Articles Posted in Certification and Licensure

probe-300x195With more than 10,000 boomers retiring each day and more seniors ending up at some point in their lives in nursing homes, regulators need to step up their oversight of elder care facilities. But there’s disturbing information they’re failing at this crucial task, allowing terrible abuses of older Americans who also may be evicted unfairly from facilities and who may be insufficiently protected when natural calamities occur.

The Minneapolis Star-Tribune deserves credit for its multipart investigation of abuses in nursing homes. As the news organization has reported of its findings:

Every year, hundreds of residents at senior care centers around the state are assaulted, raped or robbed in crimes that leave lasting trauma and pain for the victims and their families. Yet the vast majority of these crimes are never resolved, and the perpetrators never punished, because state regulators lack the staff and expertise to investigate them. And thousands of complaints are simply ignored. … Last year alone, the Minnesota Department of Health received 25,226 allegations of neglect, physical abuse, unexplained serious injuries, and thefts in state-licensed homes for the elderly. Ninety-seven percent were never investigated. That includes 2,025 allegations of physical or emotional abuse by staff, 4,100 reports of altercations between residents and 300 reported drug thefts. When the Health Department did investigate, records show that it often neglected key steps in a criminal probe. In dozens of those cases, for instance, no one interviewed the victims, and no one called the police. Health Department documents contain dire tales of residents being choked, punched, smothered with pillows, fondled and forcibly restrained.

bowser-240x300Even as District of Columbia officials struggle with deepening woes at the United Medical Center (UMC), advocates from a national, independent, and nonprofit group have offered a dim review of hospitals in the DC area.

The bad news keeps piling on at UMC, a leading provider of medical care for communities of color in the District’s Southeast area and in Prince George’s County, Md.

To its credit, the sometimes locally slumbering Washington Post has put out a disturbing, well-documented report about the death of a 47-year-old HIV-AIDS patient in UMC’s nursing home care. As others witnessing the scene clamored for them to help, UMC nurses, the Post says, let the patient fall to the floor, where he sprawled in his own waste for 20 minutes while his caregivers argued with a security guard. When the patient finally was returned to his bed, he was dead.

mwhc-front-entrance-300x174MedStar Washington Hospital Center, described by its chief medical officer as “the most important hospital in the most important city in the most important country in the world,” is under investigation by regulators in the District of Columbia due to maintenance failures that allowed sewage to seep down walls and onto operating room floors.

USA Today deserves credit for reporting on problems  in the 900-plus-bed hospital, which serves many of the District’s poor as well as providing trauma care sufficiently vital that it is supposed to be the go-to place of emergency treatment for top officials.

Its elite patients have included House Majority Whip Steve Scalise, who was taken to MedStar Washington after a deranged gunman wounded him while shooting up a Congressional baseball practice. USA Today says a room where Scalise was treated, later, after he was out of it, was among those affected by maintenance and sanitation woes.

jcgoldseal-300x300The nation’s leading watchdog of hospital safety and quality  is quick to hand out its “Gold Seal of Approval” and rarely penalizes care-giving institutions, even when state and federal officials find serious problems.

The Wall Street Journal deserves credit for its investigation of the Joint Commission, the nonprofit and industry-supported organization that is supposed to inspect and accredit hospitals nationwide. It does so for 80 percent of them, as well as for institutions serving military veterans, federal prisoners, and Native American patients in the Indian Health System.

Hospitals can either join the commission and undergo its accreditation process—including regular inspections that typically are announced in advance, conducted with flourish, and which can cost institutions tens of thousands of dollars depending on their size and membership levels—or they can be inspected by state and federal officials. Most choose the Joint Commission.

eyeliner-300x238The quest for beauty—whether skin deep or in the eye of the beholder—not only carries high costs. It also can be health risky.

Jane Brody reminds us in the New York Times that due “to a lack of federal regulations, the watchword for consumers of cosmetics and personal care products should be caveat emptor: Let the buyer beware.”

