Reporter Says Patience Key to Hospital Series

Sometimes the simplest of remarks can lead to the most significant of reports. In Alec Klein's case, a casual lunch with a source also fed him the idea for his latest two-day series, this time on how some hospitals can recondition and recycle complex medical instruments that were just designed for one-time use. While the hospitals and reprocessing contracting companies say this route saves money and still puts safety first, Klein, an investigative business reporter at The Washington Post, talks to BusinessJournalism.org Associate Editor Vandana Sinha about his stories, which detail the potential dangers involving medical devices - and how reprocessing became such big business.

How do you find your best story ideas as a full-time investigative business reporter? How did this idea on medical device reprocessing come about?

Klein: There's no formula. My last three Washington Post investigations have come about in three distinct ways. My examination of AOL's accounting irregularities was prompted by an anonymous tipster. My investigation of the corporate credit raters was initiated by one of my editors. And my latest series on the reuse of single-use medical devices arose when the topic came up while I was having lunch with a source. I had never heard that single-use medical devices were being reused. I was curious. I wanted to know more. So I began asking questions.

How do you know when a seed of an idea is a bonafide story, as opposed to some wild goose chase? How did you know in this case as well?

Klein: That's an essential question. First, you need to see what's been written about the subject. In this case, the reuse of single-use devices, while a rapidly growing trend in the United States, remained largely unknown to the public, and relatively little had been written about it. Then you need to start digging. It became clear in the early stages of my reporting that there was the potential to shed light on a subject that touched on important issues of public health.

For this series, who and what were your best sources for educating yourself on the medical devices field? How did you learn what documents are even out there and available?

Klein: For this series, there were many sources of information--doctors, nurses, hospitals, medical device reprocessors, medical device makers and others. As for documents, I went through thousands of pages. That included court records, internal company documents and federal records. As with most things in reporting, start asking questions and, in many cases, you will ultimately find documents.

How did you find the regular people - the patients affected, the cardiologist who changed policy - for this story?

Klein: In various ways. Many names were culled from records, including federal documents or court filings. In other cases, it was the end product of basic reporting: interviewing one person who leads to another person who leads to a third person.

Your story included much criticism for the reprocessing industry, including some players who had been penalized by the FDA. How did you convince those company founders and executives to comment and give their stories?

Klein: In the course of my research and reporting, I came across many records that documented the history and track record of the individuals and companies involved. I presented that information to those individuals and companies and asked them to respond.

What made you decide to expand your story to global reprocessing trends, as opposed to sticking to those in the United States?

Klein: The primary focus of the articles was on the United States, where the practice originated and is flourishing. But reprocessing is not only a domestic trend; rather, it is taking hold in various parts of the world--from Europe to Asia.

What was the hardest part of the investigation, and how did you get around that?

Klein: At times, it was difficult to get people to talk about this little-known practice. For instance, hospitals, doctors and others were concerned about liability when patients were injured or devices malfunctioned. In one case, a hospital told me it did not use reprocessed single-use devices; it only admitted that it did so after I independently verified it. In another case, I had asked federal regulators for a list of reprocessors. At first, they said they didn't keep such a list; I only received such a list after I submitted a Freedom of Information Act request. But then it turned out that the list was incomplete. And when I had identified a founder of the reprocessing industry, he declined to take my telephone calls after an initial conversation. Representatives of the reprocessing business demanded that I not speak to him. I got on an airplane anyway and, unannounced, knocked on his door. He let me in.

Some readers had questions about whether there's possible insurance fraud in using cheaper, refurbished medical devices, but charging patients for the brand new ones. Is that something you plan to follow up on in future stories? If not, what do you see as your next step in this story?

Klein: It seems that we've struck a nerve. Readers have been deluging us with follow-up ideas and tips. I am going through it all now.

What has been the reaction to this series, particularly by the reprocessing industry?

Klein: The reaction has been immediate. Several members of Congress have called for more federal oversight of the reprocessing industry, requesting information from the FDA and an investigation by the GAO, Congress's watchdog. Those in the reprocessing industry say that there is no evidence that their reconditioned devices are any riskier than new devices, that there is risk in any surgery and that reprocessing saves hospitals on average half the cost of a new single-use device.