DMC, managers trade blame over dirty instruments
Friction between unionized sterile technicians and managers has contributed to problems with dirty instruments at the Detroit Medical Center, records show.
In emails and internal reports obtained by The Detroit News, managers repeatedly expressed concern that discipline is overturned even when employees make mistakes. Three surgeons anonymously told The News they stopped filing complaints about dirty instruments because there is so little punishment.
“In order to move this department forward, we must have standards that we follow,” Lukeysih Hall, the manager of Central Sterile Processing, wrote in a March 2, 2015, email.
Replay: Chat with DMC investigation reporters
“When we have issues regarding soiled trays, which can cause the death of a patient, it should not be taken lightly. No matter how many threats of arbitration are made.”
Four unions represent about 70 sterile processing employees who make about $18 an hour to clean, sort and assemble thousands of instruments at the DMC’s five acute care hospitals in downtown Detroit.
Dirty, missing instruments plague DMC surgeries
Conrad Mallett, chief administration officer of the DMC, said managers, not unions, are to blame for problems with instrument sterilization. He said the DMC has had trouble finding and retaining competent managers to supervise the department.
The hospital system on June 1 outsourced management of its sterile processing department to Unity HealthTrust of Birmingham, Alabama. The company not only will manage workers but review the situation and implement reforms, he said.
“I don’t think we are dealing with an employee population that is any more difficult to manage than any other employee population, and you just simply cannot say your employees are the issue,” Mallett said.
“This is a process. We are all in it together. Management and employees. The DMC family has got to solve this problem.”
Emails obtained by The Detroit News show that Hall was one of a handful of CSP managers who felt frustrated in their ability to fix problems and discipline employees.
Hall, who is still employed by the hospital, declined comment.
E-mail trail: Years of problems at DMC
Her March 2, 2015, email detailed frustrations over two grievance hearings.
One involved the discovery of an unclean, used suture in a tray of sterilized instruments, contaminating the operating room. Another involved a Jan. 22, 2015, operation that went awry.
A 7-month-old girl was under anesthesia at Children’s Hospital for an operation to repair a heart defect known as tetralogy of Fallot. During surgery, a pump helps circulate blood while the defect is repaired.
The girl’s chest was open when technicians discovered a tube leading to a pump, which draws blood from the patient to the bypass machine, was jammed, documents show.
When technicians inserted a wire, a “black substance, most likely blood” gushed forth. Before the operation, a CSP technician responsible for cleaning the instrument had signed off that it was sterile.
Human resources was contacted and discipline initiated. But Hall wrote that, even though she provided ample documentation, the hearing focused instead on peripheral issues and documents that she contended had nothing to do with the issue.
Low-paid workers do a high-stakes job
In 2013, Hall’s predecessor, Laura Cortner, acknowledged in an email she was reluctant to seek discipline unless she had photo evidence of dirty or broken instruments. She was responding to complaints that one of her CSP workers delivered a surgical set — or case — to an operation that was missing instruments.
Like many hospitals, the DMC uses bar code and scanner technology to track instruments. A computer program known as Alex Gold uses the information and is able to trace which technicians cleaned instruments and are responsible for dirty ones.
That information isn’t enough in grievance hearings, Cortner said. Without photos, unions “successfully challenge” discipline, Cortner wrote.
“When we lack the substantiation, we will conduct verbal counseling only,” Cortner wrote in an email March 23, 2013.
In an email to The News, Cortner said, “There was a very strong Union presence, and that corrective/disciplinary action had to be substantiated/evidence based — to stand.”
Marge Robinson, president of SEIU Healthcare Michigan, acknowledged problems with sterile processing but said unions aren’t getting in the way of fixing them.
“You want employees to do something a certain way? Manage your department and get it done,” said Robinson, a nurse whose union represents 14,000 health care workers in Michigan, including sterile processing workers at the DMC.
“They say unions keep bad people. No, we don’t. We are trying to preserve a process and fairness. We take our family members to the DMC. I don’t want them to be treated by a bad person or getting dirty instruments.”