Safety is­sues plague hos­pi­tal

Sewage leaks at fa­cil­ity that treats na­tion’s lead­ers

USA TODAY US Edition - - FRONT PAGE - Jayne O’Don­nell 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 MedS­tar Wash­ing­ton Hos­pi­tal Cen­ter af­ter the depart­ment re­ceived a com­plaint. The prob­lems in­cluded the room where Rep. Steve Scalise, RLa., had his last surgery af­ter be­ing shot at a con­gres­sional base­ball prac­tice in June.

The hos­pi­tal serves both a lower-in­come sec­tion of Wash­ing­ton and some of the na­tion’s most pow­er­ful peo­ple. 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 govern­ment 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 and records de­scribe an ag­ing, un­der­staffed fa­cil­ity where:

The prob­lems in­cluded the room where Rep. Steve Scalise, R-La., had surgery af­ter be­ing shot at a con­gres­sional base­ball prac­tice.

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.

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 anes­the­si­ol­o­gists, left the hos­pi­tal un­der confidential agree­ments although its chief med­i­cal of­fi­cer, Gregory Ar­gy­ros, de­nied lay­offs af­fected any­one in­volved in di­rect pa­tient care.

Ar­gy­ros de­scribed MedS­tar Wash­ing­ton as “the most im­por­tant hos­pi­tal in the most im­por­tant city in the most im­por­tant coun­try in the world.”

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.

In­fec­tions and high nurse turnover are closely re­lated, said Kath­leen Bartholomew, a nurse and au­thor who trains hos­pi­tals on pa­tient safety.

Sur­geon Bikram Paul re­tired about two months ago as the hos­pi­tal’s se­nior at­tend­ing physi­cian. He said he was named the of­fi­cial White House sur­geon by ev­ery pres­i­dent since Ron­ald Rea­gan. Paul said he told Ar­gy­ros and hos­pi­tal Pres­i­dent John Sul­li­van at his re­tire­ment party not to al­low fi­nan­cial con­straints and staff cuts to push the hos­pi­tal down “to any lower stan­dard.”

SAFETY IS­SUES

Wash­ing­ton Hos­pi­tal Cen­ter said it is the best equipped in the D.C. area to treat pa­tients with lifethreat­en­ing 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’ (CMS) 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 left inside pa­tients’ bod­ies. Leapfrog Group, which rates hos­pi­tals, gives it a D.

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.

Chil­dren’s Na­tional Med­i­cal Cen­ter, which is next door, has the busiest emer­gency room in D.C. and was a 2016 Leapfrog Group “Top Hos­pi­tal” for the eighth time, thanks to lower in­fec­tion rates and higher sur­vival rates for high-risk pro­ce­dures.

Ar­gy­ros, who said the hos­pi­tal is on a “high re­li­a­bil­ity jour­ney,” con­firmed the in­ci­dents in­volv­ing for­eign ob­jects left inside pa­tients — a sponge, a rub­ber re­trac­tor, a piece of a catheter and a “tiny piece” of a drill bit.

“We need to ac­cept no less than no pa­tient harm,” Ar­gy­ros said in an in­ter­view last month at the hos­pi­tal. “It’s re­ally all about the out­comes. If out­comes are not good, we haven’t met the mis­sion.”

RAT­INGS SHOW RISK

Wash­ing­ton Hos­pi­tal Cen­ter’s rate for the in­fec­tion Clostrid­ium dif­fi­cile, known as C. diff., is 35% higher than the av­er­age at teach­ing hos­pi­tals that vol­un­tar­ily re­port to Leapfrog, ac­cord­ing to an anal­y­sis it did for USA TO­DAY of CMS data up­dated in Au­gust. Such cen­ters typ­i­cally have trauma cen­ters and treat poorer pa­tients who can be more sus­cep­ti­ble to in­fec­tion.

