Federal health officials are investigating allegations of dirty surgical instruments and other quality problems at the Detroit Medical Center in response to allegations made last week by physicians.
Three cardiologists and the top doctor at DMC Heart Hospital said they were terminated from or resigned their leadership posts after they made repeated complaints about poor patient care, including one patient death and a tray of dirty surgical instruments discovered by a doctor just over a month ago.
Failed inspections can result in the loss of federal Medicare and Medicaid funding if serious problems aren't fixed.
The Centers for Medicaid and Medicare Services also has the power to shutter hospitals or ban them from providing some medical services. Serious violations can result in the loss of hospital accreditation by Joint Commission or other accrediting agencies.
"CMS has authorized an investigation at Harper University Hospital and Detroit Receiving Hospital in response to recent media reports to determine if the facilities are in compliance with the agency’s Conditions of Participation," the federal agency said in an email last week to The Detroit News.
“The surveyors have not arrived, but we welcome the opportunity to demonstrate the effectiveness of the quality and safety protocols we have in place and how seriously we take them,” the DMC said in response last week.
The DMC has been plagued for more than a decade by problems with dirty surgical instruments, according to a six-month Detroit News investigation published in August 2016.
The health system subsequently failed state and federal inspections at several of its hospitals and was threatened with the loss of federal funding before the problems were corrected.
In the latest incident, the DMC confirmed that a tray of dirty instruments was discovered by an orthopedic surgeon more than one month ago, but said no patients were exposed.
Packets of instruments from the sterile processing center are typically checked by an operating room technician before being brought into the sterile field, the part of the operating room surrounding the patient that is strictly protected from possible contaminants.
In a letter to The News, the DMC provided a quote from the doctor who oversaw the surgery.
"As the lead surgeon in the case you reference, I can tell you that the process worked and the only surgical instruments that ever went into my OR (Operating Room) were sterile. I feel confident in what the DMC has done to help keep my patients safe," Dr. Hussein Darwiche said in a statement.
The DMC announced Oct. 2 that Drs. Mahir Elder, Amir Kaki and Tammam Mohamad, were asked to step down from leadership roles for unspecified violations of the institution's Standards of Conduct. Dr. Ted Schreiber, the top physician executive at DMC Heart Hospital, resigned on Sept. 28.
The physicians said they were asked to step down in retaliation for repeated complaints about patient care. They argued the health system publicly announced their dismissals in an effort to smear their reputations.
“Any suggestion that these leadership transitions were made for reasons other than violations of our Standards of Conduct is false," the DMC said last week. "The leadership transition is the result of a thorough review led by outside counsel into complaints from other physicians and team members.”
Concerned patients, employees and others can file complaints with state regulators if they have concerns about quality-of-care issues, said Pardeep Toor, spokesman for the Michigan Department of Licensing and Regulatory Affairs,
In its 2016 investigation, The News obtained more than 200 pages of internal emails and reports indicating that surgeons and staffers had complained for at least 11 years about improperly cleaned, broken and missing instruments. The complaints continued under the tenure of the for-profit Tenet Healthcare of Dallas, Texas, which acquired the DMC in 2013.
Improperly sterilized tools complicated operations from appendectomies and brain surgeries to cleft palate repair and spinal fusions. Patients were kept under anesthesia for up to an hour as staffers replaced instruments. Dozens of operations were canceled at the last minute, some after anesthesia was administered.
The state quickly launched an investigation following The News' stories in August 2016.
In a May 2017 interview with The News, health system CEO Dr. Anthony Tedeschi said the problems were fixed. He said the DMC spent $1.6 million on new and replacement equipment, hired additional sterilization staff, fine-tuned the chemicals used to clean instruments, and reconfigured the processes that govern when, how and by whom surgical instruments travel from operating rooms through various stages of cleaning and back again.
The DMC's public feuding with cardiologists comes as hospitals across the country are focused on attracting top cardiologists, said Minnesota-based health market and finance analyst Allan Baumgarten, who follows Michigan hospital systems.
"In general, all hospital systems around the country are very much focused on certain specialty lines of business, and cardiology is certainly one of them," Baumgarten said Wednesday, adding orthopedics, neurosurgery and oncology are also highly prized and promoted.
"They are trying to attract and retain star performers, star surgeons who will practice in their facilities, and they're making investments in the newest and brightest equipment or improving their facilities so that they are more appealing to these high performing surgeons," Baumgarten said.
"Anything that upsets those arrangements or that upsets the public reputation of that system in operating those major lines of business, I think, could conceivably have significant economic impacts."