DMC says $1.2M spent to fix dirty instrument problems

Karen Bouffard
The Detroit News

The Detroit Medical Center has spent $1.2 million since September to correct problems with dirty surgical instruments and has put multiple systems in place to ensure the safety of patients, hospital officials told The Detroit News on Thursday.

Dr. Joseph Lelli Jr., DM

Three ranking DMC officials talked to The News following revelations last week that a third hospital in the health system — Children’s Hospital of Michigan — had failed an inspection in January. Inspectors with the federal Centers for Medicare and Medicaid Services (CMS) found numerous violations of infection control and surgical services standards.

In impassioned comments, Surgeon-in-Chief Joseph Lelli Jr. said he wanted to reassure parents that their children are safe at the hospital, founded in 1886.

“Anyone at Children’s would stand in the way of a train before we’d let it hurt a child, and we do not let any of the problems that we’re having or have had in the past get to these children,” Lelli said Thursday. “I can guarantee the people of this city that they are getting the highest quality of care for children anywhere in the country, and that’s not going to change.”

Children’s Hospital fails federal surgical inspection

He added: “I have never seen (an instrument-cleaning) issue affect the outcome of a child. Never.”

During a sweep of surprise hospital inspections in late January, Children’s failed to meet federal standards, according to CMS inspectors. The hospital was ordered to submit a plan of correction and has to pass an unannounced inspection by May 23 or risk losing its state and federal Medicaid funding.

The hospital officials on Thursday said the facility had already fixed most of the problems identified by the federal inspectors.

Dirty, missing instruments plague DMC surgeries

Two other DMC hospitals — Harper University and Detroit Receiving — passed the inspections conducted Jan. 30 and 31.

Harper University and Detroit Receiving hospitals had previously failed September inspections launched in response to a six-month Detroit News investigation that uncovered a nearly decade-long problem with dirty, broken and missing surgical instruments at DMC’s five Midtown hospitals.

A fourth medical facility, Karmanos Cancer Center, which also was cited for violations in the January sweep, announced Thursday that it passed a follow-up inspection this week and was deemed to be in compliance with federal certification standards. Karmanos is not part of the DMC system, but is located on the health system’s Midtown campus and performs surgeries at its hospitals.

Lelli cited several of the corrective actions taken at DMC since September, including the implementation of a new inventory system for surgical tools that allows surgeons and sterile processing staff to track instruments through the cleaning process.

“(W)e have put in place processes where if I have a set that’s missing an instrument I know which one’s missing, and before that set goes in an operating room we determine if that one missing instrument is critical or not,” Lelli said, noting that instrument sets can include as many as 170 tools, and often include duplicates.

“Since September...the number of missing instruments and our ability to control the inventory has gotten much better. Is it perfect? No, it’s not perfect yet, but there is not an instrument set that goes in an operating room if there’s a critical instrument missing.”

CMS and the Michigan Department of Licensing and Regulatory Affairs (LARA) launched investigations in early September after the Detroit News uncovered problems with sterilization of surgical instruments at the DMC’s five Midtown hospitals. The problem stemmed from a central sterile processing department, located in the basement of Detroit Receiving, which cleans, packages and delivers surgical instruments for Children’s, Harper, Receiving, Hutzel Women’s and DMC Heart hospitals, as well as for Karmanos Cancer Center.

The health system failed the inspections at that time, but state and federal agencies closed their books on the case in December after the health system passed a surprise inspection.

A new investigation was launched by CMS in January after The Detroit News reported that a filthy surgical tool had interrupted an operation one day after the favorable inspection that ended its initial probe. That incident occurred at Children’s Hospital, which inspectors did not visit during their initial investigation despite numerous complaints reported by the News investigation in August.

Plans of correction submitted by the health system to CMS show the complexity of correcting problems that involve multiple departments and processes.

Donna Swenson, a Chicago-based sterile processing consultant who works nationally with hospitals and surgical device makers, said it’s impossible to fix a problem in months that festered for more than a decade. She questioned why LARA and CMS closed their investigations so soon.

“You’re not going to fix these problems quickly,” Swenson said. “These are deep-seated problems that are going to take time to fix. You’re going to be monitoring for years.”

Lelli told the News: “There’re multiple parts to fixing this problem, and we’ve been working for a long time on all of those.”

Scott Steiner, CEO for Harper University, Detroit Receiving and Hutzel Women’s hospitals, said the health system has invested more than $1.2 million so far. The DMC’s for-profit owner, Tenet Healthcare, doesn’t discuss budgets publicly so Steiner wouldn’t elaborate, but he said the money went to a variety of uses.

The plan of correction for Harper, submitted in February, states that the health system spent $500,000 in 2016 to replace broken or worn out instruments, with another $107,000 proposed for 2017. The DMC also hired an outside vendor, Steris, to manage their sterile processing department, which has a full-time manager on-site. The department has also added a full-time clinical manager.

Lelli said everyone who works at Children’s understands the level of responsibility they’re charged with and is working to provide the highest quality of care possible.

“We’re asked to go to a mother, we’re asked to take an infant out of her hands, we tell her we’re going to make your child unconscious.” Lelli said. “I’m going to literally cut them open, I’m going to fix the form or fit of this child, and I’m going to give them back to you safe and whole and better than they were.

“That’s a huge responsibility, and we don’t take it lightly, and there’s isn’t anyone in our hospital that would tolerate a problem getting to one of these children.”