Th­ese in­fec­tions are among the most com­mon, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. Hos­pi­tal-ac­quired in­fec­tions over­all kill about 99,000 peo­ple a year, the CDC re­ported — about three times the num­ber of peo­ple who die in car crashes an­nu­ally.

“Our data sug­gests that pa­tients are more likely to be harmed or die un­nec­es­sar­ily from an in­fec­tion at this hos­pi­tal than most other hos­pi­tals in the coun­try,” Leapfrog CEO Leah Bin­der said.

Wash­ing­ton Hos­pi­tal Cen­ter said that since 2015, its in­ter­nal data on a com­mon type of blood in­fec­tions in its in­ten­sive care and non-in­ten­sive care units dropped by 30%.

Leapfrog ’s anal­y­sis showed it was 45% higher than its teach­ing hos­pi­tal av­er­age.

Proper in­fec­tion con­trol pro­ce­dures in­clude safe syringe use, fre­quent hand wash­ing, glove us­age and per­sonal pro­tec­tive equip­ment such as gowns and masks.

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 — which D.C. in­spec­tors do for the CMS — 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?”

SEWAGE IN SURGERY

Sewage leaks have be­dev­iled the hos­pi­tal for the past cou­ple of years and well into Au­gust.

Sewage leaks in op­er­at­ing rooms are dire and could jeop­ar­dize the hos­pi­tal’s Medi­care re­im­burse­ments, in­fec­tion con­trol ex­pert Larry Mus­carella said. To get re­im­burse­ment for treat­ing Medi­care pa­tients, hos­pi­tals have to main­tain a clean en­vi­ron­ment that’s de­signed to pre­vent the trans­mis­sion of com­mu­ni­ca­ble dis­eases.

“Such sewage would vi­o­late ba­sic in­fec­tion con­trol and hy­giene stan­dards as well as CMS reg­u­la­tions and cer­tainly could pose a in­fec­tion risk,” said Mus­carella, who owns LFM Health­care So­lu­tions and the blog Dis­cus­sions in In­fec­tion Con­trol. “This vi­o­la­tion has po­ten­tially sig­nif­i­cant im­pli­ca­tions for pa­tient safety.”

Any­one would be “hor­ri­fied and dis­gusted” that the sewage leaks and other prob­lems would go on for so long, said McGif­fert, a vet­eran of 30 years in pa­tient safety.

Ar­bo­gast said last week that “all pipe is­sues have been cor­rected.”

The Health Depart­ment will de­cide whether the hos­pi­tal is sub­ject to a penalty af­ter it completes its in­ves­ti­ga­tion of the leaks, depart­ment spokes­woman Jas­mine Gos­sett said.

Em­ploy­ees know they must act im­me­di­ately if they ever de­tect the small­est amount of wa­ter on the floor, Ar­gy­ros said. That would as­sure sewage and other leaks re­main far enough away from pa­tients to pre­vent in­fec­tions.

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.

Rep. Robin Kelly, D-Ill., who has been treated at the hos­pi­tal, said, “Any time we in­ves­ti­gate this,” it shouldn’t only be be­cause safety is­sues could af­fect gov­ern­men­tal of­fi­cials. In­stead, “we should use this case to ad­dress the larger is­sues around dis­par­i­ties for all the peo­ple we serve in Wash­ing­ton, D.C.”

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.”

“When this much is wrong, it seems like fines should be as­sessed or some­thing more re­ha­bil­i­ta­tive, like pub­li­ciz­ing the prob­lems. That hap­pens with restau­rants, why not hos­pi­tals?”

Lisa McGif­fert, Safe Pa­tient Project

SIERRA LEWTER

From left, Donna Ar­bo­gast, Tonya Wash­ing­ton and Gregory Ar­gy­ros dis­cuss the state of MedS­tar Wash­ing­ton Hos­pi­tal Cen­ter.

MICHAEL OWENS, USA TO­DAY

For­mer sur­geon Bikram Paul says he urged ad­min­is­tra­tors at his re­tire­ment party not to let hos­pi­tal stan­dards fall.

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