Nearly Dead, Mistakenly


Ratings and Certificates of Need keep hospitals under the microscope of the public eye

They came really close to killing you,” said a hospital’s diagnostic treatment department chief. His eyes would have looked like sunny-side-up eggs had the irises been yellow. Several years ago, feeling as if each heartbeat was a stab wound, I went for a seven-hour stint in a Tennessee hospital emergency room and was diagnosed with pericarditis, an inflammation of the pericardium, the thin saclike tissue surrounding the heart. Pericarditis hurts. Big doses of ibuprofen eliminated the pain, but my heartbeat didn’t return to consistent rhythm. 

A month later, at 2 a.m. on a Sunday morning, I awoke with heartbeats racing so fast I couldn’t count them. At 3 a.m., off to the emergency room. The ER doctor, speaking by phone with a cardiologist, brought me several medication doses to try to restore my heart rhythm. Nothing worked. I was admitted as a hospital inpatient. At about 7:30 a.m., I rolled over on my back. A nurse appeared. “Mr. Korda, are you all right?” I answered, “I feel bad.” My wife, who’d been sleeping in the room’s reclining chair, awoke. She saw nurses gathering at their hallway station, and wondered who was in trouble. Then, they raced into my room, bringing medicine, other equipment, and a defibrillator. 

They went to work on me, moving quickly, but not hastily. They were giving directions, responding to each other, all with grave looks on their faces. They were doing some fussing, too, but not at each other, rather about the doses of medicine I’d been directed to take a couple of hours earlier. All the medication to get my heart under control had coalesced, and it was driving to dangerous depths my blood pressure and heart rate. As I recall, the bedside monitor showed my blood pressure somewhere near 60-40, well below the danger line of 90-60, as the National Heart, Lung and Blood Institute explains on its website: “If your blood pressure drops too low, your body’s vital organs do not get enough oxygen and nutrients. When this happens, low blood pressure can lead to shock, which requires immediate medical attention.”

I realized I might be dying. This was how it was going to end? With me helpless, silent, with desperate people desperately trying to save my life? Then, I wondered why I wasn’t terrified. Instead, I was strangely unafraid, which I attributed to my Christian faith. I looked again at the nurses. “I feel bad,” seemed like such pathetic last words, but I was too weak to say anything. With that, I felt myself drifting into unconsciousness… 

Sometime later, I don’t know how long, my eyes blinked open. The nurse was there almost immediately. Numbers on the monitor showed my blood pressure still lower than normal, right at about the baseline numbers below which might lead to danger. “How do you feel?” the nurse said. “I feel better,” I answered. Then came the question uppermost on my mind: “Did my heart stop?” She smiled and said, “It paused.” That seemed a distinction without a difference. The nurses saved my life. But what had occurred in the ER wasn’t meant to hurt me: the doctors had been trying to help. Had I died, that would have been another distinction without a difference.

Then came the question uppermost on my mind: “Did my heart stop?” She smiled and said, “It paused.” That seemed a distinction without a difference. 

The nurses saved my life.

A medical error—however unintended—would have been the culprit. A 2016 report on medical errors in the publication The BMJ cited medical errors as possibly America’s third leading cause of death, which was variously estimated at 250,000 to 440,400 a year. The report sparked great debate about patient safety and health care quality. One result: ratings organizations and sites that score medical quality and safety, even a patient’s experience, who make those reports public. The Leapfrog Group is one of the best known, and grades hospitals according to results of safety surveys and practices, ( Among other respected sites are Hospital Compare ( and the Joint Commission’s Quality Check (

The Leapfrog Group publishes safety grades on 3,000 hospitals. Fifteen Knoxville-area hospitals are listed: eight have ‘A’ grades, seven have a ‘B’. Among Hospital Compare’s information is quality of care, emergency services, hospital-associated infections, mortality statistics, and cost. Quality Check gives detailed rundowns on scores of quality issues of Joint Commission- accredited providers. The Joint Commission is America’s largest healthcare accrediting organization.

Ostensibly for patient pro­tection, health care is among America’s most highly regulated industries. But certain regulatory aspects may inadvertently

be problematic, such as the Certificate of Need process, through which a government-created entity decides when, or if, a health care facility can be built or expanded. Thirty-five states, Tennessee among them, have laws associated with this process. Tennessee’s Certificate of Need, the state says, “is a permit for the establishment or modification of a health care institution, facility, or service at a designated location,” and, “seeks to deliver improvement in access, quality and cost savings through orderly growth management of the state’s health care system.” But it’s not universal: as of 2021, 12 states had eliminated such laws. 

Even if approved, this effort adds time and cost to any applicant. Is it worth it? A 2020 analysis of 90 published articles on Certificate of Need laws, found on the National Institute of Health’s National Library of Medicine, says though findings are uncertain and need further study, “The literature provides mixed results, on average finding that CON increases health expenditures and overall elderly mortality while reducing heart surgery mortality. Our cost-effectiveness analysis estimates that the costs of CON laws somewhat exceed their benefits…”

A Nashville Tennessean Sept. 22, 2022 op/ed weighed in on Tennessee’s Certificate of Need law. While lauding such changes to the regulations that exempt from the law “health care services and facilities in economically distressed counties without existing hospitals,” the piece nevertheless maintained that the Certificate of Need law should be repealed altogether: “CON laws thus have a counterproductive effect: protecting entrenched interests by limiting the number of medical providers and services offered in a given area.  Naturally, that limitation of health care supply further increases costs and decreases access.”

While competition is typically understood by Americans to drive down costs, some argue that the opposite is true of health care. An example: different providers both purchase expensive technology, meaning both feel they must raise costs to justify the investment. The arguments for and against health care competition are made endlessly. But if competition weren’t important, there’d be no justification for safety, quality, and patient experience ratings, all of which enable Americans to choose – competitively – which facilities they prefer. 

Health care is a multi-billion-dollar industry that by 2028 is projected to account for one in every eight new Tennessee jobs. More importantly, our lives are in these folks’ hands, sometimes figuratively, often literally, as I learned as a result of a medical crisis I had no inkling I’d ever experience. It’s good for Tennesseans to know how their health care providers rate, and the process by which they’re able—or unable—to provide new or expanded services. And it’s incumbent on Tennesseans to make use of these sources. For safety’s sake.   

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