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Dc inspectors urge closing southeast only hospital { July 25 2003 } Original Source Link: (May no longer be active)
http://www.washingtonpost.com/wp-dyn/articles/A43169-2003Jul24.html?nav=hptop_tbhttp://www.washingtonpost.com/wp-dyn/articles/A43169-2003Jul24.html?nav=hptop_tb
D.C. Inspectors Urge Closure Of Southeast's Only Hospital
By Avram Goldstein
Washington Post Staff Writer
Friday, July 25, 2003; Page A01
District hospital inspectors are recommending that the Health Department director close Greater Southeast Community Hospital because of persistent problems with the quality of medical care, including at least six deaths they considered preventable and mistakes they say put other patients at risk.
The confidential July 18 recommendation has not been acted on by Health Department Director James A. Buford, who is trying to preserve the only hospital in the city's southeastern quadrant as its owners try to emerge from bankruptcy. Buford and City Administrator John A. Koskinen also have tried to help Greater Southeast survive a national hospital inspection agency's planned revocation of the hospital's accreditation because of clinical failures.
Hospital inspectors, led by Theodore J. Gordon, the Health Department's senior deputy director for environmental health science and regulation, initially argued for "de-licensure" in March, officials said, but Buford took no action.
They recommended again July 18 that Buford revoke the license within a week, saying Greater Southeast's "non-compliance" and its inability or unwillingness to repair deficiencies "continue to jeopardize patient welfare." In a memo to Buford that was also signed by Gordon, chief city hospital regulator Denise S. Pope wrote that Greater Southeast "has not demonstrated the capacity to prevent overt health and safety risks to patients being served at this facility."
A copy of the memo said that each year hospital inspectors typically investigate one to four incidents at each District hospital involving breakdowns in patient care. Greater Southeast had six incidents in 2001 and eight in 2002, the memo said, and it has had eight so far this year. The six deaths inspectors questioned included two involving infants, two that were the result of blood transfusion errors and one involving a man found dead on a gurney in the emergency room July 3 seven hours after arriving there.
Pope wrote that the hospital has repeatedly submitted incomplete or unresponsive plans of correction and that "schedules of compliance were rarely, if ever, met." The memo said that city monitors have given Greater Southeast more than a year to comply with standards but that compliance has not occurred.
Koskinen said he was aware that Pope and Gordon have been pressing for months for revocation of the hospital's license. "The question is whether [Greater Southeast is] getting better fast enough and whether they should be allowed to continue to operate or not," Koskinen said. "The department and regulators have an obligation to ensure quality care is provided and people aren't being put at risk, but it's in a context where the operation of Greater Southeast is important to a significant part of the city."
Tension between Gordon and Buford has built recently, said Health Department staff members, who reported a closed-door shouting match over Greater Southeast.
The hospital has been without a regular license since January 2002, when the department issued a "provisional license."
Buford was on vacation and unavailable for comment, and Gordon declined to comment. The department's chief operating officer, Ronald Lewis, issued this statement: "Greater Southeast Community Hospital is working under a provisional license, and they will be the first to know when there is any change in that status. We are working internally, reviewing the information and looking at all recommendations and options."
Pope's memo said she was particularly concerned about Greater Southeast's lack of a quality-improvement program, intended to track and improve substandard care by doctors and nurses. Every hospital in the nation is required to have such a plan.
"The lack of such a program calls into serious question whether a hospital can function effectively," she wrote. "We believe it cannot and that GSCH has not shown that the development or implementation of such a program is imminent or even possible under the current circumstances."
Greater Southeast officials said this week that they were taken aback when they learned of the recommendation for closure, and they immediately tried to persuade senior city officials to quash it.
"So far, none of this has been [officially] communicated to me," Paul Tuft, president of the hospital's parent firm, Doctors Community HealthCare of Scottsdale, Ariz., said in a telephone interview Wednesday. "It's a little awkward."
On Tuesday, Tuft announced that Greater Southeast's chief executive officer, Karen Dale, was moving to another position in the company and that he was bringing in a national hospital consulting firm, Cambio Health Solutions, to be her replacement. He also said Ana Raley, who used to run Greater Southeast, will come out of retirement and rejoin Doctors Community.
Dale declined to comment, but in interviews last year, she said the company did not furnish the cash needed for improvements. Dale's replacement, Cambio Vice President Joan G. Phillips, acknowledged in a telephone interview that the situation is serious but said Doctors Community is committed to spending what is needed to resolve inspectors' concerns.
"Doctors Community has brought on new people who are experienced in the health care field," she said. "They're willing to say their efforts in the past have not worked, so let's bring in people who do this for a living."
Greater Southeast was the private replacement for D.C. General Hospital when the city ended inpatient care at its only public hospital in 2001. The closing came after a bitter political battle in which opponents, including the entire D.C. Council, said the privatization plan would result in substandard care for the poor. Mayor Anthony A. Williams (D) and the D.C. financial control board said privatization would improve health care and end the chronic financial losses by D.C. General.
Although Greater Southeast and its parent company have been under bankruptcy court protection since Nov. 20, the hospital is the main inpatient facility for the D.C. Healthcare Alliance, the privatized health care program created to care for the uninsured. In addition to treating Alliance-eligible, Medicaid and uninsured residents, the hospital cares for D.C. jail inmates and many patients with private insurance.
Closing Greater Southeast would force those people elsewhere, and other hospitals in the city have argued for much of the past year that they cannot absorb new patients because they are struggling financially.
If Buford approves Pope's recommendation, the hospital will have 30 days to appeal.
The hospital was under financial pressure all last year after its main lender cut its cash allowance. On Nov. 20, Doctors Community filed for bankruptcy protection. Since then, the hospital has operated with about 150 daily inpatients under the supervision of a bankruptcy judge and creditors. If it is not closed, it will be sold out of bankruptcy to the highest bidder. Several parties have expressed interest, including Tuft and Howard University Hospital.
© 2003 The Washington Post Company
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