CHRONIC CONDITION Medicare's Oversight Gaps

Accreditors Blamed for Overlooking Problems

By Gilbert M. Gaul
Washington Post Staff Writer
Monday, July 25, 2005

Second of three parts

The creators of Medicare faced a problem. They were about to hand out millions -- eventually billions -- of dollars each year in tax money for hospitals to care for the nation's elderly. But how to make sure those hospitals were qualified?

Government bureaucrats had no experience overseeing the quality of health care, so in 1965 lawmakers turned instead to a private group -- a little-known organization that already was in the business of evaluating hospitals.

The responsibility as Medicare's gatekeeper came as a shock to the Joint Commission on the Accreditation of Healthcare Organizations, which never lobbied for it. "In fact, we woke up one morning and found some language in the legislation," said Dennis S. O'Leary, now president of the group. "It was a complete surprise."

Over the next 40 years, that surprise turned out to be a boon to the joint commission's prestige and finances. Today, the nonprofit is one of the nation's most influential health groups, evaluating thousands of medical facilities annually. It collects $113 million in annual revenue, mainly from the fees it charges hospitals.

Yet at the same time, the joint commission's practices raise questions about potential conflicts of interest and the rigor of its hospital surveys. It operates a thriving subsidiary that charges hospitals thousands of dollars for coaching on how to pass its reviews. About 99 percent of the hospitals reviewed by the joint commission win accreditation, and in recent years it has missed glaring examples of poor care in which patients have been injured or killed:

· The joint commission accredited California's Redding Medical Center in July 2002. A few months later, FBI agents raided the hospital amid charges that doctors had performed hundreds of unnecessary heart surgeries and tests from 1999 to 2002, allegedly resulting in some deaths.

· The joint commission gave Maryland General Hospital in Baltimore its seal of approval twice in four years. Yet even as the hospital was collecting plaudits, lab technicians complained that testing equipment didn't work and that hundreds of HIV tests were mishandled. Some patients who tested positive for the virus may have been told they were negative. State regulators found last year that the lab had been "rife with equipment failures and malfunctions" and had lost or mishandled specimens.

· Norwalk Hospital in Connecticut won accreditation from the joint commission in May 2004. Less than a month later, state regulators reported numerous violations at the hospital. One patient received 10 times the prescribed dosage of a painkiller, according to state records. Another had his left testicle mistakenly removed. Still another, experiencing suicidal thoughts, was given a taxi token and told to find a treatment center. He hanged himself hours later, according to a November 2004 consent agreement between the hospital and state. Norwalk officials agreed to pay the state a $50,000 fine without admitting wrongdoing.

· The group awarded accreditation in August 2000 to Florida's Palm Beach Gardens Medical Center even though the hospital received a less than satisfactory grade on infection control. It affirmed the accreditation in 2003, about the time that state and federal regulators were poring over more than 100 complaints of life-threatening infections in the heart unit. The hospital's owners were later fined by the state and paid $31 million to settle plaintiffs' allegations of poor care.

O'Leary said the group's surveys "are the most rigorous in the world," with safety and quality standards that exceed those of Medicare. He acknowledged that joint commission reviewers "still miss" problems, "but so do state agencies and others," he said. "I bet if we went in behind state regulators, we would find things, too."

Some state regulators and consumer advocates take a different view, saying that Medicare relies too heavily on the joint commission and other private groups, which are closely aligned with the health facilities they review.

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