Safety of D.C. hospital in doubt
Sewage leaks at facility that treats nation’s leaders
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.”