Claire Dawson
Hospitals are required to report deaths in certain circumstances. For example, hospitals in Alaska, Arkansas, Delaware, Georgia, and Hawaii are required to report hospital-acquired infections (HAIs) to their respective state departments or the National Healthcare Safety Network (NHSN). Additionally, a new law mandates hospitals to disclose device-related injuries and fatalities, requiring them to report instances where a device has likely caused or contributed to a patient's death. However, the U.S. Department of Health and Human Services (HHS) has stopped requiring hospitals to report COVID-19 deaths, leading to questions about data transparency.
| Characteristics | Values |
|---|---|
| Hospitals required to report COVID-19 deaths | The U.S. Department of Health and Human Services (HHS) stopped mandatory hospital reporting of COVID-19 deaths in 2022. |
| Hospitals required to report device-related injuries and deaths | The Safe Medical Devices Act of 1990 requires hospitals to report device-related injuries and deaths. |
| Hospitals required to report HAIs | Hospitals in Alaska, Arkansas, Delaware, Georgia, and Hawaii are required to report HAIs to the National Healthcare Safety Network (NHSN) or their respective state departments of health. |
| Public comparison of hospital performance | Thirty-eight states have passed laws to provide the public with hospital infection report cards, allowing for public comparison of hospital performance. |
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What You'll Learn
Hospitals no longer required to report COVID-19 deaths
On January 6, 2022, the US Department of Health and Human Services (HHS) announced changes to the reporting requirements for hospitals and acute care facilities. The new guidelines stated that hospitals were no longer required to report the "previous day's COVID-19 deaths" to the federal government. This change sparked controversy, with some questioning the motive behind the decision and expressing concerns about the transparency of COVID-19 data.
The HHS's decision to stop mandatory reporting of COVID-19 deaths by hospitals was met with criticism and speculation. Dr. Jorge Caballero, a medical doctor and Clinical Instructor at Stanford University, took to Twitter to express his concerns. He questioned why the federal government would choose to discontinue the daily reporting of COVID-19 deaths by hospitals. Caballero's tweet brought the issue to public attention and sparked discussions on social media and news platforms.
In response to the HHS's announcement, fact-checkers and media outlets claimed that the US government was not entirely ending daily COVID-19 death reporting. They argued that hospitals would still report to state health authorities and that the change could streamline data collection processes. However, critics pointed out that the HHS system relied on direct reporting of medical diagnosis codes, raising doubts about the accuracy and reliability of the data.
The decision to no longer require hospitals to report COVID-19 deaths has significant implications for data collection and analysis. Some sources suggest that hospitals may have been incentivized to inflate COVID-19 death counts by including COVID-19 on death certificates, potentially impacting the accuracy of the data. Additionally, the lack of transparency from the Centers for Disease Control and Prevention (CDC) and HHS regarding COVID-19 and vaccine-related data has made it challenging for researchers and public health experts to draw conclusions and make informed recommendations.
The move by the Biden administration to weaken the reporting of COVID-19 deaths follows a similar pattern set by the Trump administration. The House COVID Subcommittee's 2021 year-end report revealed that Trump Administration officials had purposefully weakened CDC's coronavirus testing guidance in 2020 to obscure the true severity of the pandemic. The CDC has also been criticized for not publishing large parts of the data collected during the COVID-19 pandemic, particularly regarding hospitalizations and the effectiveness of boosters in people under 65.
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Hospitals must report device-related deaths
In the United States, the Safe Medical Devices Act of 1990 requires hospitals to report device-related deaths. This law applies to "device user facilities", which include hospitals, nursing homes, and outpatient centers. The law mandates that these facilities must report instances where there is information suggesting that a device has caused or contributed to a patient's death or serious illness.
The Medical Device Reporting (MDR) regulation contains mandatory requirements for device user facilities to report device-related adverse events and product problems to the Food and Drug Administration (FDA). Hospitals must report suspected medical device-related deaths to both the FDA and the manufacturer within ten working days of discovery. Additionally, they must report device-related serious injuries to the manufacturer or, if the manufacturer is unknown, to the FDA.
The FDA is responsible for monitoring device performance, detecting potential safety issues, and contributing to benefit-risk assessments of medical devices. They receive over two million medical device reports annually, including suspected device-associated deaths, serious injuries, and malfunctions. The FDA encourages healthcare professionals, patients, caregivers, and consumers to submit voluntary reports about serious adverse events associated with medical devices.
The law has important medico-legal implications for facilities and individual users and may create a substantial reporting burden. The FDA aims to minimize negative effects by writing useful but minimally burdensome regulations. However, there are still ambiguities in the law that need to be defined, such as what constitutes a "reasonable probability" and the exact way in which a device has "contributed" to an adverse event.
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Infection rates and deaths are publicly reported
As of 2022, the U.S. Department of Health and Human Services (HHS) has stopped mandatory hospital reporting of COVID-19 deaths. However, this does not mean that infection rates and deaths are not publicly reported.
