Hospital Patients

"A Season in Hell," by Marilyn French. Knopf. 272 pages. $23. Marilyn French, whose seminal novel "The Women's Room" is one of the sacred texts of the 1970s feminist movement, has spent the better part of the 1990s in an ongoing, devastating medical crisis. Diagnosed in 1992 with metastasized esophageal cancer - usually fatal - and thrown into aggressive chemotherapy and radiation treatments, French also at one point fell into a coma for six weeks.She developed agonizing arthritis, recurring kidney infections and diabetes.

WALNUT CREEK, Calif. -- The woman who putters in the garden at the blue stucco house is bony and frail, with a soft handshake and wide blue eyes. She brings to mind a character from a Tennessee Williams play -- delicate, ethereal, immersed in a world of her own.Linda Schneider's mind is slipping away; a rare genetic disorder is eating at her brain. Her conversation is like water rolling across a tabletop -- elusive, hard to grasp. Her memory dances in and out of reality.Not so long ago, this 49-year-old woman was active and vibrant, a dental hygienist and part-time travel agent.

Carroll County General Hospital is well on its way to becoming an almost paper-free institution.A new computer system links many hospital departments, lab tests are ordered and recorded by computer, and soon local doctors will be able to read their patients' hospital records on computers in their offices.The $2.4 million system, which has been installed over the past three years, has made it possible for doctors to receive medical information on hospital patients and has eliminated many mistakes caused by human error, hospital officials say."

A dying patient wants to spend one last holiday with her family. A man puts beer in his feeding tube at home. A woman can't be discharged from the hospital because she is not a U.S. citizen.The problems vary widely but the people have one thing in common. All are patients facing difficulties that go well beyond the illnesses or accidents that brought them into hospitals.Coping with their needs is a group of hospital employees whose role has grown along with the pressure to discharge patients much more rapidly than in the past.

When the Greater Baltimore Medical Center invested in state-of-the-art technology years ago for its radiation oncology center, it assumed its competitors would be other hospitals that operated under the same rules.But a convergence of forces changed the landscape. The cost of the machines used by GBMC to deliver high-intensity beams of radiation dropped substantially as the cancer rate in Maryland rose to the highest in the country, increasing demand for treatment.The result: The state is saturated with privately owned, competitively priced cancer treatment centers that are beginning to lure away hospital patients.

WASHINGTON -- Out of the shadowy past of mental hospitals, when all-but-forgotten patients lived an almost brutish existence, comes a modern sequel that is slowly moving toward national prominence.For 17 years, two law partners in a small Indiana firm have been trying to win millions of dollars in wages for mental patients who were in state hospitals there -- patients who were forced, allegedly under threat, to work for nothing at the most menial tasks done in those facilities.The case has just reached the U.S. Supreme Court, posing a major test of whether the Constitution's ban on slavery and forced labor applies to the mentally ill, the retarded or to juvenile delinquents kept in state institutions.

Ruth A. Smith fills her mind with compassion and a sense of humor before she leaves for work.As a volunteer at Fallston General Hospital, the 72-year-old resident of Black Horse has to be prepared to alleviate the fears of those about to undergo or recuperating from operations and to humor other hospital patients.Her work and commitment -- she has worked as a hospital volunteertwice a week for the past 13 years -- were recognized late last month. She was named a 1991 recipient of the Maryland Jaycees' Outstanding Senior Citizen award, an annual honor given to just 20 Marylanders this year.

For Donald and Joann Miles, the spare hours accompanying retirement are put to good use.The Woodbine couple has worked more than 600 hours this year in volunteer jobs at Howard County General Hospital. There, each has begun a second career -- but this time, they don't get paid.Donald Miles, 63, has donated approximately 1,350 hours since he joined the hospital volunteer staff in 1988, working at least two days a week in the emergency room and the recovery room. He worked Christmas Day."I was in the hospital one day and it seemed to me that they could use some help," said Donald, a retired planner who worked 37 years with the Potomac Electric Power Co. "You always hear retired people say they have nothing to do, so I decided I'd do something."

To protect patients and doctors from the spread of an escalating disease, former patients of the Johns Hopkins Hospital cancer surgeon who died of AIDS are calling for mandatory screening of hospital patients and hospital surgeons for human immunodeficiency virus, which causes the lethal disease.And, while state law prohibits mandatory screening for HIV, Dr. Hamilton Moses III, Hopkins' vice president of medical affairs, said the hospital would encourage new legislation now that time has brought "a clarification of the disease."

Johns Hopkins Hospital, dealing with disclosures that one of its surgeons died of AIDS, is calling for legislation that would require all health care workers infected with the virus to report their illness to their supervisors or hospitals."

