaching hospitals in Northern California’s San Francisco Bay Area, Stanford’s [C. diff] rates were the highest of any of the seven Bay Area teaching hospitals,” they wrote. “In fact, in 2013 and 2014, Stanford’s [C. diff] rates were so high that they nearly doubled those of UCSF Medical Center — the teaching hospital with the second highest rate of [C. diff] for those years.”

SEIU-UHW complaints have also addressed more worker-focused issues at SHC, including inadequate time to clean rooms and a high turnover rate among temporary workers. Members of the union even worry that these labor-facing issues exacerbate the patient-facing ones.

“They don’t give them adequate time to do the cleaning or training and I think that really contributes to the high infection rates,” said Linda Cornell, a Patient Unit secretary and employee of SHC for 37 years.

The bigger picture

SEIU-UHW’s reform efforts have extended beyond just the radio campaign and website.

In February, the 19th Undergraduate Senate voted to support the Accountable and Affordable Health Care Initiatives, which “would ensure that a significant portion of revenue from medical care payers is used to improve the quality of care at hospitals through measures such as better equipment and higher staffing ratios,” as per the text of the passed bill.

The bill also cited the prevalence of HACs at Stanford Hospital while contrasting that with an average operating income growth of 32 percent a year between 2010 and 2014.

“They’re understaffed, and there’s also no shown correlation between the really expensive costs of care and the quality of care, at least at Stanford Hospital,” said Senator Ana Queiroz ’20. “So it just really seems out of place that it’s that expensive.”

SEIU-UHW has also been sponsoring a proposed law that would cap Stanford Hospital bills to 15 percent above the cost of treatment (plus quality improvement cost). They would need to get 2,400 petition signatories to be eligible for the Nov. 6 ballot.

“When an institution has made it very, very clear that they have policies in place that don’t reflect what’s right for the community and the workers within the institution, that’s when we stand up,” said San Mateo County Supervisor David Canepa during a February rally in support of the initiative. “The responsibility is clearly to stand with our working men… and women.”

The campaign pointed to the high rates of C. diff and other HCIs as proof of the need for more focus on patient outcomes.

Bartosch called the initiative “unconstitutional and invalid if enacted,” and added that “all hospital charges reflect the various levels and complexities of care provided by these health care organizations.”

“At Stanford Health Care,” he said, “we are committed to providing the best value for our patients and community.”

But the members of SEIU-UHW would beg to differ — and in their new campaign against SHC, they do just that.

“The hospital promotes itself as exceptional,” Wherley said. “In this case, patient infection, it’s not exceptional. In fact, it’s the opposite.”

 

Contact Brian Contreras at brianc42 ‘at’ stanford.edu.