Oversight board hits DMC's 'perceived deterioration' in patient care

Karen Bouffard
The Detroit News
DMC Sinai Grace Hospital in northwest Detroit on  January 17, 2019.

The board charged with overseeing the Detroit Medical Center's commitments to the community is concerned about a "perceived deterioration in the quality of patient care" and other issues, according to an annual report released Monday.

The often-critical report expressed the board's worries about the quality of care at the eight-hospital health system after Harper University Hospital, Detroit Receiving Hospital and Sinai-Grace Hospital last year failed health inspections. The federal Centers for Medicare and Medicaid Services scheduled termination of Medicare funding at all three hospitals. 

Harper and Receiving returned to good standing after passing inspections earlier this year.  Sinai-Grace is on an extended plan of correction with the CMS and has until Aug. 31 to pass an inspection and retain its Medicare funding.

The Legacy DMC Board is worried about "the negative impact on DMC's clinical reputation as a result of the failed inspections," according to the report.

The board also is concerned about whether the eight-hospital system is meeting its research and education commitments. Through the year, the DMC has failed to provide detailed information that Legacy requested to determine whether the health system is spending enough money to maintain its "historic commitment" to education and research, the report noted.

"It's hard to conclude that there is a meaningful support for research if the buyer, Tenet, can produce no evidence of actual financial support," Legacy DMC President John Walsh said Monday. "It’s an infrastructure and background that needs to be in place for a set of doctors to stay competitive."  

The request for financial information on research spending was prompted by Wayne State University's talks last year with the Henry Ford Health System, Walsh said. The university signed a letter of intent last September to enter into an educational partnership with Henry Ford Health System. 

The health system did not immediately respond to a request for comment on the Legacy report. 

The Legacy DMC Board oversees promises made to the Detroit community when the former nonprofit health system was sold to the for-profit, Tennessee-based Vanguard hospital chain in January 2011. Vanguard was acquired by Dallas-based Tenet Healthcare in October 2013, making for-profit Tenet the health system's owner. 

Quality-of-care issues first arose nearly three years ago and have continued. 

State regulators inspected Harper and Receiving in December 2018, on behalf of CMS, after three cardiologists and the the top medical executive at DMC Heart Hospital complained they were fired from their management roles in retaliation for their complaints about quality-of-care issues. Heart Hospital adjoins Harper and shares many of its facilities and services.

The inspection at Harper found flying insects in an intensive care unit, improperly attired surgical personnel and lapses in sterile processing of surgical instruments. An April inspection cleared the hospital.

At Receiving Hospital, inspectors found the hospital had discontinued surveillance of some infections due to budget cuts. But it avoided Medicare termination after passing an unannounced March 7 inspection.

Sinai-Grace spent most of 2018 under threat of Medicare termination over building problems and quality of nursing care, but recovered its "deemed" status in September after passing inspections. 

Sinai-Grace was inspected again in January after The Detroit News reported the facility was unable to treat a heart attack patient during a power outage on Nov. 21, 2018, because the cardiac catheterization lab wasn't operational. The patient died after being transferred to another hospital. 

The quality-of-care issues first arose after a six-month Detroit News investigation published in August 2016 found an 11-year history of problems with dirty surgical instruments at five hospitals on the DMC's Midtown campus.

Harper and Receiving, as well as Hutzel Women's Hospital and DMC Children's Hospital of Michigan, were threatened with the loss of Medicare funding over problems with dirty surgical instruments. Their "deemed" status was restored after the DMC invested more than $1 million in new surgical instruments and other improvements.

Asked for comment on issues raised by the Legacy DMC Board, Wayne State University vouched for the integrity of the oversight group in a statement.

"The members of the Legacy Board are conscientious and experienced professionals who are acting in the best interest of the health of our Detroit community," Wayne State spokesman Matt Lockwood said. "Their report is the result of honest and thoughtful analysis, and we believe it speaks for itself."

Legacy members met with DMC officials and senior Tenet executives several times during 2018 "to express concerns about a perceived decline in DMC's status as a teaching and research hospital system, the need to meet its research and education commitments, significant concerns about perceived deterioration in the quality of patient care, and the negative impact on DMC's clinical reputation as a result of the failed inspections," according to the report. 

The health system about three weeks ago sent an email with more information about research activity and funding, but it wasn't illuminating, Legacy DMC said in its report.

"It does not appear that the contents of the email adequately respond to Legacy's requests for detailed financial data, particularly comparative data as to VHS's (Vanguard Health System) annual out of pocket research expenditures since the sale to VHS," Legacy DMC wrote.

Relations between the Detroit health system and Wayne State University Medical School have been tumultuous for years. They nearly ended their century-long partnership in May 2018 over a breakdown in negotiations to extend a contract between the DMC and university physicians.

The WSU Physicians Group, a medical group formed by doctors affiliated with the School of Medicine, and the DMC agreed last fall to extend their partnership, under which the group’s doctors provide medical services to seven hospitals and other facilities.

The University Physicians Group, which represents hundreds of physicians on WSU's medical school faculty, filed for bankruptcy in November. The group emerged from bankruptcy on June 3 when the federal bankruptcy court in Detroit approved its reorganization plan.

Meanwhile, some other faculty physicians have sought new university partners. University Pediatricians, which represents 220 pediatricians at DMC Children's Hospital of Michigan, signed a clinical affiliation agreement with Central Michigan University in January. 


Twitter: @kbouffardDN