DMC says surgical instrument issues fixed

Karen Bouffard
The Detroit News

Correction: This story has been updated to correct a quote from Eric Evans, the president of hospital operations for Tenet Healthcare Corp.

The Detroit Medical Center’s problems with dirty surgical instruments are behind them after a complete overhaul of its sterilization operations, top leaders from the DMC and owner Tenet Healthcare said Thursday.

“I can’t remember the last time I got a report on an instrument,” said Dr. Anthony Tedeschi, the DMC chief executive officer, who gets daily reports on conditions at the system.

The officials admitted that the health system is not doing as many surgeries as before the publication of a six-month investigation by The Detroit News uncovered problems with dirty, broken and missing surgical instruments that had plagued the DMC’s five Midtown Detroit hospitals for at least 11 years.

Eric Evans, president of hospital operations for DMC’s parent company, Tenet Healthcare Corp., said the issues at DMC were a “production process” and that the system is now taking steps “to do it right,” adding that the company is committed to more transparency about its operations.

DMC “has gone through rapid and concrete improvements,” said Tedeschi, who replaced former CEO Joe Mullany who departed abruptly in January. “Everything has changed.”

Tedeschi said he “would have no issue” with having his own family members undergo surgery at the DMC.

“The improvement has been marked. There’s been positive impact with doctors, they feel good and confident,” he said.

Among those changes, the health system has spent $1.6 million on new and replacement equipment, hired additional sterilization staff, fine-tuned the chemicals used to clean instruments, and reconfigured the processes that govern when, how and by whom surgical instruments travel from operating rooms through various stages of cleaning and back again.

It was the first time the for-profit Texas-Based Tenet has talked publicly about issues that caused the health system to fail three state and federal inspections following the News’ exposé, resulting in threats to billions in federal funding.

“We have to, as leaders, own up to the fact that this happened,” Evans said.

All of the health system’s hospitals are back in good standing with state and federal regulators after passing surprise inspections by the federal Centers for Medicare and Medicaid Services (CMS) on April 4, and their accreditation has been affirmed by Joint Commission, a nonprofit that vouches for hospitals’ safety.

Evans said the issues at DMC were rooted in the health system’s culture and “early warning signs weren’t working.” He said the corporate parent had deferred to local executives on those issues at the time, but vowed officials from the Dallas headquarters would be more involved in the future.

“Detroit is a major part of our company,” he said. “We like what’s happening here.”

Tedeschi said the DMC is about three-fifths of the way through a methodical inventory of tens of thousands of surgical instruments to remove and replace tools that aren’t up to standard.

The health system has been assisted by an outside sterile processing company, Steris, which took over management of its central sterile processing unit that conducts instrument cleaning operations. Among other moves, the hospitals and Steris are providing a sterile processing “liaison” between the central sterile processing unit and the operating room units to oversee the supply and condition of surgery tools.

The News series, published in August and based on 200 internal emails, spurred investigations by the Michigan Department of Licensing and Regulatory Affairs (LARA) and the federal Centers for Medicare and Medicaid Services (CMS) that found numerous health and safety violations.

The agencies closed their investigations in December after the health system passed an inspection, but CMS launched a second investigation in January after the News reported that a surgery patient had been exposed to a dirty instrument just one day after that inspection was passed. That investigation also was closed.

Evans said the hospitals had to deal with cultural and communications issues, which led to the delays in dealing with the dirty instruments. He said the processes at DMC were different from other hospital operations across the country. “It was a trade-off of complexity to efficiency,” he said.

The culture has changed, in part, because the health system has empowered employees to “stop the line” if they detect any problem in the sterilization process, Evans said.

“We have empowered employees to be their best,” he said. “We have had a lot of our employees here engaged in the process (of change).”