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Photo credit: Theodorakis/NY Daily News

The coverups hid a trail of human suffering among patients who were maimed and relatives who were never told the truth about how their loved ones died or were injured unnecessarily.

A months-long probe found coverups at all 11 Health & Hospitals Corp. hospitals — the only option for millions of New Yorkers who cannot afford private medical centers.

From 2004 through September 2008, the state cited city hospitals 68 times for violating laws that require immediate reporting of "adverse events," records show.

Each hospital — Bellevue, Coney Island, Elmhurst, Harlem, Jacobi, Kings County, Lincoln, Metropolitan, North Central Bronx, Queens and Woodhull — had at least one citation.

The law requires all New York hospitals to quickly report all serious medical mishaps to the state.

"There's a tremendous lack of confidence in the reporting," said Arthur Levin, director of the Center for Medical Consumers. "It matters because it is a way to understand where the safety problems are. . . . This identifies what goes wrong and where."

Hidden incidents uncovered by The News — corroborated by dozens of interviews with doctors, patients, lawyers and families of victims — bordered on the Medieval.

Some incidents were simply not reported, while others were reported long after the fact, making investigation impossible. Some records were incomplete or even fictional.

* A stroke victim's leg had to be amputated after gangrene was left untreated. No report.

* An ill infant died after sitting, unexamined by a doctor in an ER for 24 hours. Confronted for not having enough doctors on duty, they produce a "corrected" report saying there was – a month after the fact.

* A mental patient hanged himself and, after several days, died. Though hospitals must report suicides, they report this one as an "unexpected death."

* Records were altered after medical students made mistakes and an infant died.

* Logs for a respirator were changed after staff failed to notice it wasn't turned on. The patient died.

The findings come a year after employees of Kings County Hospital tried to hide the death of 49-year-old Esmin Green. Hospital staff wrote in records that she was fine; a shocking video showed Green dead on the floor.

The Green coverup, The News found, was part of a larger pattern found in thousands of pages of internal hospital records obtained under the Freedom of Information law and documents found in dusty court files.

'TOTAL DYSFUNCTION'

Simply because of their size, city-run hospitals generate a lot of "adverse incidents."

As the busiest municipal system in the U.S., the city's 11 acute-care hospitals last year served 1.3 million patients; 450,000 had no health insurance.

Data make clear that medical mishaps occur fairly frequently in all hospitals, including those run by HHC. Often those mistakes result in state Health Department citations.

From 2004 through September 2008, the latest data available show HHC hospitals were issued 517 citations for screwups ranging from fatal misdiagnoses to "unexpected removal of organ."

In response to multiple written questions, HHC officials defended their system, acknowledging that underreporting is a problem but – given the huge number of patients – a relatively small one:

"All hospitals in New York City, not just HHC, have been challenged by the issue of underreporting. It's important to examine the numbers in context. During this same time period, 2005 to 2008, HHC had more than 1 million patient discharges. That means we were cited in less than a fraction of 1% of the cases during that time."

There is, however, usually little punishment. From 2002 through June – when there were hundreds of citations – there were only 12 enforcement actions brought against all 11 city-run hospitals. Fines totalled a paltry $235,000.

Five of the 11 hospitals faced zero enforcement actions and zero fines in that time period, though the five racked up hundreds of complaints.

Answering the News' questions, a state Health Department spokesman downplayed the significance of the low rate of enforcement actions:

"Events referred for enforcement are the most severe and result in fines. Additionally, changes in policy and procedures on many cases have proven effective to help prevent errors from ever reaching the patient level."

The state is supposed to track and analyze all medical incidents and implement improvements. The problem is this oversight system — the New York Patient Occurrence Reporting and Tracking System (NYPORTS) — is a disaster.

Since 1999, all New York hospitals have been required to self-report a long list of medical incidents to NYPORTS, which in turn analyzes the incidents and implements patient safety reform.

Sunday NYPORTS barely functions. The Statewide Council that oversees it hasn't met in more than two years. Though NYPORTS is supposed to release "annual" reports, the last one filed is dated 2004.

