Hospital inspections lag
By Frank Cho
Advertiser Staff Writer
For at least the past two years, state health inspectors have been routinely renewing some hospital licenses without conducting required annual inspections of the facilities.
At least eight of the state's 30 hospitals — nearly one in four — have not been inspected in more than a year for licensing, according to state records. Until last month, The Queen's Medical Center in Honolulu, the state's biggest hospital, had not been inspected in nearly two years.
State law requires Hawai'i hospitals to be inspected and licensed annually by Health Department officials or face possible closure.
State officials say they are aware of the problem, but have been hampered by staff shortages and competing priorities. They say that in the past year, however, they have added more staff and have increased the number of inspections they conduct. For example, inspectors have visited seven hospitals in the past four months compared with four hospitals in the first six months of this year.
Still, at least one facility remans more than five months overdue for its annual state inspection and two hospitals are more than two months overdue.
"We have fallen behind in our inspections and we are still behind, but we are catching up," said Bruce Anderson, the state health director. "This isn't a hospital problem, it is our problem."
Hospitals administrators say that while current state inspections are important, the lack of one does not necessarily indicate a problem. They say hospitals undergo a variety of inspections by federal, state and industry organizations throughout the year for licensing, accreditation and certification, with many of those inspections overlapping.
"In the short term, I don't think this is a real problem. Hawai'i hospitals deliver some of the best services in the country," said Thomas Driskill, chief executive officer for Hawai'i Health Systems, which operates a dozen hospitals around the state. Three of those hospitals are overdue for inspections.
"Basically (the lack of a current inspection) doesn't affect us much," said Gerald Matsui, an assistant administrator at Maui Memorial Hospital. "We are obligated to follow state laws, rules and regulations anyway."
Dan Ditto, chief executive officer at Kahuku Hospital, said his hospital will probably be inspected four times this year by state, federal and industry regulating organizations looking at specific parts of the hospital's operations for certification of its procedures and hospital accredition. Ditto said areas being inspected sometimes overlap.
"It's difficult and expensive for a hospital to go through so many inspections, nevertheless there is value there," Ditto said. "We hope to police ourselves to the highest standards but it's always helpful to have another set of eyes."
At least one physicians' group voiced some concern about lax state inspections at local hospitals.
"If there are not enough properly trained nurses, or doctors don't have confidence in the staff, that can become a problem," said William Donahue, executive director of the Hawai'i Independent Physician's Association.
Donahue, however, said he has not seen any evidence of problems with patient care as a result of the lax state inspection schedule.
"I don't want to make light of it. To the extent that there has been laxity in the paperwork side and the accounting side, it is of concern," Donahue said. "But the inspections have their limits. They are only a snapshot in time."
The state licensing program was created to ensure that Hawai'i hospitals were delivering health care in a safe, efficient manner. The inspections, which can take a few days to more a week, look at every aspect of how hospitals deliver health care, from administration to laboratory operations to food service.
If a facility scores poorly on its inspection, which the state refers to as a survey, the hospital must submit a plan on how it intends to correct the deficiencies. In a worst-case scenario, the state could close the hospital if it does not take corrective action.
The inspection backlog had grown so serious at one point that in September the Health Department considered turning the job over to a nonprofit national group.
Anderson said he no longer supports that idea and believes that the state will be caught up on its hospital inspection program in about six to 12 months.
"Patients are getting excellent health care in Hawai'i. We have not had any unusual increase in the number of complaints over the last few years. My assessment is that hospitals are providing excellent care," Anderson said.
Anderson said the state's hospital inspection team had a large number of retirements over the last two years, leaving it short-staffed and contributing to the backlog.
But the head of the state's licensure program said that even at full staffing, it will be difficult to keep up with inspections because of the growing number of other clinics and long-term care facilities that the program is becoming responsible for.
"Realistically, I don't think we are going to be able to do what we need to with the current level of staff," said Gerald Chung, chief of the state's Office of Health Care Assurance, which regulates 200 facilities statewide including the 30 hospitals.
Chung said he has 12 inspectors who are responsible for handling hundreds of annual inspections, investigating complaints and accrediting facilities receiving government medical reimbursements.
So far this fiscal year, the inspectors have been largely operating with federal money; state money makes up 20 percent of the program's budget under an agreement with federal health officials, Chung said. That means federally required tasks often take priority over state licensing inspections, he said.
About $1.5 million in federal and state money has been budgeted for Chung's office over each of the last two years, with most going toward salaries.
That is partly why Anderson said he considered using the Joint Commission on Accreditation of Health Care Organizations certification reports when deciding whether to renew a hospital's license.
The Oakbrook Terrace, Ill.-based commission, founded in 1951, accredits such health care providers as nursing homes, rehabilitation centers and hospitals. The commission's stamp of approval runs for three years compared to the state's annual program.
But Anderson said such a move would require the Legislature to change the law, and the savings to the state would be minimal because it would still have to inspect hospitals in the two years between the commission's inspections.
Anderson also said other issues make relying on commission inspections less attractive, including the fact that they are prearranged with the hospital while the state's visits are unannounced. The state inspections also cover more areas than just the delivery of health services and include follow-up visits.
More than two-thirds of the state's 30 hospitals — 22 in all — already receive accreditation from the commission to qualify for Medicare reimbursements, but many rural or small hospitals cannot afford the commission's inspection fees, which can cost more than $20,000.
Anderson said that once the department has caught up on its inspections, the challenge will be to not fall behind again.
"We simply have not had any increase in funding and as we start licensing more residential care facilities, I expect the workload will only increase," Anderson said. "We have significant challenges ahead of us."
Reach Frank Cho at 525-8088, or at cho@honoluluadvertiser.com.
