Hospital Oversight Is Slipping Away
It is becoming increasingly likely that patients at California's hospitals who are injured or even killed due to that facility's negligence, there will be few consequences. That is despite a landmark 2006 law that empowers the California Department of Public Health (CDPH) to penalize and fine hospitals for any incidents that unnecessarily endanger a patient's life.
An analysis Payers & Providers undertook concluded that the number of administrative penalties and fines levied by CDPH against hospitals for dangerous medical errors have shrunk by about half in recent years. In fact, it has been nearly eight months since the agency has announced any penalties or fines at all. And in the rare instances of late when it does make announcements, CDPH no longer holds press conferences to discuss them, suggesting that it is becoming more opaque than transparent about the issue.
The CDPH certainly did not help its case when it issued a series of responses that mostly failed to answer the numerous questions posed by Payers & Providers on the recent trends.
CDPH Director Karen Smith, M.D., also declined to give an interview to the publication.
Likely this would not be the case were Payers & Providers the Los Angeles Times or the Wall Street Journal. But CDPH's failure to answer questions says two things: It is indeed pulling back on disciplining hospitals for dangerous medical errors, and the agency does not feel the need to address this issue directly.
There is never a good time to pull back on such oversight. But a recent U.S. Senate investigation concluding that patients were unnecessarily infected from unclean duodenoscopes due to hospitals failing to report early incidents in a timely manner demonstrates just how crucial a role CDPH and other agencies play in ensuring Californians are safe whenever they receive care in a hospital. Patients at both Ronald Reagan UCLA Medical Center and Huntington Memorial Hospital were among the victims.
As a result, there must be an immediate and extensive overhaul of the way the CDPH oversees hospitals.
California's hospitals only grudgingly acquiesced to the CDPH's oversight powers – it dropped objections to the 2006 law only after lawmakers agreed to lower the maximum fine that could be levied. Previous reports by Payers & Providers have indicated many hospitals are using the state's administrative law courts to appeal penalties and fines – using the CDPH's apparent slowness to complete investigations and mete out discipline as a defense. That is yet another issue on which the agency has been evasive when queried in the past.
Californians injured by medical errors can sue their doctor or doctor for malpractice. However, the existing statutory $250,000 cap on non-economic damages – which has not changed in 41 years – makes it exceedingly difficult to find an attorney willing to take on such cases on a contingency basis. The constrictions on that avenue of action means the CDPH cannot drop the ball on ensuring hospitals and other healthcare facilities are as safe as possible.
Where should the overhaul begin? CDPH Director Smith needs to immediately work on a strategy for beefing up hospital inspections throughout California, and either hiring or reassigning agency staff in order to ensure that occurs. This action plan should be issued and deployed no later than the first half of 2016. She could also consider some consumer-friendly options, such as a hotline to call in errors and even a public service announcement to promote it.
Whether Dr. Smith is up to such a job remains to be seen. She was appointed director 10 months ago with no prior experience at state health agencies. She spent the prior decade as the deputy director at the Napa County Health and Human Services Agency, a small entity that serves a mostly rural constituency.
Nevertheless, it is time for her to step up and address this critical issue. The safety of the millions of Californians who seek care at the state's hospitals every year is at stake. If Dr. Smith cannot do so in the coming months, she should resign.
Ron Shinkman is the Publisher of Payers & Providers.
