Safety of D.C. hospi­tal in doubt

Sewage leaks at fa­cil­ity that treats na­tion’s lead­ers

USA TODAY International Edition - - FRONT PAGE - Jayne O'Don­nell @jay­neodon­nell USA TO­DAY

WASH­ING­TON Sewage that leaks down the walls and on the op­er­at­ing room floors is among the many prob­lems at the go-to hospi­tal for Congress and the White House, ac­cord­ing to in­ter­views and doc­u­ments ob­tained by USA TO­DAY.

The D.C. Health De­part­ment is in­ves­ti­gat­ing the leaks at Med Star Wash­ing­ton Hospi­tal Cen­ter af­ter the de­part­ment re­ceived a com­plaint. The prob­lems in­cluded the room where Rep. Steve Scalise, R-La., had his last surgery af­ter be­ing shot at a con­gres­sional base­ball prac­tice in June.

Of­fi­cial Wash­ing­ton’s trauma hospi­tal of choice suf­fers from some of the area’s worst hospi­tal rat­ings.

USA TO­DAY in­ter­viewed two dozen cur­rent and for­mer hospi­tal em­ploy­ees, lo­cal gov--

ern­ment of­fi­cials and health ex­perts to de­ter­mine how this once-ven­er­ated health care fa­cil­ity — dubbed “ER One” be­cause of its emer­gency room’s dis­as­ter-fo­cused-de­sign — has fallen so far in rep­u­ta­tion.

Doc­tors, nurses de­scribe an ag­ing, fa­cil­ity where:

uThe last op­er­at­ing room in which Scalise had surgery, No. 11, had to be closed be­cause of a sewage leak two days later. The main op­er­at­ing room — made up of about 20 smaller op­er­at­ing rooms — is in the hospi­tal’s base­ment, and some of the rooms are un­der bath­rooms.

uEm­ploy­ees in “pro­tec­tive” foot cov­er­ings scur­ried back and forth be­tween sewage-soaked op­er­at­ing rooms and sur­gi­cal in­stru­ment stor­age ar­eas into hall­ways as pa­tients passed on gur­neys and lined the halls.

uBuck­ets have been used to catch wa­ter leaks from ceil­ings at least twice dur­ing surg­eries. Th­ese were the same ceil­ings through which sewage leaked.

uPortable fans were used to elim­i­nate strong “porta potty” odors in the op­er­at­ing rooms and to dry them, even though fed­eral stud­ies show fans can spread bac­te­ria in the air.

uFour for­eign ob­jects were left in­side pa­tients in the 12 months ended in Fe­bru­ary, which prompted a spe­cial staff meet­ing Feb. 14.

uFlies are a reg­u­lar prob­lem in op­er­at­ing rooms, and the in­sects landed on open wounds at least twice and of­ten else­where on pa­tients.

“This de­scribes a hospi­tal that is out of con­trol,” said Lisa McGif­fert, direc­tor of Con­sumer Re­ports’ Safe Pa­tient Project.

Against this back­drop, Wash­ing­ton Hospi­tal Cen­ter grap­pled with a $16 mil­lion short­fall af­ter the most re­cent fis­cal year ended in June. This prompted a memo alert­ing de­part­ment heads that they needed to cut mil­lions from their bud­gets. Physi­cians, in­clud­ing and records un­der­staffed anes­the­si­ol­o­gists, left the hospi­tal un­der con­fi­den­tial agree­ments al­though its chief med­i­cal of­fi­cer, Gre­gory Ar­gy­ros, de­nied lay­offs af­fected any­one in­volved in di­rect pa­tient care.

About 400 nurses out of 1,780 left their jobs last year — up from about 300 a year from 2010 to 2015, ac­cord­ing to data com­piled by Na­tional Nurses United, which rep­re­sents them. That comes to about a 22% turnover rate, com­pared with the

14% rate pro­vided by hospi­tal spokes­woman Donna Ar­bo­gast.

