By BJ Austin, KERA News
http://stream.publicbroadcasting.net/production/mp3/kera/local-kera-982576.mp3
Dallas, TX – Parkland Hospital plans to make a highly critical report public Friday after giving federal officials a plan to correct nine serious infractions. Investigators called two of the violations an "immediate threat to patient health." Prior to the report's online release, Parkland CEO Dr. Ron Anderson and Chief Medical Officer Dr. Jay Shannon talked with KERA's BJ Austin about the report.
The Commission on Medicare and Medicaid Services, or CMS, found two areas that fell in the most serious category of "immediate jeopardy". They were infection control, and emergency room care.
"I was shocked and very, very disappointed."
Dr. Jay Shannon, Chief Medical Officer at Parkland, says part of the CMS report deals with violations of EMTALA, or the Emergency Medical Treatment and Active Labor Act. That's the anti-dumping law prohibiting hospitals from refusing care because patients can't pay. It also requires certain care standards.
Shannon: Practically speaking, what EMTALA says is that people need to be seen, assessed and stabilized. And then if they are transferred to another facility, you've got to have an absolutely flawless hand off of information so it is a safe transfer of that patient.
Parkland CEO Dr. Ron Anderson says the "safe transfer of ER patients" raised a red flag.
Anderson: In the case of Children's we merged with them in 1994, all of the acute care services except for burns and nurseries. So, we used to take patients through the back hallway quickly to Children's when they came in through the wrong door. Now, we're going to have to treat em, and stabilize em and get em ready and package em up and take them over there.
Dr. Anderson says the strict transfer protocol is there to protect the patient. Rushing an unstable emergency patient to another hospital or location could be harmful.
There were also issues with the medical screening of emergency room patients. There are six different intake areas of the ER. They were put in place a couple of years ago to cut the wait time and allow more patients to be seen. But questions arose about qualifications of some screeners that were making medical decisions about emergency treatment.
Infection control was the other major infraction. Dr. Anderson admits Parkland has been too permissive - not enforcing "best practices" rules.
Anderson: What they look at is the potential risk. So if a doctor is walking through the hospital with bootie covers on, or with a mask hanging down on his chest.
Anderson says the protective gear is supposed to be left in each individual patient's room. It is not supposed to travel throughout the hospital. He says that could spread infection from bed to bed. And that could be deadly. The Centers for Disease Control says there are nearly two million healthcare associated infections in American hospitals each year. Patients die in about six percent of the cases. Dr. Anderson says Parkland's rate of infection is low.
Dr. Shannon says he's confident Parkland will fix the problems outlined by the CMS report.
Shannon: They don't get more serious. They don't get more important than this. So, we absolutely have to get this right.
Dr. Shannon says the Commission on Medicare and Medicaid Services conducted the sweeping survey of Parkland upon a request from state health officials following the death of a psychiatric patient.
Dr. Anderson says much of the CMS report involves very specific protocol and policy for dealing with patients.
Anderson: The intent really at Parkland was to do the right thing for the patients. I think what we've done to correct it will be satisfactory to CMS because we want to do the right thing for the patients the right way.
If corrections aren't made, Parkland would lose its Medicare and Medicaid funding. Dr. Anderson says that would sink Parkland - the largest Medicaid provider in Texas.
And Ron Anderson says the CMS report could also put his job in jeopardy.
Anderson: What they do as far as my board or the Commissioners Court, that's really not in my control. I work at the pleasure of the board. This happens to be a new board and I have empathy for them having this fall in their lap.