How I Got the Story: "Quantity of Care" by The Seattle Times

   

A tip, a database, a lawsuit and then a “reply-all” email lead to The Seattle Times’ award-winning Quantity of Care series, which exposed how a prominent local hospital’s brain and spine surgery center grew in patients and revenues even as nurses and doctors expressed grave concerns about patient care.

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In a Q&A with the Asian American Journalists Association’s enterprise affinity group, the project’s lead investigative reporter Mike Baker [pictured right] answers questions about the two-year investigation. Baker, 33, is an award-winning journalist who joined The Seattle Times in 2014. He won the 2017 Livingston Award for a series looking at the predatory nature of Warren Buffet's mobile-home empire, and in 2015 was a part of The Seattle Times team that won the breaking news Pulitzer Prize for coverage of the Oso landslides that killed dozens of people.

Q: What was the initial tip and what were your first thoughts about it? Take us through your first steps and how you mapped out your reporting strategy. What were the most useful sources of information for your story?

We started after hearing about turmoil at the Swedish Neuroscience Institute. To me, that seemed like a potential story, in part because this neuroscience center was such a celebrated institution in the city. A lot of the early reporting involved tracking down some former workers at the institute to gauge their feelings about the hospital, and it became clear that there were widespread concerns about the organization’s shifting culture.

We continued reaching out to former workers and current ones. LinkedIn was a big help to identify people. Nexis was helpful in finding home addresses and contact information. The world of brain and spine surgery is also relatively small, so even medical professionals outside of Swedish were aware of the turmoil and peers who had been affected. To better understand the experience of patients who had bad outcomes, we sought them out in a variety of ways— lawsuits, Department of Health complaints, death records, attorneys, Facebook. You’d be surprised at how often people publicly discuss their medical experiences on Facebook.

But even as we pursued those angles, we still weren’t sure whether it was true that the institute had become a particularly high-production center. Workers were saying it was out of the norm, but I kept wondering whether it was busy but still somewhat normal. Maybe other surgeons in the area were just as busy. That’s where the data was so important.

Q: Without having any previous healthcare reporting experience, you tapped into a state database to help quantify and justify the concerns you’d heard from sources. Often, this is the toughest part— what lead you to these databases? How did you know where to look? What type of records request did you submit?

Our newsroom had some past experience with the database, which is called the Comprehensive Hospital Abstract Reporting System (CHARS) and can be purchased from the state Department of Health. I had played around with the database a bit, only to find that it is an enormous dataset filled with many numerical codes. It’s a big task to gain proficiency in the data, but it provides extensive (and anonymous) details on every inpatient hospital visit in the state, so we were willing to make that investment of time.

My colleague, Justin Mayo, is a data specialist. We spent months learning and working with the data. To examine brain and spine surgeons, Justin pulled federal data from the National Plan and Provider Enumeration System. That system supplies a unique 10-digit number called the National Provider Identifier (NPI) for all healthcare providers. From this, we created a subset of doctors whose primary specialty was neurological surgery or orthopedic surgery of the spine.

Justin matched the NPI numbers from our slice of the federal data to NPI numbers in the state data so that we could look at all patients whose attending doctor was a neuro or spine specialist. Justin’s analysis showed a drastic change for Swedish in both the numbers of patients and the billed charges for those patients. And the top doctors at Swedish really surged ahead of their peers in the state. The data also allowed for other analyses of certain types of cases, including specific diagnoses, specific procedures and specific outcomes.

Some states have this kind of data available. Others do not. For those that don’t, reporters may want to try using Medicare data as a proxy. There’s a lot available at data.medicare.gov and data.cms.gov.

Q: How did you find Talia Goldenberg’s story? How did you get her family to open up for that haunting narrative?

Talia’s family had pursued a lawsuit against the hospital, so we came across that during our reporting. The records from the case gave us a glimpse into what had happened.

When I first approached her parents, they declined an interview. They seemed unsure of whether they’d want to participate in a news story and unsure of what they could say about Talia’s death due to the limitations of how their legal case was resolved.

I then tried talking with the family through their attorney, and they remained reticent but not opposed to speaking with me. I later called other family members to learn more about Talia’s life and what she was like as a person. After those interviews, her parents expressed an interest in speaking. They had some limitations on what they could talk about, and that was challenging, but they were still able to detail Talia’s compelling life story and what things were like in the hours surrounding her surgery. I can’t imagine what it was like for them to answer those kinds of questions, but I’m grateful that they were willing to share Talia’s story.

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Q: A source forwarded you an internal email where Swedish addressed the ongoing staff concerns about the star surgeon at the center of your series, to which you made the gutsy move to reply all [pictured above], in order to solicit new sources, even though it put your investigation full out in the open. Did you have any hesitation about that and how did that accelerate your reporting?

No hesitation. Part of the anonymous internal message was some discussion about how a Seattle Times reporter had been calling current and former employees. So plenty of people were aware of the work I was doing and the questions I was asking. As soon as I saw the email, I thought it was an opportunity to directly engage in the broader conversation that was happening at the health system and let people know that I was interested and available to talk. There were more than 100 medical professionals on the list, including some top Swedish leaders, so it was an efficient way to reach a lot of folks that I had been trying to contact through other methods.

The email resulted in new information and new leads. We still had a lot left to examine at that point, so it was helpful.