Levin, a consumer member of the NYPORTS Council, says he's watched the system "sort of gradually slide into total dysfunction."

Levin said the state lacks resources to enforce reporting requirements and to review information NYPORTS gathers to improve patient safety.

Many incidents are reported — not by the hospitals — but by anonymous complaints from others like family members, doctors, nurses and staff.

The anonymity that surrounds the system also is a problem in changing the culture of coverup.

Information collected by hospital internal investigations is deliberately kept secret. Incredibly, if the HHC's inspector general, who is charged with investigating corruption, finds evidence of criminal activity in those investigations, he is barred from turning it over to prosecutors.

This issue emerged in the recent Department of Investigation examination of the death of Esmin Green at Kings County Hospital.

DOI was barred from reviewing crucial hospital interviews of staffers "who faced potential criminal liability regarding falsification of medical records and other omissions."

DOI Commissioner Rose Gill Hearn said the rules "hinder criminal investigations by shielding important investigative information rather than exposing it."

A Brooklyn grand jury is now investigating the case.

Families of patients injured or killed are also kept in the dark. Rarely are they interviewed by state investigators. Usually, the victim or their kin are never told the hospitals were cited for violations.

"The way it is done is grossly unfair to the patient and the patient's family," said Adam Slater, a lawyer who has represented several victims in malpractice suits against city-run hospitals.

A CHRONIC DISEASE

Nonreporting of incidents is not a new problem. In the last 10 years, all New York City hospitals — including those run by the city — have been repeatedly singled out for underreporting medical mistakes.

In 2001, the state Health Department found most hospitals across the state, and especially in New York City, were "significantly underreporting adverse events."

Eight years later, in a report issued in March, city Controller William Thompson cited the same persistent pattern of "significant underreporting" at city hospitals.

The state Health Department said besides NYPORTS, the department has other means to monitor patient safety, including investigating doctor misconduct, probing complaints from the public and tracking rates of infection.

Asked about the effectiveness of NYPORTS, the state spokesman responded, "NYPORTS is vital for the department and health care facilities to assist them with making quality of care decisions, and to address and prevent incidents."

HHC offered a similar response: "We support the purpose and goals of the NYPORT system which ensures health care institutions be accountable for medical errors and stay focused on patient safety."

However, records make clear that on average city-run hospitals report incidents at a lower rate than hospitals in the rest of the state.

In 2008, as a whole HHC facilities reported 34.8 incidents for every 10,000 patients discharged. That compares with 45.5 incidents at non-HHC hospitals across the city and state. Similar rates appeared in 2007.

Experts say this does not reflect a lower number of incidents, but is a red flag indicating HHC hospitals are underreporting problems.

Asked about this, the state health Department spokesman said HHC has their own information reporting system. He did not elaborate.

Perhaps the most shocking aspect of the News investigation was the discovery that hospitals violated reporting requirements in what are termed "unexpected" deaths.

State investigators uncovered multiple incidents in which HHC hospitals violated reporting requirements when a patient died under "unexpected" circumstances.

At Kings County, for instance, a state review in late 2006 re-examined 30 incidents reported to NYPORTS from January 2004 through November 2006 and found the hospital's reporting was "not complete and lacked a thorough review."

For instance, a hospital committee that's supposed to review all cases of "unexpected" disease or death simply did not review six of 14 such cases from January through November 2006.

One particularly disturbing fatal incident emerges in an internal report by another state agency, the state Commission on Quality of Care and Advocacy that monitors mental health facilities.

The report describes a Bellevue patient discovered Feb. 5, 2007, in the in-patient forensic unit "hanging with a piece of cloth tied around his neck and connected to a gate."

The patient was alive but unconscious and died when removed from life support on Feb. 16, 2007. Yet in its report to NYPORT, Bellevue claimed to have zero suicides in 2007.

Late Friday HHC insisted they had reported the incident – filing this suicide as an "unexpected death."

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