Quality Of Care

A Tennessee-based company that has provided medical services to most of Maryland's prisons for the past five years announced yesterday that it failed to win a new contract for inmate medical care potentially worth tens of millions of dollars. America Service Group Inc. of Brentwood, Tenn., said in a statement that it had not yet received formal notification from Maryland officials that its subsidiary - Prison Health Services Inc. - lost the state's business in a bidding process that began last fall.

When Toby Adele Heller went for a physical exam July 26, 2002, the doctor found blood in her stool and recommended that a specialist evaluate her for, among other things, a tumor. Toby was profoundly retarded and could not speak for herself, so it was up to Baltimore-based Autumn Homes - paid $127,672 a year by the state to care for her in a group home - to follow through on the recommendation. They never did. Over the next 11 months, Toby would often lash out in apparent pain: screaming, pushing people, banging her head, according to records and interviews.

A report card that evaluated the quality of U.S. health care has concluded that American adults receive only about half of the treatments recommended for both acute and chronic conditions and half the recommended preventive care. The Rand Corp. report, based on one of the largest studies of health care quality ever undertaken, says inadequate care translates into tens of thousands of deaths and unnecessary complications, posing "serious threats" to the public's health. The study was published in the journal Health Affairs.

CHICAGO - Responding yesterday to concerns that Americans lack critical information when choosing home health-care services, the federal government began publishing data comparing the quality of the nation's 7,000 home-care providers. The reports measure how effectively home health agencies provide care to patients in need of short-term help with essential daily activities - comparing everything from dispensing medicines correctly to getting patients out of bed or bathed. Administration officials say the comparisons might be more important than nursing home numbers released last year.

When Elizabeth Shilling's aging mother moved in with her five years ago, she wanted to make sure the elderly woman, who was contending with a battery of medical conditions, was getting the best health care possible. But her mother's doctor, Shilling said, was unwilling to coordinate the numerous medications and specialized care that 90-year-old Alice Beer Engeman required. She and her mother were in an all-too-common position, according to a national study by the Rand Corp., which found that patients received proper medical care for a variety of ailments only 55 percent of the time.

Her family knew Sophie Bernstein could be demanding, but they were stunned when told she was about to be evicted from her nursing home. Too difficult, a nursing home official told them, after she'd been living there three weeks. She wouldn't sleep in her bed. She refused to cooperate with staff. Sometimes, she'd wander into other people's rooms. Dena and Hillel Soclof, her daughter and son-in-law, were at their wit's end -- until they found the one employee at Levindale Hebrew Geriatric Center and Hospital in Northwest Baltimore who could come to their aid. They asked for help from Heather Allen, the nursing home's patient advocate.

Question of the Month Some education reformers want to require students to take more frequent and rigorous standardized tests. President Bush has proposed mandatory annual tests for all students. Do you think such testing helps improve student achievement or squanders classroom time? We are looking for 250 words or less; the deadline is Aug. 20. Letters become the property of The Sun, which reserves the right to edit them. By submitting a letter, the author grants The Sun an irrevocable, non-exclusive right and license to use and republish the letter, in whole or in part, in all media and to authorize others to reprint it. Letters should include your name and address, along with a day and evening telephone number.

ASK ALMOST ANY new mom what her biggest worries are, and getting high-quality child care when it's time to return to work will invariably rank among the top three. It's a huge hurdle for working parents. For starters, infant slots are few and far between. (Just check out the waiting lists.) Good care doesn't come cheap. Relatives aren't always available to fill in. And a squeeze is being felt as day-care workers leave the profession for better-paying jobs in other fields. Yet the quality of care that children receive in their earliest years is a key predictor of not only their future academic achievement, but also their emotional well-being, researchers say. I guess that's why I feel as lucky as a beneficiary of the Bill Gates estate whenever I think about my aunt's daily contribution to my growing family's welfare: a positive environment for my 11-month-old son while his dad and I work to make ends meet.

How will hospitals be able to provide life-saving care? I am writing in support of the concerns expressed in The Sun's January 2 editorial "Are state regulators starving Maryland hospitals?" While regulators have quietly adjusted downward hospital revenues over the past few years, hospital trustees, managers, physicians and nurses have attempted to call attention to the obvious impact of these actions: namely, a potential decrease in the quality of care, delays in implementation of new life saving technology and reduced access to care through preventative and primary-care outreach programs for the community.

STATE regulators placed Maryland hospitals on a rate-loss diet a few years ago, but the bureaucrats may have overdone it: For some medical centers, it has turned into a starvation diet that could threaten patients' well-being. Indeed, there is evidence that regulators' cutbacks on hospital rate charges helped precipitate staffing reductions at Shady Grove Adventist Hospital in Rockville, especially nursing shortages, that led to serious medical problems for patients. Shady Grove's accreditation is now threatened.