Reporters at the Cleveland Plain Dealer and The New York Times, using very different methods and approaches, found infants and pregnant women are at risk of critical injury and death.
The Plain Dealer used computer databases from the beginning. The reporters said the story would have been impossible to do without them. At The New York Times, computer-assisted methods were the final phase of the reporting.
Cleveland reporters Joan Mazzolini and Dave Davis looked at Ohio's system for treating at-risk pregnancies and infants. A state formula gives hospitals designations to ensure that the sickest babies and most at-risk mothers are routed to the best medical care. But the reporters found that the system has broken down and that every year hundreds of extremely ill and premature babies are sent to hospitals that may not have the equipment and expertise to care for them.
Using birth certificate databases purchased from the state Department of Health, Mazzolini and Davis were able to identify how many premature babies were born in Ohio in 1992 and 1993, where they were born and where they and their mothers were transferred.
"This really allowed us to question hospitals about treating babies not suited to their designation," Davis said. "The thing we really tried to focus on was looking at hospitals treating premature babies they were not equipped for."
Death certificates were integral in identifying the babies. Ohio law requires that the names on birth certificates be removed before being released to the public, but names are included in death certificates.
"There was enough matching information to link (the two databases) and figure out names," Davis said. "In matching the birth and death records we identified the babies who had died and were able to find the families. We got some very moving stories. Without the computer we couldn't have done that. Matching the birth and death records allowed us to find real people. Some of the stories were amazing."
The series also showed that low-income communities are prone to underweight babies. "It's something we always kind of knew," Mazzolini said. "But it's nice to see it on paper." Using census information and zip codes from the birth certificates, along with mapping software, the reporters were able to plot where underweight babies are born. The three-month investigation published on Nov. 27, 1994, was "not as difficult as it looks," Mazzolini said. "Reporters need to find out what is in their state's birth certificates. Ohio's turned out to be a wealth of information. You can get great snapshots of your city, county or your state."
Davis advised reporters thinking about tackling a similar story to be ready for a fight. "Hospitals are very powerful institutions. I've taken on a lot of different types of institutions and people, but I think doctors and hospitals are the most powerful seen," he said. "We had letters coming in threatening to sue us. And they weren't going to us. They were going to the publisher. That is a sinking feeling. You just have to be prepared for it."
In New York, reporters Jane Fritsch and Dean Baquet had already uncovered the horror stories of the city's public hospitals before computer-assisted reporting was employed to analyze mortality rates. In three-part series, "Mismanaged Care: How Public Hospitals Fail," beginning on March 5, 1995, the reporters showed that every year dozens of newborns die or are left to struggle with life-long injuries because they are treated by inexperienced doctors or poorly supervised midwives and nurses in New York City's overcrowded delivery rooms. The story got started when The Times decided to look at how much litigation was taken against the New York Health and Hospitals Corp., a city agency that runs the public hospitals. "It quickly became clear that there was something going on in the delivery rooms," Fritsch said. Court records that allowed the reporters to take a peek at usually-closed hospital records, was central to the investigation, Fritsch said, adding that they used the whole spectrum of document-gathering, from public records to FOIA requests.
"The computer stuff really came at the end," she said. "I resist depending on the computer and I think some other people resist it because you can end up with stories that report the obvious."
Fritsch added, however, that the statistical analysis for Mismanaged Care, gave the reporters more information to work with, confirmed hypotheses and "rounded things out."
"The overall point of the computer study was our ability to put into perspective the claims of the city people and the hospital people who said they had more problems because they have a vastly sicker population," Fritsch said. "It turned out the computer study brought that assertion into question."
The reporters had much anecdotal evidence to back up the story and statistical analysis of infant mortality rates done by Josh Barbanel made the narratives difficult to dismiss. Even accounting for such variables as poor prenatal care and the mother's health, the statistics showed infant mortality to be significantly higher at public hospitals in the city compared to the private institutions. While the computer-generated information gave the reporters more ammunition for their story, Fritsch advised reporters wanting to do similar work to avoid the computer at the outset of the investigation. "Start with sources, with documents, with real people. Otherwise you could end up with something that is theoretical and distant from the subject," she said. "Use the computer to test hypothesis - but develop the hypothesis first."
Thousands of patients get sick every year from infections spread inside hospitals mainly from health workers' hands. The Tacoma (Wash.) News Tribune examined 1.7 million records from the state Health Department's Comprehensive Hospital Abstract Reporting System. Thirty-five other states have similar databases. Reporters Adam Berliant and Elaine Porterfield cited several instances where patients died from hospital-borne infections. Even though the health department database did not include patient names, the journalists were able to find those cases by linking the database with a state death certificates. They found likely cases by joining the day, place and cause of death in the two sets of records. The series ran May 28-29, 1995.
After finding gaps in a Centers for Disease Control database that extrapolated cancer rates, Newsday built its own database. The newspaper used U.S. Census records to find 75 similar counties - places with large populations and high development. Bob Tiernan, senior editor for projects, said the newspaper surveyed the health departments for those counties. The results were a key part of reporter Ford Fessenden's story on June 27, 1993, which showed Long Island posted one of the biggest cancer rates.
Newsday also used a New York State Health Department database to examine how area hospitals treated breast cancer with surgery. The Sept. 11, 1994, story revealed a vast difference in the rate of lumpectomies versus mastectomies, including one controversial hospital that performed twice as many mastectomies as other facilities in the region.
U.S. News & World Report used the Federal Drug Administration's MedWatch database for a Jan. 9, 1995, cover story that examined drugs with dangerous side effects, including the Norplant birth control implant. U.S. News' Penny Loeb said the database is "tough to work with," but helped yield a powerful story. The magazine also discovered many drugs banned by the FDA are still sold legally over the counter in pharmacies across the country. That, according to the May 15, 1995, story, includes drugs sold at a Rite Aid located inside FDA headquarters.
Using data from a U.S. Department of Health and Human Services, Hartford Courant reporter Robert S. Capers Jr. tracked survival rates of transplant recipients at area hospitals. He downloaded the data, which was compiled by the United Network for Organ Sharing, into an Excel spreadsheet. The organ-by-organ, hospital-by-hospital analysis ran March 26, 1995.
Sarah Christian can be reached at (314) 882-0684, or send e-mail to c636013@showme.missouri.edu