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We're From The Government, We're Here To Help …

The clock is ticking for Parkland Memorial Hospital in Dallas.

Last week, Parkland was cited by the Centers for Medicare & Medicaid Services for several “serious threats” to patient safety. As a result, the hospital is now in jeopardy of losing its ability to participate in the Medicare program unless it submits “correction plans” to CMS by August 20, 2011.

According to a CMS spokesperson, two violations relating to infection control and emergency care issues were “so serious that they triggered ‘immediate jeopardy'” for the hospital. In fact, the reasons for the citation were so heinous that CMS won’t even disclose them to the public until Parkland submits plans on how to fix those super secret problems. That’s the subject of another WTF discussion, but we’ll save that one for later.

The event triggering the CMS investigation involved a schizophrenic psychiatric patient with a heart condition who died while in the emergency department. The report states that the technicians who subdued the man did not have “effective training” and that the patient was not closely monitored before his death.

According to the article and an interview Parkland’s Chief Medical Officer, Parkland was cited for several reasons. Based on what I can gather from the article, two of the hospital’s citations were for:
– Moving patients with less serious symptoms to a separate urgent care center for medical screening
– Staff touching a patient and then touching other surfaces that people would come into contact with

Think about how grave these dangers are.

When a patient is more than 20 weeks pregnant and has abdominal contractions, what happens when she comes to the emergency department? She gets put in a wheelchair and brought directly to the obstetrical department for further evaluation. So by virtue of their presenting complaint, some pregnant women are immediately sent to a different department for medical screening. This process is apparently acceptable for CMS because it happens everywhere in the country.

Suppose the same 20 week pregnant patient has a hangnail instead of being in possible labor. Now, instead of moving the patient to obstetrics for pregnancy evaluation, Parkland was moving the patient to its urgent care department for further medical evaluation.

Both “moves” are made based upon a patient’s presenting symptoms. However, when a patient with one presenting complaint is sent to one area of the hospital for further evaluation, it is entirely acceptable while sending the same patient to a different part of the hospital for a different presenting complaint constitutes a “serious violation” and a “threat to patient safety” that must be stopped immediately.

Makes perfect sense to me.

Then there’s the “let’s have a sterile universe” violation of epic proportions.
Touching a patient and then touching surfaces that other people may contact is a “serious and immediate” health threat? Let’s see this logic. I’m assuming that the government means that it is a serious health threat to potentially transfer germs from one person to another.
What should healthcare providers do in order not to create a “serious and immediate health risk”?
All bathrooms must be completely sterilized between each use. After all, one patient could come into contact with a surface that another patient touched.
Doorknobs to all hospital doors must be sterilized after every person touches them. After all, one patient (or worse … a visitor [gasp]) could come into contact with a surface that another patient touched.
Beds. Walls. Chairs. Everything must be sterile, dammit. Otherwise, we’ll all crumple up and die like those things on War of the Worlds.

Do I think that medical providers need to wash their hands more frequently? Of course.
Could we do a better job at controlling infections all over the world (not just in hospitals)? Sure.
Is there any basis in medical science showing that avoiding contact with surfaces after touching patients will control infections when no other fomites are addressed? Not a shred.
What if a patient touches a surface in a common area directly? What if a patient touches the registration desk? What if a blood pressure cuff is put on the surface after being used on the patient? What if a hospital gown touches the floor after a patient used it? What if the patient was going through the drawers without the medical staff’s knowledge?
Maybe we should just bug bomb every hospital in the US every hour on the hour.
Got, that, Parkland? Put that in your plan of action. Bug bomb the hospital every hour on the hour and have a steady stream of alcohol sanitizer spraying from sprinkler heads. That’s the only way you’re going to keep your Medicare privileges.

I’m sure that CMS has more infection control violations in its own offices than Parkland has in its hospital. You CMS wonks sterilize your computer keyboards much? Door handles? How about your telephones (when you answer them, of course)?

And what is CMS’s official position on presidential candidates shaking hands during election campaigns? I don’ t see the candidates washing their hands between shakes. Nope. Nary even a squirt of alcohol sanitizer. Those germ infested malevolents are engaging in a serious and immediate risk to the health of every prospective voter at these rallies! They’re like giant bumblebees pollinating the population with deadly germs! GACK! Call off the elections!

Unless CMS is holding back on some other huge bombshell about Parkland’s practices, labeling the above triage policy and infection control violations as “serious and immediate threats to patient safety” is alarmist, capricious, and just plain wrong.

And we wonder why health care in this country is in such a wonderful state of affairs right now …


  1. I have been undergoing treatment by Parkland’s Gyn Onc and Internal Medicine clinics and I feel I have received excellent care from them. I have been bothered by our local newspaper’s alarmist coverage of this situation and feel all of it has been way overblown.

  2. But on to the important issue: Where is the current picture of your father’s day present?

  3. “Shannon said examples violations of infection prevention included staff touching a patient and then touching a surface that other people would come into contact with.”


    I guess I know where this guy (Dr. Bloody Gloves) got a job after he was fired…

  4. I live about an hour north of Parkland…all of our major traumas go there… For trauma, it most generally cannot be beaten…Google the Dallas Morning News for Parkland related issues. The “issue” will probably be there…One of the biggest factors is a Parkland employee went in to have a routine knee surgery, apparently not a major procedure, and ended up losing her leg apparently r/t the fact her doctor did not do the surgery, and the resident was not skilled to handle the procedure, and the complications which arose from said procedure.

  5. The trigger event I could buy – a never event, albeit with the power of hindsight ;-)

    The other two citations are insane : no ER in the world could function according to those standards.

    CMS are nutso if they think they’re being helpful, or doing anything useful…

    “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience”. ~ C.S. Lewis

  6. check out wfaa.com for the details or the dallas news website…www.dmn.com Some of the requirements are definitely, how do I say this, unique?

  7. When my hospital was under the CMS survey guns, we were spanked for not having our individually-wrapped herbal tea bags separate from one another (touching each other GASP! the horror!) and neither the teas nor the salt and pepper had any expiration date noted. And you all know how fast salt spoils!

    Yeah, I’m less impressed by CMS than I am by the JC, and I didn’t think such a thing was possible before our audit.

  8. It’s all about the government justifying their job.
    Like OSHA, they will NEVER find nothing wrong with an inspection. Instead, they will find some terrible exaggerated problem and then proclaim to the public how they saved their lives- and their own jobs.

  9. Who’s the governor of Texas again? Hmmmmmmm

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