Safety issues plague hospital
Sewage leaks at facility that treats nation’s leaders
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