DMC avoids loss of federal funding
The Detroit Medical Center has avoided a debilitating loss of federal funding, passing a surprise inspection of surgical instrument sterilization prompted by a Detroit News investigation.
This week, the Centers for Medicare and Medicaid Services notified the hospital system that it found no deficiencies during inspections Nov. 1 and 2. The system was set to lose all federal funding — which totaled $705 million last year — if problems weren’t fixed by Dec. 14.
“Your hospital is now in compliance .... Therefore, we are rescinding our decision to terminate your participation in the Medicare program,” Jacqueline Lewis of the CMS wrote Tuesday in a letter to the DMC.
The DMC released the letter Thursday, saying it’s “pleased” with the reversal. That means the DMC likely will escape financial penalty for problems with dirty instruments at Detroit Receiving, Children’s, Harper University, Hutzel Women’s and DMC Heart hospitals. CMS can’t fine hospitals that flout regulations.
Even so, doctors and a top union officials told The News on Thursday that work remains to solve longstanding problems with instrument sterilization. That upsets Vanessa Slaughter, who said she’s endured a lifetime of pain after acquiring an infection at Harper Hospital in 2009 that she suspects — but can’t prove — was caused by improperly sterilized equipment.
The Detroit woman said she developed abscesses in her stomach after hernia surgery and has had five operations to address the complications. The doctor who performed the initial surgery, Ali El Horr, was sentenced to 18 months in prison in September for health care fraud.
“They don’t know about all the infections, the patients like me who got hurt,” said Slaughter, 67, a retired auto worker.
“I live with this every day. I have so many stomach problems. I feel like it’s going to shorten my life. But nothing is going to happen to the people who hurt me.”
The DMC has maintained that no patients were harmed or infected because of dirty instruments but has declined to release confidential records to prove the contention. Proving an infection is difficult because they can be caused by dozens of sources at hospitals.
The CMS inspection removes the biggest threat to the DMC, but the system remains under scrutiny by two other agencies. It’s working to resolve eight public health code violations issued by the state and was recently inspected by the Joint Commission, an accreditation agency that verifies the cleanliness and safety of hospitals.
The investigations followed The News’ investigation that was based on 200 pages of emails and documents showing doctors have complained for a decade about dirty instruments. The problems complicated operations from appendectomies and brain surgeries to cleft palate repair and spinal fusions, kept patients under anesthesia for up to an hour and canceled dozens of operations.
“It’s unfortunate that it took (the News’) reporting to make that happen, but it’s important that things have changed,” said Brett Jackson, president of the Economic Alliance for Michigan, a nonprofit that works on health care issues.
“This is a strong vote for transparency — that what gets seen gets better. When they see an issue that needs to be improved, shining a light on it make that issue better.”
The DMC implemented numerous changes after the Medicare agency issued its warning. Among other things, it increased education and training for workers who sterilize equipment and hosted regular meetings about the issue.
In operating rooms, all personnel must now wear foot coverings, which were optional, and cover all body parts such as arms. Between each surgery, floors are cleaned with a new compound that takes 10 minutes to dry.
One Children’s Hospital doctor said the changes are superficial and don’t address the root cause of problems — persistent issues with a central sterile processing department.
“It’s all window dressing to make it appear they are they are doing something but they aren’t,” said the doctor, who demanded anonymity in fear of job reprisals. “The problems are still there.”
The initial federal inspection found systemic issues with the handling of tools in operating rooms. It concluded the DMC “failed to implement aseptic cleaning procedures in operating rooms” and “failed to develop and/or implement infection control policies and procedures.” One in three sets of instruments opened by regulators during the inspection wasn’t properly sterilized.
The inspection documented workers putting dirty gloves back in a box with clean ones, mopping blood-stained floors without moving cleaned equipment, failing to wipe blood off surgical instruments while collecting them for cleaning, neglecting to perform audits of cleaned equipment or require workers undergo training and failing to soak tools after surgeries — a basic step in the sterilization process.
Al Garrett, president of the American Federation of State, County and Municipal Employees Council 25 that represents sterilization workers, said he’s seen some improvements since early fall but work remains.
Late last month, CleanStart Surgical of Plymouth was hired to ensure all equipment is properly cleaned. Its arrival was dictated in an agreement in late September between the DMC and state Department of Licensing and Regulatory Affairs that required a third party inside the hospital system to verify that equipment is sterile while the hospital works to come into compliance.
The company is focused on the sterilization department inside Detroit Receiving that cleans and assembles tens of thousands of surgical tools per day for Receiving and the other hospitals.
Consolidated several years ago, the department has been besieged with morale problems and friction between unions and management. Workers contend the department is understaffed, falling to about 75 technicians this summer from 105 about 10 years ago.
Garrett said outside contractors are “filling the void” until permanent employees can be hired. The union and hospital also are amid studies to see if pay for technicians — about $18 an hour — is competitive, said Garrett, whose union represents three of four locals for sterilization workers. Service Employees International Union is the other.
“Employees are committed to improvements and management is working with us. With that going on, we’re optimistic,” Garrett said.
Both the state and federal investigations were conducted by state regulators. They “continue to monitor the DMC’s progress ... to ensure that all violations of the public health code are remedied,” said Jason Moon of the state licensing department.
In the next several weeks, the state likely will reinspect the DMC to see if it has resolved the health code problems. Among other things, the state investigation found workers routinely missed training seminars and a company that had been hired to manage sterilization workers spent little time at the hospital.
The state can issue fines but, instead, generally works with hospitals to ensure problems are fixed.
What’s less known is the status of the ongoing inquiry by the Joint Commission, the largest of three agencies that offer seals of approval that are needed to continue to receive federal funding.
In an email, Joint Commission spokeswoman Elizabeth Zhani said the agency “is aware of patient safety issues” at Children’s and Harper hospitals and “is currently reviewing the concerns.”
Zhani confirmed that the Joint Commission conducted an unannounced inspection of Detroit Receiving on Oct. 6. She provided no details of the results, saying only that Receiving remains accredited.
The DMC confirmed the visit and said it “resulted in no requirements for improvement.”