Is It Health Care Or...Health I-Don't-Care?

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Is It Health Care Or...Health I-Don't-Care?

HealthNewsDigest.com - New York,NY*

By D. Shaw, Contributing Columnist - HealthNewsDigest.com

Sep 21, 2008

http://www.healthnewsdigest.com/news/Family_Health_210/Is_It_Health_C

are_Or_Health_I-Don_t-Care.shtml

(HealthNewsDigest.com) - We've made the point many times in this

column that the so-called health care crisis is forever debated

within the parameters of funding and availability. Rarely is

anything said about quality and outcomes. Recently, though, two big

stories broke the mold: one examining the value of hospital

accreditations, and the other detailing serious lapses in infection

control that led to the closing of a dialysis center.

At the core of both of these stories is the rather sad finding that

those who get hurt the most are the ones who can least defend

themselves.

Reporter Yamil Berard of the Fort Worth Star-Telegram took a hard

look at the matter of hospital accreditation, and, to be kind, found

it wanting. Most of his piece focused on the Joint Commission, a non-

profit organization, whose mission is " ...to continuously improve

the safety and quality of care provided to the public through the

provision of health care accreditation and related services that

support performance improvement in health care organizations. "

The origin of the Joint Commission goes back to the American College

of Surgeons (ACS), a group dedicated to the principles of Ernest

Codman, M.D., who proposed the " end result system of hospital

standardization. " This meant that a hospital would track every

patient it treated long enough to determine whether the treatment

was effective. If the treatment was not effective, the hospital

would then attempt to determine why, so that similar cases could be

treated successfully in the future.

In the early 1950s, a few other medical groups joined with ACS to

form the Joint Commission on Accreditation of Hospitals, but it was

not until 1965—and the advent of Medicare—that the Commission came

into its own. According to former president Dennis S. O'Leary, the

responsibility as Medicare's gatekeeper came as a shock, since they

certainly did not go out looking for the job. " In fact, we woke up

one morning and found some language in the legislation. It was a

complete surprise. "

Fast forward to the present. Although hospitals can be accredited by

state agencies, 88 percent choose the Joint Commission. But now,

Congress is requiring the Commission to reapply for authority to

certify that hospitals meet federal standards, and for some critics

it's about time. For years, many have complained that essentially

all the Commission's revenue comes from hospitals, leading to

potential conflicts of interest.

Dr. Sidney Wolfe, director of Public Citizen's Health Research Group

complains that " The situation resembles a country-club-like setting.

What's the point of having a regulator that's a cheerleader over the

institution they are supposed to be regulating? "

And then there are the horror stories...

The Joint Commission gave land General Hospital in Baltimore

accreditation twice in four years. However, at the time, lab

technicians were complaining that test equipment didn't work and

that hundreds of HIV tests were mishandled. State regulators found

that the lab had been " rife with equipment failures and

malfunctions " and had lost or mishandled specimens.

Norwalk Hospital in Connecticut won accreditation in May, 2004. Less

than a month later, state regulators reported numerous violations at

the hospital. One patient received ten times the prescribed dosage

of a painkiller, and another had his left testicle mistakenly

removed. A suicidal patient was given a taxi token and told to find

a treatment center. He hanged himself hours later.

Florida's Palm Beach Gardens Medical Center was accredited in

August, 2000 even though the hospital received a less than

satisfactory grade on infection control. The accreditation was

affirmed in 2003, around the time that state and federal regulators

were investigating more than 100 complaints of life-threatening

infections in the heart unit. Fines were issued, and the hospital

paid $31 million in lawsuit settlements.

Perhaps the most egregious story—and biggest embarrassment—is that

the notorious King/Drew Medical Center in Los Angeles, which was

finally closed down in August, 2007, after being given numerous

chances to clean up its act, did have its accreditation withdrawn by

the Commission in February, 2005. However, that was only a short

time after it was awarded the Commission's prestigious Gold Seal of

Approval. Moreover, serious problems at the facility were well-known

since at least 1999.

Given that nearly 99 percent of the hospitals reviewed by the Joint

Commission win accreditation, these situations—while certainly rare—

are not really surprising.

The Commission will argue that they can't be in every facility all

the time, and even rigorous federal inspections will miss items.

Still, inasmuch as their new policy of " unannounced visits " actually

provides 48 hours' notice to the facility, one cannot help but

conclude that the entire process is a bit lax.

As to the dialysis center story, the New York State Health

Department closed down the Life Care Dialysis Center in Manhattan on

September 16th, after inspectors found poor infection control

practices and indicated that at least one patient has contracted

hepatitis C after undergoing treatment there.

This particular inspection revealed a host of difficulties,

according to Hutton of the Health Department. " It was

repulsive, she said. " The treatment chairs that they gave people to

relax in had someone else's dried blood on them. " Cold comfort that

the inspection that finally closed them down was a follow-up visit

to check on previous violations.

Inspections and accreditation are fine, but they will never

substitute for adequate training, better salaries for health care

workers, and actually caring about the patients.

D. Shaw

Exec VP

Interscan Corporation

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