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Health and Medicine


Reports reveal health and safety violations at the Cleveland Clinic
A collective look is provided by healthcare journalists
Story by SARAH JANE TRIBBLE


 
Courtesy of Sarah Jane Tribble
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In The Region:

Each year, the Association of Healthcare Journalists updates a database of federal inspections for hospitals nationwide. Our review of those records and others obtained through a freedom of information request reveals a startling number of health and safety violations at the Cleveland Clinic. Some of the incidents were serious enough for the inspectors to threaten to withhold federal funds. For Ohio Public Radio, WCPN's Sarah Jane Tribble has the story.

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Last year, the Cleveland Clinic was cited for 23 health and safety issues.  Plus, it received two letters warning that reimbursements for Medicare patients would be stopped if corrective action wasn’t taken within days.

Financial reports indicate the Clinic gets 43 percent of its revenue from Medicare. So, this was a BIG deal and more so because it wasn’t the first time the Clinic had received letters threating a cut in federal funding.

It has received at least two other similar warnings over the last four years.

In a letter to CEO, Dr. Toby Cosgrove, last June the U.S. Centers for Medicare and Medicaid said the issues raised “limit your hospital’s capacity to render adequate care and ensure the health and safety of your patients.”

"These are the standard forms. The first time I got one of these, I said, Oh My God what’s all this about.

That’s the Cleveland Clinic’s Chief Quality Officer, Dr. Michael Henderson.

Among the problems that have been cited by federal inspectors:operating room fires that burned patients; inadequate accounting of tools used in surgery; expired blood tubes found in the operating rooms; failure to make sure surgeons had the correct credentials for the operations they were performing.

Lisa McGiffert, who directs the Safe Patient Project at Consumers Union says the reports can be shocking to read, but  "I think those are things that can happen in any hospital and I think that the situation about Cleveland Clinic is that there’s a pattern of repeated violations.

Numerous violations
Dr. Henderson says after a visit from inspectors in May 2013 found numerous violations, the Clinic moved to clean up inventory tracking and has reassessed its protocols.

"This was really when we kicked into a much higher gear of how we manage policies across our whole health system and led to us revamping our whole privileging and credentialing process.

Inspectors for CMS cannot levy fines when they spot violations. So, instead, they send letters to the hospital and when it’s bad enough they use their only tool: a threat to pull the agency’s funding.

That threat is generally saved for only the most severe condition violations.

Henderson says about 20 percent of the Clinic’s violations were at this severe level.

And many of those were focused on how the Clinic manages its staff and operating room procedures. The medical staff, governing body and Dr. Cosgrove were all cited during inspections.

"We usually find about two-thirds of these are what I would call more administrative and the other third are what we call clinically related.”

Individual and collective look
Dr. William Jessee, a former executive of the national accrediting board and a professor of health systems management at the University of Colorado, says there’s a good reason inspectors focus on those administrative concerns.

"Individually, a lot of them look very much like administrative issues but collectively they form the infrastructure for trying to protect patients and optimize patient safety."

These particular citations by the Centers for Medicare and Medicaid all were initiated because of complaints. Modern Healthcare, an industry trade publication, found that more than 9,500 complaints had been filed at 1,600 hospitals during the four years covered in the database. The federal agency also gives citations based on its routine surveys and inspections. We don’t have details on those.

It’s clear the Clinic is not alone. But the complaint-based citations show it has had far more citations than other metro-area hospitals.

"As Chief Quality Officer here, these kinds of things help me enormously move things forward to another level of excellence and I think Dr. Cosgrove also is the first one to say these can be painful but they always make us better."

Last week, Dr. Cosgrove’s name surfaced as a possible Administration choice to become the new head of the Veterans Administration. Cosgrove took his name out of the running.  He says the federal health and safety inspections had no bearing on that decision.

TAG: Federal inspections of all hospitals nationwide, including the Cleveland Clinic, can be found at hospitalinspections.org sponsored by the Association of Health Care Journalists.

Listener Comments:

23 complaints out of how many actual visits? I think a more accurate way to report this is to list how many patient encounters they had that include the complaints. For example, if they had 24 visits, 23 would be a high number. But if the had 23 million, then, 23 is a statistic.


Posted by: dave on June 16, 2014 10:06AM
wondering which federal agency conducted the monitoring?


Posted by: Rob (Cleveland) on June 15, 2014 2:06AM
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