As the new year gets under way, regulators and lawmakers need to look hard at a nightmare in New Jersey involving a free-standing surgical center and to a nationwide harms occurring in psychiatric hospitals to ensure that these and other institutions improve the safety and quality of their patient care.
USA Today and the Wall Street Journal, in separate stories, reported about shoddy practices and lax oversight that contributed to significant problems in the medical facilities.
The Journal investigated hospitals for the mentally ill and found that, “More than 100 psychiatric hospitals have remained fully accredited by a major hospital watchdog despite serious safety violations that include lapses linked to the death, abuse or sexual assault of patients.”
USA Today said state health officials fear that flawed instrument handling and sterilization, and injection practices at a free-standing surgical center in Saddle Brook, N.J., exposed “more than 3,000 patients … to HIV, hepatitis B and hepatitis C.” No infections have been found as of now, but thousands of patients have been urged to undergo testing and the center has been shut.
Though they may treat disparate patients, surgical centers and psychiatric hospitals both can put the vulnerable at risk because they work in areas where laws haven’t caught up with changes in medical practice or watchdogs rely on other groups to take on vital oversight duties, such as amassing key information on safety violations.
The Journal’s story on psychiatric hospitals extended the newspaper’s investigation of accreditation by the Joint Commission, an independent but private health industry group that holds what amounts to a monopoly on the process by which caregiving institutions prove they meet federal safety standards. This then allows them to get paid billions of dollars under programs like Medicare and Medicaid.
The commission announces well ahead of time that its staff and collected experts will arrive at a site and conduct “inspections,” and the group also makes good money advising institutions on best practices in medical care, including how to meet its standards and pass muster when under scrutiny.
The newspaper reported:
[The commission] revoked or denied full accreditation to fewer than 1 percent of psychiatric hospitals it oversaw in fiscal years 2014 and 2015, the latest time for which detailed federal data are available. State inspectors found about 16 percent of those hospitals, or about 140 institutions, operated with such severe safety violations that federal funding was at risk.
Further, the journalistic reckoning on the group showed:
The Journal found 141 psychiatric hospitals, out of about 490 across the country, that were accredited by the Joint Commission and cited by state officials from fiscal 2014 and 2015 for serious violations. For most of the 141, those violations weren’t the first; they had an average of eight serious violations in the years going back to 2011, according to state inspection records and hospitalinspections.org. Some had dozens of previous violations.
The incidents were serious, including: sexual assaults; a case in which a teenage patient said she had been raped; “the administration of psychotropic medication without consent; and failure to give insulin to diabetic patients,” the newspaper said, adding, “One hospital failed to adequately investigate when a staff member used a [cell] phone to take pictures of a patient’s breasts.”
Medicare and Medicaid administrators said the newspaper’s investigation raised troubling questions, including with conflicting data provided by the commission and psychiatric hospitals. They said they would investigate, and the Journal said congressional probes already have begun of the Joint Commission and its nationwide accrediting system.
As for the New Jersey surgical center, USA Today reported that it was owned by a real estate investor with no experience in health care but enough money to acquire a nearby hospital, as well as two of the free-standing facilities that allow doctors to operate closer to patients at lower cost and greater convenience.
Such surgery centers often have gotten ahead of oversight and regulation, New Jersey media reported, noting they often lack supplies and resources to deal with medical emergencies that may develop while patients are under the knife and anesthesia. New Jersey law also allows them to forgo licensing, if they have only one operating suite.
State lawmakers hope to pass bills to regulate the centers and safeguard patients better, officials say. USA Today and the independent, nonpartisan Kaiser Health News Service in the fall investigated the burgeoning and profitable surgical centers and found them swamped with many of the same safety and quality concerns that already plague academic medical centers and hospitals.
In my practice, I see the harms that patients suffer while seeking medical services, not just in hospitals and academic medical centers but also in specialized treatment facilities like surgical centers and psychiatric hospitals. As occurs in academic medical centers and hospitals, these new and specialty facilities contribute to the rising toll of patient injury and death, much of it attributed to medical error.
Medical errors claim the lives of roughly 685 Americans per day─ more people than die of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It means medical errors rank as the third leading cause of death in the U.S., behind only heart disease and cancer.
The injurious actions, in-actions, wrong plans, or “deviation” from standard care — as well as allowing malevolent staff and outsiders to harm patients — are unacceptable in a U.S. health system on which Americans spend more than $3 trillion annually and in which they put their full faith, trust, and well-being.
Patients undergoing ever-more complex operations in surgical centers shouldn’t need to fret whether tools used on them have been correctly sterilized, or if injections they may receive are administered properly. HIV and hepatitis are conditions that pose serious health challenges, and patients shouldn’t be wary of getting infected with these diseases while receiving medical care. Similarly, loved ones and friends of the mentally ill should rest easy that psychiatric hospitals will take extra steps to protect patients who already may be suicidal or intent on harming themselves and who may be treated for in private areas where others cannot monitor their care. 2019 already presents safety challenges in medical care that we need to address for patients’ sake.