Willie Mae White began worrying how she'd pay the $36,224 bill from Johns Hopkins Bayview Medical Center a few weeks after having emergency brain surgery. She lived off Social Security and food stamps after decades working as a housekeeper. So she was thrilled when Bayview informed her in writing that her bill would be forgiven, at least in part. The hospital had little to lose, since it can recover its costs of free and unpaid care under a unique state program. Instead, the hospital sued her 15 months later to collect the bill.

WASHINGTON -- Many hospital patients are dissatisfied with some aspects of their care and might not recommend their hospitals to friends and relatives, the federal government said yesterday as it issued ratings for most of the nation's hospitals, based on the first uniform national survey of patients. The survey was meant to provide a constructive way for patients to complain about arrogant doctors, crabby nurses and dirty or noisy hospital rooms. Medical experts said some of the complaints bore directly on the quality of care.

Four patients in an intensive-care unit at University of Maryland Medical Center have been isolated after lab tests showed that they have a relatively uncommon bacterial infection that is resistant to antibiotics. Doctors identified the bacterium as Acinetobacter baumannii, known to attack wounded military personnel and hospital patients with weakened immune systems. The isolated patients at the hospital have a treatment team assigned to them, members of which wear gowns and gloves, and the hospital has minimized risks that the infection might spread to its nine other intensive-care units, said Dr. Harold Standiford, medical director of infection control.

Blood clots can be painful, difficult to diagnose, even life-threatening. But hospital patients -- who are at an especially high risk of developing the condition -- often don't receive treatment to prevent them, researchers have found. A hospital stay, even one as short as a few days, can greatly increase the chance of developing a clot in the legs or lungs. In fact, blood clots in the lungs, known as pulmonary embolisms, are blamed for as much as 10 percent of deaths in hospitalized patients.

CHICAGO -- Illinois is poised to become the first state to require hospitals to implement programs combating a dangerous, drug-resistant bacterium that kills thousands of people in the U.S. each year. Under a bill moving through the Legislature, hospitals would be required to test for methicillin-resistant Staphylococcus aureus, or MRSA, in all intensive-care and "at-risk" patients, such as those transferred from nursing homes. If it is detected, aggressive measures to prevent transmission would kick in. MRSA is a potentially virulent bacterium that has developed strong defenses against common antibiotics such as penicillin.

A second Maryland hospital has reported losing sensitive computerized data on tens of thousands of patients, raising another alarm about how consumer information is protected. Up to 130,000 former and current patients at St. Mary's Hospital in Leonardtown have recently been notified that a laptop with personal information was stolen from the hospital in December. Just last week, Johns Hopkins officials reported the loss of thousands of employee and patient records. Last seen Dec. 5 in St. Mary's emergency care center, the computer included the names, Social Security numbers and birth dates of patients who had been treated as long ago as 1989, said Christine Wray, the hospital's president and chief executive officer.

A second Maryland hospital has reported losing sensitive computerized data on tens of thousands of patients, raising another alarm about how consumer information is protected. Up to 130,000 former and current patients at St. Mary's Hospital in Leonardtown have recently been notified that a laptop with personal information was stolen from the hospital in December. Just last week, Johns Hopkins officials reported the loss of thousands of employee and patient records. Last seen Dec. 5 in St. Mary's emergency care center, the computer included the names, Social Security numbers and birth dates of patients who had been treated as long ago as 1989, said Christine Wray, the hospital's president and chief executive officer.

Johns Hopkins began notifying thousands of university employees and hospital patients yesterday that backup computer tapes containing personal information about them - some of it sensitive - have been missing for seven weeks. Hopkins officials said they believe the data, which did not include patient medical information, wasn't compromised. Still, two regulatory agencies that oversee hospitals are discussing whether to investigate Hopkins' security practices amid concerns of identity theft.

If you enter the hospital with pneumonia today, there's a good chance you'll be treated by a new kind of specialist - a hospitalist - instead of your family doctor. More than half of all large U.S. medical centers now use hospitalists, and new programs are springing up across the country. Fifteen years ago, the situation was far different: primary care doctors were in charge of treating many hospital patients. "It's a sea change in the nature of health care," says Dr. Bob Wachter, a hospitalist and researcher at the University of California at San Francisco.

Many children needlessly die and huge amounts of money are wasted because of safety lapses in hospitals, according to the most comprehensive study done on the impact of the problem. More than 4,000 children died in 2000 because of lapses, which cost more than $1 billion in extra hospital charges from longer stays and follow-up care for the ill and injured. The study, published in the new issue of Pediatrics, found that the youngest and poorest patients were the most vulnerable. Researchers considered 20 of the most common patient safety problems, from post-operative infections or bleeding to failure to revive a patient.