There are numerous studies that have been conducted to estimate the risks of COVID-19-associated hospitalization and death using publicly available data. These studies have considered various factors such as age, exposure characteristics, contact rates, and case-hospitalization and fatality ratios to calculate the risks. For example, a study published in PLOS One estimated the risks for a 90-day period at a median daily summertime COVID-19 case incidence of 10.8 per 100,000 for individuals between the ages of 20 and 60 years. The corresponding 90-day period risk of hospitalization ranged from 13.7 to 69.2 per 100,000.
Another study published in Frontiers in Public Health analyzed global trends in COVID-19 incidence and case fatality rates from 2019 to 2023. This retrospective analysis provided valuable insights into the global dynamics of the pandemic and highlighted significant disparities in infection and mortality rates across different continents and income levels. The study found that as of April 2023, COVID-19 incidence was higher in high-income countries, while mortality rates were higher in low-income countries.
In addition to these studies, publicly reported data on infection incidence by geographic setting, residence type, and known exposure can also help estimate the risks of hospitalization and death. This allows for a more precise estimation than what is possible with currently available public data.
While the HHS has stopped mandatory hospital reporting of COVID-19 deaths, it is important to note that infection rates and deaths are still publicly reported through various studies and data sources. These reports help individuals understand their personal risks and contribute to the development of effective public health strategies and policies.
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Hospitals incentivised to admit COVID-positive patients
As of 2022, the U.S. Department of Health and Human Services (HHS) has stopped mandatory hospital reporting of COVID-19 deaths. However, there have been concerns about hospitals being incentivized to admit COVID-positive patients.
Whistleblowers working with attorney Thomas Renz, who is investigating hospital abuses, have reported that hospitals are incentivized to admit PCR-positive patients, prescribe remdesivir, place patients on ventilators, and include COVID-19 on death certificates. It is believed that hospitals could receive up to $100,000 for each patient who meets all the incentivized criteria. While "fact checkers" have disputed this claim, they have been accused of simply changing the semantics of how COVID-19 deaths are counted and how hospitals are compensated for COVID-19 patients.
The HHS decision to stop requiring hospitals to report COVID-19 deaths has raised questions about the transparency of data. Some have suggested that the government is trying to hide or stop the flow of data, similar to accusations made against the Centers for Disease Control and Prevention (CDC) regarding the effectiveness of booster shots.
The new guidelines announced by the HHS on January 6, 2022, noted the "retirement of fields which are no longer required to be reported," including the "previous day's COVID-19 deaths." This change in reporting requirements for hospitals and acute care facilities sparked concerns about the motivation behind the decision and the potential impact on public health and policy-making.
While the HHS publicly announced the change, fact-checkers reported that the U.S. government was not ending daily COVID-19 death reporting. It is important to examine how data is collected and presented to ensure transparency and accuracy, especially during a public health crisis.
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Hospitals must report work-related fatalities
A work-related fatality must be reported to OSHA if it occurs within 30 days of the work-related incident. The report must be made within eight hours of the employer becoming aware of the fatality. If exigent circumstances exist, this deadline can be extended to 24 hours. Reports can be made by telephone or through a specified online mechanism.
In addition to reporting fatalities, employers must also report inpatient hospitalizations, amputations, and losses of an eye as a result of work-related incidents to OSHA. Inpatient hospitalization is defined as a formal admission to the inpatient service of a hospital or clinic for care or treatment. Treatment in an emergency room only is not considered inpatient hospitalization and does not need to be reported. Amputations include fingertip amputations with or without bone loss, medical amputations resulting from irreparable damage, and amputations of body parts that have been reattached.
It is important to note that there may be variations in reporting requirements by state, as some states operate their own occupational safety and health programs. However, all states must have or be in the process of developing requirements that are at least as effective as OSHA's.
As an example of specific state regulations, in California, employers must immediately report any serious injury, illness, or death of an employee occurring in a place of employment or in connection with any employment to the Division of Occupational Safety and Health. "Immediately" is defined as no longer than eight hours after the employer becomes aware of the incident, with a possible extension to 24 hours if exigent circumstances exist.
It is worth noting that during the COVID-19 pandemic, there were changes in reporting requirements for hospitals and acute care facilities. The U.S. Department of Health and Human Services (HHS) announced that hospitals were no longer required to report COVID-19 deaths daily. This decision raised questions about data transparency and the potential influence on public health decisions.
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Frequently asked questions
No, this varies by state. For example, hospitals in Alaska, Delaware, Georgia, and Hawaii are required to report HAIs (hospital-acquired infections) to the National Healthcare Safety Network (NHSN). However, Arizona, Arkansas, and Florida hospitals are not.
As of 2022, the U.S. Department of Health and Human Services (HHS) has stopped mandatory hospital reporting of COVID-19 deaths.
Yes, the Safe Medical Devices Act of 1990 requires hospitals to report device-related deaths.
Yes, thirty-eight states have passed laws to provide the public with hospital infection report cards.
