Detroit Medical Center facing surprise inspection from state, federal regulators

Detroit Medical Center soon faces a surprise quality inspection from state and federal regulators, according to an official from the Chicago office of the Centers for Medicare and Medicaid Services. CMS said Wednesday it has authorized an investigation at Harper University Hospital and Detroit Receiving Hospital in response to recent media reports to determine whether the facilities are in compliance with the agency's Conditions of Participation.

And multiple sources told Crain's this week DMC managers informed employees and clinical staff that surveyors from the Illinois-based Joint Commission would be at Harper Hospital for a multidepartment inspection. The Joint Commission said Thursday it did not conduct a survey at DMC Tuesday or Wednesday.

The inspection by CMS follows a Monday Crain's article raising infection control and instrument cleaning issues at the DMC.The Oct. 8 article cited ongoing problems with surgical instrument cleaning and also outlined a federal investigation into DMC's cardiology program, the use of employed nurses for private doctors and other matters at DMC.

"Quality control is paramount to the DMC. For surgical care, that includes having appropriate safety protocols in place and multiple checks and balances as part of the preoperative process, which takes place before surgery begins," DMC said in a Wednesday statement.

Quality inspectors at the state Licensing and Regulatory Affairs department also confirmed they are looking into allegations made in the Crain's article that quoted sources saying that DMC has had multiple incidents this year with dirty or contaminated instruments reaching operating rooms in at least three adult hospitals. None of the dirty instruments, those with surface blood or bone fragments, were used in any operations, the sources said.

In 2016 and 2017, DMC was cited for multiple infection control infractions by state and federal regulators. DMC later submitted a plan of corrections that was accepted by the Centers for Medicare and Medicaid Services. It has since restructured its sterile processing department, including creating a second one at DMC Children's Hospital of Michigan, Crain's has reported.

In a statement Monday, Jason Moon of LARA said: "We are closely reviewing allegations in the (Crain's) news report. We encourage anyone who believes there is a violation" to file a report.

Another LARA official told Crain's late Wednesday night that the state would be inspecting DMC in an unannounced visit on behalf of CMS. The official encouraged anyone with knowledge of potential problems at DMC to contact LARA or CMS with complaints.

On Tuesday, CMS told Crain's: "Patient care and safety are top priorities for CMS. In order to protect the integrity of the survey process, all surveys conducted by CMS are unannounced. If individuals have questions or concerns related to quality of care, we encourage them to contact the State Survey Agency."

In an interview Wednesday, two physicians told Crain's that DMC managers told the Cardiovascular Center's catheter lab staff Tuesday morning to get ready for a visit from the Joint Commission. One of the sources said management last week asked lab staff to "clean" the lab and make sure all rules about proper clothing, eating and drinking are enforced.

Two other sources said that DMC unit managers in a medical intensive care floor at Harper on Tuesday were told to prepare for Joint Commission surveyors and to "be helpful."

The Joint Commission accredits healthcare organizations and many oversight bodies and payers rely on the quality inspections as evidence of good standing. For example, state Medicaid and Medicare payers, along with private payers, recognize accreditation as a proxy for their own inspections. Some payers require accreditation as prerequisite for insurance reimbursement or managed care bidding.

According to the Joint Commission's web site, Detroit Receiving and Harper Hospital were last reaccredited in 2017 and are in good standing.

Over the past nine months, sources have told Crain's of at least two examples of surgeons or nurses in DMC's adult hospitals in Detroit discovering dirty or bloody instruments. Both times, the dirty and contaminated instruments were discovered before operations.

Following Monday's story that included a bloody instrument involving surgeon Hussein Darwische, Crain's confirmed another incident of dirty instruments reaching a DMC operating room. In Darwische's case, he said in the Monday story that safety processes worked as intended.

In a second case, a surgeon doing foot surgery at Harper opened a tray and found it to contain bloody and dirty instruments, according to a source with direct knowledge of the incident. The surgeon ordered a second tray and found the same problem. A third tray was delivered and the surgery was completed.

The adult sterile processing department is located in the basement of Detroit Receiving Hospital. Under former CEO Mike Duggan, DMC centralized all instrument and equipment sterilization into a single location from multiple hospital departments to save money.

Each day, DMC's sterile processing department cleans and assembles thousands of instruments into surgical sets, or trays, for the hospitals of the DMC's downtown campus, which includes Receiving, Harper University, Hutzel Women's and DMC Cardiovascular Center.

Editor's note: This story was updated to clarify that the Joint Commission says it was not on site this week at the DMC.

"Detroit Medical Center facing surprise inspection from state, federal regulators" originally appeared in Crain's Detroit Business.