Investigations like that into D.C. hospital's sewage leaks seldom result in major penalties

Hospitals that fail to report or address safety problems, including those that increase the risk of infections, rarely face meaningful repercussions by state or federal officials, health care experts say. 

USA TODAY reported last week that MedStar Washington Hospital Center is under investigation by the D.C. health department for recent sewage leaks, although the problem has been going on for up to two years. The go-to hospital for members of Congress and the White House also suffers from poor quality ratings, particularly on foreign bodies left inside patients and certain infections. 

An inspection report and the hospital's "corrective action" plan is expected soon. The last time a D.C. hospital was fined was in 2013, when Specialty Hospital of Washington had to pay a penalty of $10,000.

Two years ago, a state investigation found 13 violations of state and federal law in a Florida hospital's handling of a major sewage leak, including failure to assure the sewage was cleaned up properly and to conduct an infection control risk assessment. Investigators reported finding live rats above ceiling tiles affected by the leak, along with other problems, according to the Herald-Tribune in Sarasota. 

Venice Regional Bayfront Health spent more than $28 million to "repair and strengthen the infrastructure, equipment and technology" since the leak, says spokesman Bob Hite. Venice also submitted a "plan of correction" that was submitted to and accepted by the Florida Agency for Health Care Administration, which also hit the facility with what Hite called "a nominal $4,000 penalty."

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"Providing a safe environment for our patients to receive quality medical care is our top priority, as demonstrated recently by our ability to continue operations while the Venice community was battered by Hurricane Irma's tropical storm force winds," Hite said in an email. "We are diligent about maintenance and maintain a rigorous pest control program."

Washington Hospital Center spokeswoman Donna Arbogast says "all pipe issues have been corrected." The hospital has also been doing an education campaign reminding employees not to flush wipes down toilets.

One sewage leak, USA TODAY reported, occurred in the operating room in which Rep. Steve Scalise, R-La., had his last surgery after suffering a gunshot wound in June. 

"Our team handled the referenced incident immediately and effectively, involving an outside company to certify the room was safe for patient care," the hospital's president, John Sullivan, said in a letter to USA TODAY. 

Sullivan also noted the "independent Joint Commission and D.C. Department of Health regularly and rigorously inspect every inch of our hospital, and we are fully accredited." The Joint Commission has been under fire recently — including in a Wall Street Journal article last week — for what have been described as lax standards that accredit even hospitals at risk of losing Medicare reimbursement. 

Internal and external audits after major safety lapses would be more effective than negotiated corrective action plans, says Lisa McGiffert, director of Consumer Reports' Safe Patient Project.

CMS could make the plans require more accountability, which would show that regulators “want hospitals to get better,'" she says.

A big question remaining is what penalties, if any, Washington Hospital Center will face if they too are found in violation of state laws or CMS rules requiring that hospitals maintain a clean and sterile environment.

To get reimbursement for treating Medicare patients, hospitals have to maintain a clean environment that's designed to prevent the transmission of communicable diseases, notes infection control expert Larry Muscarella. Sewage leaks in operating rooms could easily violate that, he says.

Hospitals are seldom fined, and as recent news reports about lax accreditation practices shows, almost never lose their accreditation, says Muscarella, who owns LFM Healthcare Solutions and the Discussions in Infection Control blog. 

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Even when state health care investigators find potentially serious infection-control issues, the facility may not always have to pay much of a fine and certainly not what Muscarella thinks would be commensurate.  

"Sometimes there are no penalties or censures at all," he says. 

Often state investigators tell hospitals when they are coming, allowing hospitals to put staff on high alert and clean up in advance. The surveys should be unannounced, Muscarella says.

Consumers deserve to know more about how these inspections are conducted and what is found, he says. For example, the sewage leaks at Washington Hospital Center and the health department's investigation were not public until USA TODAY reported on them.    

Hospitals have few reasons to publicize issues if there are few repercussions to report possible infection risks or other safety issues to health regulators. That's despite changes in the health care system aimed at helping consumers make more informed decisions about where to seek treatment.

“Financial incentives can sometimes encourage focusing on the bottom line more than necessarily quickly fixing an apparent lapse," says Muscarella. "Being cited by a state agency for an infection-control lapse can sometimes have little or no consequence.”

Hospitals can save so much by making quality improvements that the amount or even use of fines becomes far less important, says David Kashmer, a trauma and emergency surgeon and health care quality expert. He says health care is about a decade behind the rest of industry and that the median savings from implementing error prevention programs is about $250,000 — not even including the costs of legal defense and settlements when things go wrong. 

"We have advanced quality tools available, but unfortunately we see some centers where, because of the culture or the situation, don't use them," says Kashmer, who reviews the quality of hospitals that apply for the prestigious Malcolm Baldrige Quality Award. The key characteristic of a quality health care system "is the ability to collect and use meaningful data to make changes to their system the interest of patient safety and quality," he said.