Sixty per cent of 2,750 American hospitals surveyed in the past year have been found substandard by national accrediting officials for failing to meet tough new building safety or medical auditing rules.
Hospitals here that got less than their usual two-year accreditation include such nationally known institutions as Walter Reed Army Medical Center, the Naval Medical Center in Bethesda, Georgetown University Hospital and Johns Hopkins.
Massachusetts General Hospital - teaching hospital for Harvard Medical School - and the University of Chicago Hospital have likewise been given limited accreditation.
So have the University of Maryland Hospital in Baltimore, the Medical College of Virginia Hospitals in Richmond, Washington Adventist Hospital in Takoma Park and Arlington's National Orthopedic and Rehabilitation Hospital.
Most of these and hundreds of other downgraded hospitals throughout the country failed to meet tighter "life safety" standards demanded by the federal government. Their physical plant deficiencies often included doors, windows and walls that would fail to keep smoke or fire from nearby patients.
Their medical deficiencies were mainly failures in the ways their doctors "audited" each others' performance. Most experts believe medical records and audits reflect the quality of a hospital's care.
Dr. Charles A. Sanders, general director of Boston's famed Massachusetts General Hospital, was among a number of hospital administrators who criticized the new life safety standards as unrealistic costly.
He said it would cost his hospital, and others like it, "millions of dollars" to remodel and rebuild, though it has not been lost a patient to fire in its 156 years and there is "no objective evidence" that the new rules will save lives. He called the standards "often picky regulations" that threatened "to drive (hospital) costs into the stratosphere."
At the University of Maryland Hospital, however, Director G.Bruce McFadden said "we may not like the process, " but more is being expected of hospitals," and "it's a good thing for patients," But he said he regrets possibly having to ask the state for $400,000 for alterations and still hopes for a waiver on some of them.
Instead of the two year accreditation that hospitals cherish as a seal of approval, all these hospitals were given only a one-year accreditation - an accrediation conditional on repairing deficiencies - by the Joint Commission on Accreditation of Hospitals.
The joint commission is a cooperative supported by the American Hospital Association, American Medical Association, American College of Surgeons and American College of Physicians. It has tightened both its life safety rules in response to federal pressure, and its many rules on medical record-keeping and auditing.
Dr. George Graham, the commission's associate director, said in an interview: "One year accreditation very definitely means we are telling hospitals there are things they must correct or they will not be reaccredited." He defended the tighter rules, saying, "We and the government are both looking at every standard we develop to ask, 'Is it cost effective? Will it do that much good?"
The joint commission has been judging hospitals since 1918. And with the start of Medicare in the mid-1960s, the Department of Health, Education and Welfare began "deeming" accredited hospitals as automatically "certifiable" for federal payments.
Then senior citizens' groups complained that HEW was letting the private commission approve substandard hospitals. So in 1972, by order of Congress, HEW began its own "validation surveys": spot checks of accredited hospitals conducted at HEW request by state fire marchals and other state officials.
Of 105 accredited hospitals scrutinized in the first such round, 65 were found to have important life safety defects. Of 156 seen in the 1974-75 round, 91 were called deficient.
This - and the writing of a new lifesafety fire protection code by the National Fire Protection Association, and pressure from many directions for tougher medical standards - led to the tighter inspections started by the commission a year ago.
If the "voluntary approach" to assuring health care quality fails, such inspections may "become a function of government," Dr. John Affeldt, commission president, recently warned.
If a hospital repeatedly fails to win accreditation, it may also lose approval as a training place for a residents or young doctors, who give much of the medical care, as well as for health workers. And other staff doctors and nurses and technicians will soon begin to look for other places to work.
The results of the commission's zeal actually began showing a few years ago. In 1975 St. Elizabeths Hospital here lost its long-standing accreditation, and in 1976 D.C. General Hospital was disaccredited.
Until this year, however, two-year accreditations outnumbered limited one-year approvals by three to one. This year, said Graham, 35 per cent of all hospitals surveyed have been given one-year approvals because of life safety defects; 20 per cent because of "quality assurance" deficiencies (mainly inadequate self-evaluation by medical staffs), and 5 per cent for defects in both areas.
Last September Temple University Hospital in Philadelphia was disaccredited, though it is appealing the findings. Massachesetts General Hospital was downgraded on building safety and lack of enough medical audits. Duke University and University of Alabama hospitals, Boston Hospital for Women and Boston City Hospital were also on the new one-year list.
On the one-year list in the District, Maryland and Virginia are:
Georgetown University Hospital for several safety derects including lack of enough "smoke'stop" partitions and adequate smoke-stop doors and corridor walls that would not block smoke.
Washington Adventist Hospital, Takoma Park, for similar violations in older sections.
The District of Columbia government's Glenn Dale Hospital for long-term care in Prince George's County for similar defents.
National Orthopedic and Rehabilitation Hospital, Arlington, for life safety, medical record and audit problems.
Walter Reed Army Hospital for deficiencies in smoke-stop barriers, stairwells, doors and fire alarm systems (all to be corrected as a new hospital is occupied in coming months), and lack of rehearsals for disasters.
Naval Medical Center, Bethesda, for similar safety deficiencies. (A new hospital is under construction for 1980 or 1981 occupancy.)
Naval hospitals in Annapolis and at Portsmouth,Va.,and Kirk Army Hospital at Maryland's Aberdeen Proving Grounds for similar problems.
University of Maryland Hospital, Baltimore, for failure to complete medical records and lack of documentation of internal disaster plans, as well as building problems.
John Hopkins for "multiple" safety hazards in buildings dating back to 1889, but also lack of enough fire drills.
Medical College of Virginia Hospitals, Richmond, for safety problems. (A $100 million building and renovation program is under way.)
For a variety of problems, the Public Health Service Hospital, Baltimore; hospitals in Chestertown, Easton, Fallston and Frederick, Md., and Culpeper, Danville, Farmville, Front Royal, Grundy, Hampton, Hopewell, Lynchburg, Luray, Newport News, Norfolk, Norton, Petersburg and Richlands, Va,. as well as others in Richmond.
Officials of most of the major hospitals said they ave started or have planned renovations or new building. A Johns Hopkins official estimated that renovation there will cost $750,000.
Georgetown Hospital was reinspected recently, and officials hope for a full, two-year approval. Some others are in the same position. Columbia Hospital for Women here recently won two-year approval after a spell on the one-year list.
But some hospitals here and elsewhere still on the two-year rolls have yet to be reinspected, or have yet to hear the possibly dim results of a recent, tougher look.
"It was a blow!" said a Georgetown official of that hospital's bad news. "But it made us do a lot of work to comply."