DMC hospital may lose federal aid after discovery of infection-control issues

A Detroit Medical Center hospital may lose federal funding after a key agency cited Harper University Hospital for infection-control issues, including bugs flying around an intensive care unit.

Among the problems listed in the report by the federal Centers for Medicare and Medicaid Services were two cardiologists wearing surgical skull caps without a required bouffant protective covering and an intensive care patient's urine-filled catheter bag dragging on the floor. 

Inspectors also found a tray of sterile surgical instruments improperly stored in the labor and delivery area, storage drawers littered with crumbs and dusty shelves, among other issues at Harper hospital. 

A six-month Detroit News investigation published in 2016 uncovered an 11-year history of problems with dirty surgical instruments at five DMC hospitals on the health system's Midtown campus. The health system subsequently failed state and federal inspections at several of its hospitals and was threatened with the loss of federal funding before the problems were corrected.

Detroit Medical Center instruments investigation

"We have determined that the deficiencies cited are significant and limit your hospital’s capacity to render adequate care and to ensure the health and safety of your patients," the CMS informed Harper hospital in a letter sent Nov. 7 and obtained late Monday by The Detroit News. 

The letter stated, "(Y)our hospital is no long deemed to meet the Medicare Conditions of Participation..."

The federal agency threatened to withhold federal funding if the problems are not fixed.  The inspection was conducted for CMS by the Michigan Department of Licensing and Regulatory Affairs.

"It’s really detrimental to their public image," said Minnesota-based health market and finance analyst Allan Baumgarten, who follows Michigan hospital systems. 

Baumgarten said CMS might set a higher bar for the DMC given that two years have passed since the agency initiated proceedings to end Medicaid payments over failings related to dirty surgical instruments. 

"My sense is there’s somewhat of an attitude of ‘Fool us once shame on you, but fool us again and...,' " Baumgarten said Tuesday. "I think that they’re going to be more demanding in terms of really making the corrections and not be inclined to give DMC much latitude."

The next step is an unannounced survey, a CMS representative said Monday night. If the survey discovers continued issues, the federal agency would likely cut federal assistance.

In response, the DMC provided the federal agency with a plan of corrective action, saying "The hospital corrected the various issues identified related to Dietary. Facilities and Environmental Services, and developed and implemented ongoing actions to sustain the corrections."

But the DMC did not respond Monday or Tuesday to requests for comment.

The inspection was prompted by reports in October that three cardiologists and the top medical executive at DMC Heart Hospital were terminated from their leadership posts after complaining about about poor quality of care. Heart Hospital is connected to Harper and shares many of Harper's facilities.

Detroit Receiving Hospital was also inspected in response to the physician's complaints, but the inspection report has not yet been released.  DMC Children's Hospital of Michigan was inspected due to an unrelated complaint and was found to comply with federal standards. 

Bugs around 'for long time'

At Harper hospital, the report said inspectors found gnats, tiny flying insects, in several locations in the Intensive Care Unit. A nurse told an inspector that "these bugs have been here for a long time, more than three months. We usually see more of these gnats in the summer, but this fall has been bad."

A nurse manager said staff "are aware of the gnats and have placed several work orders." Inspectors requested copies of the work orders but didn't immediately receive them. 

Problems were also found in the kitchen area, where the floor "was found to have multiple large spills."

"The floor in the grill area was found to an accumulation of dirt and debris. The tray holding the reach near the grill area was found to have a black film substance on each holding rack arm where trays sit for holding food," the inspectors wrote.

"The designated clean gray tubs (four of four observed) for holding clean instruments were observed to have a large quantity of dust and debris located in the bottom of the tubs. The walls located near trash receptacles were found to be splattered with a red fluid substance, The floor area in-between the grill area and the storage area of clean cooking instruments was found to have a floor drain with thick silver tape surrounding the drain."

In its Plan of Corrective Action, Harper Hospital said officials had contacted a pest control company about removing the insects, and took numerous actions such as requiring only disposable headgear covering hair. They also re-educated workers on proper handling of catheter bags and started reviewing the hospital's sterile techniques policy with clinical staff during daily huddles.  

Staffers extensively cleaned the kitchen, and the hospital established a maintenance routine schedule that includes covering, labeling and dating all food stored in coolers.

“Noncompliance with corrective action by hospital staff will result in immediate remediation and appropriate disciplinary action in accordance with the hospital’s human resources policies and procedures,” according to the DMC's Plan of Action.

mhicks@detroitnews.com

kbouffard@detroitnews.com

Twitter: @kbouffardDN