Wash­ing­ton Hospi­tal Cen­ter said it is the best equipped in the D.C. area to treat pa­tients with life-threat­en­ing in­juries, not­ing that it ranks in the top 10% when it comes to pre­vent­ing death af­ter gun and knife wounds at Level 1 trauma cen­ters, cit­ing non-pub­lic Amer­i­can Col­lege of Sur­geons data. That makes it 40% less likely th­ese pa­tients will die at Wash­ing­ton Hospi­tal Cen­ter com­pared with all other U.S. trauma cen­ters, Ar­bo­gast said.

When it comes to pub­lic qual­ity and safety scores, it is among the low­est rated. The cen­ter gets two out of five stars in the Cen­ters for Medi­care and Med­i­caid Ser­vices’ fed­eral safety rat­ing, pushed down in large part by high in­fec­tion rates and com­pli­ca­tions. Th­ese in­clude in­ci­dents known as “never events,” things that shouldn’t hap­pen be­cause they are so dan­ger­ous and pre­ventable, such as for­eign ob­jects be­ing left in­side pa­tients’ bod­ies.

A higher rate of in­fec­tion and com­pli­ca­tions is to be ex­pected at the hospi­tal with the city’s sec­ond-busiest emer­gency room, the hospi­tal and its de­fend­ers said. In­fec­tions are com­mon af­ter se­ri­ous ab­dom­i­nal gun­shot wounds such as those suf­fered by Scalise. They are also far more likely at a hospi­tal with as poor a record of in­fec­tion con­trol as Wash­ing­ton Hospi­tal Cen­ter’s — and far from the norm at other Level 1 trauma cen­ters.

Scalise had a se­ries of surg­eries and de­vel­oped an in­fec­tion about three weeks af­ter he ar­rived, which led to two more surg­eries. Ar­gy­ros, the hospi­tal’s chief med­i­cal of­fi­cer, de­clined to dis­cuss Scalise’s case, cit­ing pri­vacy laws. In an in­ter­nal memo to staff af­ter a USA TO­DAY story about the hospi­tal, MedS­tar’s David Mayer, the vice president of safety and qual­ity, said it is im­proper to link in any way some­one shot with a “dirty bul­let from a dirty gun on a dirty ball field” with a hospi­tal’s high over­all in­fec­tion is­sues.

A 102-page D.C. Health De­part­ment in­spec­tion re­port from last Septem­ber high­lighted ex­am­ples of nurses fail­ing to wash their hands af­ter treat­ing wounds and not wear­ing pro­tec­tive cloth­ing. Un­der a ne­go­ti­ated cor­rec­tive plan, the hospi­tal was re­quired to de­velop a pol­icy to pre­vent in­fec­tions, in­clud­ing guid­ance for em­ploy­ees on how to keep their hands clean.

USA TO­DAY ob­tained the re­ports un­der a Free­dom of In­for­ma­tion Act re­quest.

“When this much is wrong, it seems like fines should be as­sessed or some­thing more re­ha­bil­i­ta­tive, like pub­li­ciz­ing the prob­lems,” said McGif­fert, who re­viewed the hospi­tal’s in­spec­tion re­ports from 2015 and 2016 for USA TO­DAY. “That hap­pens with restau­rants, why not hos­pi­tals?”

Ar­gy­ros said only two of the five sewage leaks this year oc­curred in op­er­at­ing rooms while pa­tients were be­ing treated. Each pa­tient and their fam­i­lies were no­ti­fied, and they were mon­i­tored for in­fec­tions. None of the liq­uid waste came near the pa­tient or the “ster­ile field,” he said.

In a state­ment, Scalise’s wife, Jen­nifer, said, “Steve and I are com­pletely sat­is­fied with the qual­ity of care he re­ceived at MedS­tar Wash­ing­ton Hospi­tal Cen­ter and are greatly ap­pre­cia­tive of the work of their doc­tors, nurses and staff.”

SIERRA LEWTER

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