In a new study on obstetrics and patient safety, Consumer Reports has given 50 Florida hospitals the worst possible rating: the dreaded black dot. That's almost half of the hospitals that have obstetrics services in the state.
The black dot (a quality rating system called Harvey Balls) indicates a risk to patient safety, and a major factor in the calculation is whether the hospital has standards in place to avoid unnecessary Caesarean sections -- birth through an incision in the abdomen rather than the vaginal canal.
South Miami Hospital, at about 45 percent, had the highest C-section rate in Florida on the magazine's list. Hialeah Hospital and Kendall Regional Medical Center were tied for second-highest at 38 percent.
Looking just at high-volume centers -- hospitals with at least 5,000 low-risk deliveries over two years --South Miami Hospital had the highest rate in the nation, according to a chart from Consumer Reports.
Attempts to get a response from South Miami Hospital officials weren't successful. But we noticed something: South Miami Hospital has actually made some progress in its C-section rate since Health News Florida took an in-depth look at the phenomenon in 2010. At that time, South Miami's reported annual C-section rate was 61 percent -- and it wasn't even the highest. Kendall Regional, where almost two-thirds of births were by C-section, had it beat.
State reports in the past have shown a strong correlation between the ethnicity in a given area and the C-section rates, with the percentages increasing as one moves south below I-4. It reflects high C-section rates among some countries in Central and South America, where C-sections are seen as a status symbol and vaginal birth is regarded as appropriate only for the lower classes.
Excess C-sections drive up the cost and risk of delivery for women, but they bring in extra money to doctors and hospitals, the consumer magazine noted. Doctors say it's the patients' choice, but patients say their doctors pressure them into it, the article said.
Health News Florida studied the C-section rate in 2010 to see whether this state mirrored findings from one conducted in California. There, the rates tended to be higher at for-profit hospitals and lower at non-profit and public hospitals. That suggested the increased income from the surgery might play a role.
But our analysis found no difference between rates at non-profits and for-profits. The distinguishing factor lay in demographics. The highest rates of C-sections were found in Miami-Dade County, where 62 percent of residents claimed Hispanic ancestry.
“It’s sort of a cultural phenomenon,” Dr. Rafael Perez, an obstetrician on the South Miami Hospital executive committee, said at the time.
Getting back to Consumer Reports, the magazine said healthy women at low risk who undergo their first C-section had three times higher rate of serious complications than women giving birth vaginally in a long-term analysis of more than 2 million Canadians published in 2007.
Babies benefit from vaginal delivery, as well, the magazine said. They are more apt to breastfeed and are less likely to have breathing problems.
"How you deliver your baby should be determined by the safest delivery method, not which hospital you choose," said John Santa, medical director for Consumer Reports Health.
The worst-rated Florida hospitals -- the ones that received the full black dot from Consumer Reports on obstetrics -- are, starting with the highest:
- South Miami Hospital, 45 percent
- Hialeah Hospital and Kendall Regional, 38 percent.
- Holy Cross Hospital in Fort Lauderdale, 36 percent.
- Mount Sinai Medical Center in Miami Beach, 34 percent.
- Palmetto General Hospital in Hialeah, 33 percent.
- Memorial Hospital Miramar, 31 percent.
- Jackson Health System, 30 percent.
- Physicians Regional Medical Center-Pine Ridge in Naples; Plantation General Hospital; and Baptist Hospital of Miami, all 29 percent.
- Cape Coral Hospital and Bayfront Health Dade City, both 28 percent.
- Heart of Florida Regional Medical Center in Davenport; St. Joseph's Hospital in Tampa; and St. Vincent's Medical Center-Riverside in Jacksonville, all 27 percent.
- Boca Raton Regional and Homestead Hospital, both 26 percent.
- Mease Countryside Hospital in Safety Harbor; Lawnwood Regional in Fort Pierce; Northwest Medical Center in Margate; North Shore Medical Center in Miami; Memorial Hospital Jacksonville; DeSoto Memorial Hospital in Arcadia; and West Boca Medical Center, all 25 percent.
- Memorial Regional in Hollywood; Palms West in Loxahatchee; Brandon Regional; Broward Health in Fort Lauderdale; Lakeside Medical Center in Belle Glade; Bayfront Health in St. Petersburg; Fort Walton Beach Medical Center; Florida Hospital Tampa; and Florida Hospital North Pinellas, all 24 percent.
- Orlando Regional; South Lake Hospital in Clermont; Sarasota Memorial; and Lee Memorial in Fort Myers, all 23 percent.
- Florida Hospital in Orlando; Bethesda Memorial in Boynton Beach; Baptist Medical Center Beaches in Jacksonville Beach; Florida Hospital Memorial Medical Center in Daytona Beach; Bayfront Health Port Charlotte; Memorial Hospital West in Pembroke Pines; St. Mary's Medical Center in West Palm Beach; and Lower Keys Medical Center in Key West, all 22 percent.
- Florida Hospital Zephyrhills; Baptist Medical Center Jacksonville; NCH Downtown Naples Hospital, and Wellington Regional in West Palm Beach, all 21 percent.