Citing a recent editorial in the Internal Medicine publication of the Journal of the American Medical Association, Brody reports that, despite a $26.3 million lawsuit settlement involving 200 women, a hair care maker continues to tout the benefits and safety of its products, about which federal regulators have received more than 20,000 complaints of hair loss or scalp damage.

umc-pic-300x111Health officials caught expectant mothers, local politicians, and the D.C. community off guard by ordering the only full-service hospital in the southeast part of the District of Columbia to stop delivering babies and to shut its nursery for 90 days.

Details weren’t provided as to why D.C. regulators slapped restrictions on United Medical Center’s obstetrics and nursery care license. The hospital itself has acknowledged that at least three incidents, which it says it cannot discuss due to rigorous federal patient privacy rules, prompted the official rebuke.

This shutdown provides a harsh reminder just how little the public gets to know about important issues affecting doctors, hospitals, and patient safety and quality care.

nucarmen-189x300Although smaller community hospitals may provide treatments that are as good and as safe, Americans flock to academic medical centers for specialized care and complex procedures. They’re lured to the big, pricey institutions by their stellar reputations, state-of-the-art facilities, and top-line specialists. These tall, shiny complexes, combining medical education, research and clinical care, also have deep roots in their communities and become political powerhouses in their own right.

Which is why many in the nation’s No. 2 city are abuzz over a Los Angeles Times investigation into the “secret life” of Carmen A. Puliafito, a Harvard-trained eye expert. Until 18 months ago, he had served for a decade as the $1 million-a-year dean of the University of Southern California’s Keck School of Medicine. As Keck’s top doc, the paper says, he “oversaw hundreds of medical students, thousands of professors and clinicians, and research grants totaling more than $200 million … [and] was a key fundraiser for USC, bringing in more than $1 billion in donations, by his estimation.”

The university—which is Los Angeles County’s largest employer, a haven for affluent offspring of West Coast elites, and long has craved global recognition—hired and backed Puliafito to boost the medical school’s  standing.  But during his tenure, the Los Angeles Times found, Puliafito also “kept company with a circle of criminals and drug users who said he used methamphetamine and other drugs with them.” As the paper describes it:

Nursing-home-holding-hands-300x200Federal regulators need to ramp up their oversight of nursing homes, big time, with recent news reports and studies finding persistent abuses of elderly patients, including during crackdowns on problem operators, and facilities failing to care for vulnerable charges so they don’t lapse into emergency or hospital care.

Jordan Rau and the independent Kaiser Health News Service deserve kudos for digging into Uncle Sam’s “special focus status,” in which the nation’s “most dangerous” nursing homes get an ultimatum to correct major and continuing harms to patients or they may lose crucial Medicaid and Medicare funds from the federal government.

Rau found that more than half of the 528 homes deemed since 2014 to require the supposedly stringent “special focus” from regulators and that still are operating have since harmed patients or put them in jeopardy in the last three years.

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

d magazineJust how difficult can it be to stop a highly credentialed but dangerous doctor from hop-scotching around a metropolitan area to perform brutal spinal surgeries in different hospitals, including a respected academic medical center? Just ask crippled patients, neurosurgeons, medical licensing officials, and prosecutors in Dallas what it took to derail Dr. Christopher Duntsch.

As detailed well in the latest edition of the upscale city magazine D, Duntsch was a high-flying physician who moved from Tennessee to Texas, carrying with him an excellent reputation, which later would be challenged, as a medical scientist. Although established as a cancer stem cell-researcher, the neurosurgeon also morphed himself into a spinal surgeon based on training earlier in his career.  He eventually won privileges to operate at three Dallas area hospitals, including the well-regarded Baylor Regional Medical Center at Plano, Texas.

He was a loner and boastful, though colleagues liked him at first. They  quickly were horrified by his surgeries. Among the damages he is criminally accused of inflicting: amputating a patient’s spinal nerve, causing paralysis; cutting another patient’s vertebral artery and ignoring the major bleeding that occurred; installing a too-long screw so that it punctured a big vein, causing extensive bleeding and nerve damage; slashing a patient’s esophagus and a neck artery, leaving the man struggling to eat, breathe, and with blood loss to the brain.

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