Editorial: No excuses, no delays in cleaning up DMC

The Detroit News

Detroit Medical Center is one of the region’s premier hospital systems. But patients can be forgiven if they decide to go elsewhere for surgeries. A six-month investigation by The Detroit News reveals that for 11 years the system’s Midtown hospitals have struggled to properly clean surgical instruments.

Improperly sterilized instruments can trigger infections, septic shock and even death. And yet the DMC, despite repeated warnings from medical staff, has allowed the unsafe conditions to continue for more than a decade.

This is an outrageous endangerment of patient lives and a shocking indication of poor management practices at the Detroit facilities. What’s most disturbing is that the DMC has been fully aware of the issue, and did little until recently to address it.

This isn’t a problem without a solution. No technical innovation is needed. Workers simply need to do their jobs correctly, and management must stand up to labor unions that have protected incompetence.

The News studied more than 200 pages of internal emails and reports that showed surgeons and staffers have complained on numerous occasions about dirty instruments, as well as some broken and missing implements in surgical kits. The paper found that in one recent 17-month period, Children’s Hospital, part of the DMC system, registered 186 complaints about dirty, missing or incomplete instrument sets.

In some cases, tools that hadn’t been sterilized properly caused surgeons to stall operations ranging from appendectomies and brain surgeries to cleft palate repair and spinal fusions. Patients would be kept under anesthesia while instruments were replaced, and sometimes operations were canceled.

“We are putting patients at risk frequently and now canceling up to 10 cases this week ... promises just aren’t cutting it,” Joseph Lelli, chief surgeon at Children’s Hospital, wrote in an email to top administrators on June 29, 2015, at least his third warning in six months, according to The News’ investigation.

Four unions represent the workers whose job it is to sterilize the implements; the emails and memos reviewed by The News indicate that attempts to discipline or dismiss employees responsible for the shoddy work are almost never successful.

But put the blame where it belongs — at the top. DMC Chief Administration Officer Conrad Mallett, said, “... we are not negligent, we are concerned.”

No, Mr. Mallett, you are negligent. Infections are one of the leading causes of hospital deaths. Medical centers across the country are attacking the causes of infections in hopes of assuring better outcomes for patients and controlling costs.

And yet the DMC tolerated filthy equipment in its operating rooms for 11 years.

DMC officials promise they’re working on the issue, and argue no known infections have occurred from unsterilized instruments. But they can’t possibly know that for certain.

The DMC in May contracted with an outside company to manage the sterilization work. If that switch doesn’t result in an immediate resolution of the problem, then the sterilization functions should be outsourced to workers who are more accountable.

In the meantime, surgeries at DMC should be either halted or greatly curtailed until the hospitals can assure patients that they have cleaned up their act, and their operating rooms.