A District of Columbia government internal investigation has found more than 75 percent of the city's public health clinics are dirty, cockroach-and mouse-infested places where some patients are given outdated drugs.
According to the investigators' report, "in several clinics entire stocks of certain drugs had expired . . . which increased the opportunity for the administration of outdated drugs or no administration at all for purposes of treating needy patients."
The 22 clinics, which are run by the Health and Hospitals Administation of the Department of Human Resources, serve tens of thousands of people each year and are the only provider of health care for many of the city's poor residents.
According to the report of the internal investigation, which has not been publicly released, 18 clinics "maintained expired drugs on shelves, emergency trays and in refrigerators."
"Outdated drugs had not been segregated from currently dated stock. In addition, drugs pre-packaged by the DHR warehouse from five to seven years ago still were dispensed and administered at the clinics. The labeling on these drugs did not indicate expiration date and [they] should have been returned to the warehouse for disposal," the investigators wrote.
The investigators also found drugs dispensed without childproof caps, as required by the federal Poison Prevention Packaging Act and "drugs were dispensed and labeled by personnel unlicensed and unauthorized to perform such duties."
Dr. Raymond Standard, chief of the Health and Hospitals Administration, was out of town and could not be reached for comment.
The investigators from the environmental health branch of the city's Department of Environmental Services, also found:
Roach and rodent infestations were present in almost half of the 22 clinics;
Two of the clinics had no hot water at the time of the inspection, though "the most common vehicle for disease-producing organisms in healthcare facilities is failing to cleanse the hands;"
"Sterilization [and] disinfection . . . of medical instruments was substandard in seven of the clinics evaluated;"
Upon completion of the sterilization process, jointed medical instruments such as scissors and forceps still had evidence of rust and blood residue."
According to the report, the problems with instrument sterilization "provide an ideal opportunity for cross-contamination of patients."
In addition, 21 of the 22 clinics "showed no evidence of an effective housekeeping program. Substandard housekeeping was exemplified by conditions of soil residue on the walls, floors and equipment located in examination rooms and general storage areas."
Ninety percent of the clinics were judged to have less than minimal space standards for medical examinations and two had evidence of "hazardous asbestos material" in the ceilings and walls of hallways, offices and an examination room.
While such problems as cockroach and mouse infestations may appear an inevitable part of urban living, the report said, "from an infectious disease standpoint in health care facilities, insects and rodents can be responsible for the transmission of bacterial and viral agents . . . Cross-contamination from vermin-to-medical-equipment-to-patients can serve as a common reservoir of infectious disease transmission."
The investigators also found physical safety deficiencies "throughout all of the clinics evaluated. [these] consisted of blocked fire exits, hallways cluttered with furniture, defective oxygen tank valves and improperly secured oxygen tanks."
One of the things which most disturbed the investigators was the way in which prescription drugs and vaccines were stored and dispensed. The use of expired drugs, said investigators, is a particular problem.
Dr. Edna F. Fleischman, a staff physician at the clinic at 1325 Upshur St. NW, said "the expiration date doesn't necessarily mean [the drug] isn't potent." Vaccines, she said, are "good within 60 days" of the expiration date.
The investigators, however, said some clinics have been administering DPT serum, designed to protect infants and children against diphtheria, tetanus and whooping cough, three to six months after the expiration date on the vials.
A spokesman for Wyeth Laboratories, a manufacturer of DPT serum, said "None of our warranties are in effect after the expiration date."
Drug manufacturers do not guarantee the strength of their products after the expiration date, an investigator said, and thus children may be getting useless vaccines, leaving them unprotected against easily preventable diseases.
According to clinic nurses interview-by city investigators, DHR "pharmacists have allegedly informed them that manufacturers allow a 90-day 'grace period' beyond the expiration date on the label of the original containers . . ."
The report also states that vaccines given to children are being stored improperly. The vaccines, which must be stored at specific temperatures to maintain their potency, are taken from "refrigerators at the beginning of [clinic] sessions and [placed] in a a cup of ice. With clinic sessions of four to six hours, the temperature and storage conditions of the vaccine are altered."
The report said the vaccines later were returned to the refrigerator for future use.
The inspectors also said that patients were being given drugs without a written warning about the danger of mixing certain medications, and without the warnings that the combination of some drugs with certain foods makes the drugs ineffective.
"A drug which has deteriorated because of improper storage can be a detriment to public health," the inspectors concluded." A drug not in stock poses a threat to the patient in dire need of medication. Medications distributed to patients without proper labeling instructions and cautions may cause significant health hazards." CAPTION: Picture, Paint peels from walls of public health clinic at 1325 Upshur St. NW, where James Harrison, 9, sits in lobby. By Linda Wheeler-The Washington Post; Graph, no caption, The Washington Post