CDPH Mostly Quiet On Hospital Enforcement Issue

The California Department of Public Health (CDPH) provided few answers this week regarding a steep decline in the number of administrative penalties and fines issued against hospitals for serious medical errors that threaten or claim the lives of patients.

Payers & Providers reported last week a significant drop-off in the penalties and fines CDPH has issued against hospitals in recent years. The agency cited 22 hospitals and levied $1.475 million in fines last year, records show. It cited 19 hospitals and also issued $1.475 million in fines in 2014.

But in 2013, it cited 39 hospitals and issued $3.63 million in fines. In 2009, it cited 58 facilities in total. It has not announced any penalties or fines against hospitals since May 2015. 

Hospitals in some major population centers – such as Alameda and Fresno Counties – have not had penalties levied in years. And, in many cases, reports about penalties posted to the CDPH website were later removed. In Los Angeles County, for example, 10 of the 60 penalties that have been issued over the years have had their supporting documentation removed. In Riverside County, Southwest Healthcare in Murrieta in Riverside County, the most cited hospital in California with 13 administrative penalties since 2009, two penalties issued in 2014 did not include any supporting data. 

CDPH officials have said privacy concerns were behind the reasons for the removals, although the reports never mention patient names or other identifying information.

The drop in penalties and fines and the increase in opacity raised some concerns in the safety community. CDPH Director Karen Smith, M.D., declined to speak with Payers & Providers on the issue. 

Asked directly about what might be causing the current penalty drop-off – whether hospitals are safer or if there is a manpower issue -- the agency issued a statement by email that said: “The California Department of Public Health’s first priority is to protect patient safety. CDPH has not formally studied the relationship between issuing administrative penalties and improved patient safety.”

The agency also directly declined to answer whether the trend of hospitals appealing fines and penalties in the state's administrative law courts has been making the agency less aggressive in its enforcement actions. Many hospitals have been claiming a laches defense – arguing that the agency has exceeded statutory time limits to take enforcement actions, and thereby getting the penalties and fines dismissed. At least 95 penalties have been or are under appeal, with the process often taking years due to a shortage of capacity in the state's administrative law courts.

“CDPH takes enforcement action when it is appropriate and warranted,” the agency said.

The hospital sector itself was unwilling to talk about the issue. 

“We don't comment on the actions of public agencies,” said Jan Emerson-Shea, vice president of external relations for the California Hospital Association (CHA).

The CHA launched in 2013 the Hospital Quality Initiative (HQI), which is in itself an umbrella for several regional programs that focus on improving patient safety, although much of the group’s work has been on curbing hospital-acquired infections. 

The HQI's Chief Executive Officer, Julianne Morath, was not available for comment this week.