Citing reports of injuries and deaths resulting from medical negligence, a government study yesterday sharply criticized the inspection system intended to ensure quality health care in U.S. hospitals.
The study, released by the inspector general at the Department of Health and Human Services, June Gibbs Brown, said that although "the current system of hospital oversight has specific strengths that help protect patients . . . it also has major deficiencies."
The report criticized the private agency responsible for regulating most hospitals, and called for more vigorous oversight to minimize "unnecessary patient harm." It pointed to a Harvard report on patients hospitalized in New York in 1984, which found that 1 percent suffered "adverse effects caused by negligence" and estimated that negligent care was responsible for 27,179 injuries and 6,895 deaths in the state that year.
The federal government relies on two types of external review to ensure minimum standards of care for U.S. hospitals and enable them to participate in Medicare, which covers 38 million elderly and disabled people. The primary body responsible for this oversight is the Joint Commission on the Accreditation of Healthcare Organizations, which regulates about 80 percent of the nation's 6,200 hospitals. State agencies provide certification for the remainder.
The two-year study said that the hospital surveys conducted by the JCAHO every three years are "unlikely to detect substandard patterns of care or individual practitioners with questionable skills." Although it plays an important role in "reducing risk and fostering improvement," its approach affords "little opportunity for in-depth probing of hospital conditions or practices," according to the report.
The Joint Commission has been the subject of periodic controversy for some years, partly because it is a private body, funded by the hospitals, that receives limited government oversight. In a letter published with the report, the National Health Law Program said the JCAHO should be barred from calling itself independent.
The report "confirms what nurses have been saying for years about hospital inspections, that they are a sham, that they are foxes guarding the chicken coop," said Janet Bass, spokeswoman for the Federation of Nurses and Health Professionals.
A letter by Dennis S. O'Leary, JCAHO president, in response to an earlier draft of the report said that criticisms of the group were "unfounded and not substantiated by the evidence cited." Nonetheless, in a statement released yesterday, the Joint Commission said it welcomed the report and said it was taking steps to improve its accreditation process.
The HHS study contrasted the increasingly "collegial" oversight approach employed by the JCAHO with the "regulatory" approach of state agencies. The Joint Commission accepted the need for a balance, but denied that the collegial mode was becoming dominant.
And although the report, titled "The External Review of Hospital Quality," praised the state agencies for offering a "timely, publicly accountable mechanism" for responding to complaints, it also accused them of failing to conduct enough routine surveys. In 1997, about 50 percent of "nonaccredited" hospitals regulated by the states had not been surveyed within the three-year industry standard, and some had not been surveyed for eight years.
The report urged the Health Care Financing Administration (HCFA), the government agency that administers Medicare, to increase its limited oversight of the JCAHO and the state agencies. Among the recommendations, the inspector general urged the HCFA and the JCAHO to ensure an increased random selection of hospital records, an improvement in response to patient complaints, and more unannounced surveys. Hospitals are now given 24 to 48 hours' notice on "unannounced" surveys, which made up about 5 percent of all surveys from June 1995 through May 1998.
The report said the hospitals' right to self-regulation by the JCAHO should be reviewed from time to time. But Deputy Inspector General George F. Grob said yesterday, "There is no sense in setting up another system -- you might as well use the one that's there. . . . We certainly don't want to reinvent this from scratch."