{
  "id": "1996-december-rocking-the-rules",
  "slug": "1996-december-rocking-the-rules",
  "url": "https://dwillis.github.io/uplink/article/1996-december-rocking-the-rules.html",
  "year": 1996,
  "month": "December",
  "monthNum": 12,
  "headline": "Rocking the rules",
  "kicker": "Baby business",
  "author_name": "Laurie Snyder",
  "author_title": "projects reporter",
  "affiliation": "The Cleveland Plain Dealer",
  "summary": "Cleveland Plain Dealer reporters discovered that Level II hospitals were illegally accepting severely premature babies to increase profits, resulting in significantly higher death rates compared to specialized Level III hospitals. The investigation used birth and death records to expose how financial incentives were overriding patient safety protocols in neonatal care.",
  "keywords": [
    "hospitals",
    "premature",
    "deaths"
  ],
  "topics": [
    "Health & Environment",
    "Investigative Methods",
    "Data & Databases"
  ],
  "technologies": [
    "9-track tape",
    "PC",
    "FoxPro"
  ],
  "full_text": "On a tip, The Cleveland Plain Dealer's Joan Mazzolini, medical reporter, and Dave Davis, projects reporter, investigated why several hospitals were lobbying against tighter restrictions on neonatal care units.\n\nBy examining two years of birth and death records, the reporters found that many hospitals were accepting transfers of extremely premature babies, even though a state system was supposed to route these sick babies to the most sophisticated medical centers. These centers, which are certified as Level III hospitals, had cutting edge technology and a staff of specialists.\n\nBut in a time of managed care and shrinking profits, many hospitals are searching for ways to generate funds - and obstetrics, especially neonatal intensive care, is a good way to do it. In Ohio, the average cost of treating a premature baby, in 1994, was about $40,000 and could hit upwards of $400,000.\n\nSo many Level II hospitals, in an effort to \"get a bigger piece of the baby market,\" Davis says, were squeezing by state restrictions and presenting themselves to parents as able to provide the most advanced neonatal care.\n\nHowever, when it comes to the treatment of premature babies, all hospitals are not equal. The Plain Dealer series, which ran on Nov. 27 and 28, 1994, shows that the death rate of premature babies was significantly higher at the Level II hospitals than at nearby Level IIIs. The articles highlights what Davis calls \"another example of the business side of hospitals dictating how health issues are handled.\"\n\nThe data\n\nMazzolini and Davis requested Ohio's birth and death records for 1992 and 1993, although, at the time, only eight months of the 1993 records were available.\n\nEach nine-track magnetic tape cost $100. Getting the records was relatively easy, Davis says. \"In most cases, we had the data a few days after we filed our request\" with the state health department. And, the data were clean.\n\nThe reporters transferred the data from the tapes to an IBM 486, then used FoxPro for their analysis.\n\nMazzolini and Davis discovered that birth records are a CAR gold mine, with more than 60 fields of information. The records included when and where the baby was born, as well as such details as the gestation age of the baby, the mother's ZIP code, the number of prenatal doctor visits; and, most important, whether the mother was transferred from one hospital to another, either during labor or afterwards. \"Basically, we were able to track the flow of babies,\" Davis says. The birth records allowed Mazzolini and Davis to identify the hospitals that were treating extremely premature babies, Davis says. Then, linking this information to the death records using the hospital code number, they calculated the death rates at various Level II hospitals vs. those certified as Level III.\n\nFinding the names of babies who died wasn't as easy. Birth records do not contain the names or an unique identifier, such as a Social Security number, so they roughly matched the birth records by linking the birth date and hospital code to these same fields in the death records, which do contain names.\n\n\"We had good luck; out of 20 names, 15 would be correct matches,\" Davis says.\n\nThey also downloaded data from the Census Bureau site (www.census.gov), which provided the median income level for various ZIP codes. This data did need some cleaning, Davis says. The Census database listed nine numbers in the ZIP code column, so they wrote a program in FoxPro that removed the last four digits.\n\nAfter the series ran, the state legislature issued a moratorium on hospitals adding neonatal intensive care units-and, in the years since, have closed the loopholes that allowed Level II hospitals to skirt state restrictions. But, Davis says reporters should revisit the issue. \"Hospitals routinely thumb their noses at the state health department.\"",
  "provenance": {
    "extracted_by": "anthropic/claude-sonnet-4-6",
    "extracted_at": "2026-07-05",
    "verified": true
  },
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      "slug": "1995-april-tracking-hospitals-that-mistreat-babies",
      "score": 0.47
    },
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      "score": 0.238
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  ],
  "html_url": "https://dwillis.github.io/uplink/article/1996-december-rocking-the-rules.html",
  "json_url": "https://dwillis.github.io/uplink/article/1996-december-rocking-the-rules.json"
}