[Congressional Record Volume 144, Number 15 (Wednesday, February 25, 1998)]
[Extensions of Remarks]
[Pages E228-E229]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   JCAHO ACCREDITATION PROCESS A SHAM; MILLIONS OF LIVES AT RISK AT 
                        ``ACCREDITED'' HOSPITALS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, February 25, 1998

  Mr. STARK. Mr. Speaker, a recent investigation of New York City 
hospitals has uncovered startling evidence of substandard care at 
hospitals with high accreditation scores from Joint Commission on 
Accreditation of Health Care Organizations (JCAHO). In a scathing 
report, the Public Advocate for the City of New York presents strong 
evidence that hospitals circumvent JCAHO's annual announced survey 
visits--simply by hiring extra staff to make operations look smoother 
than they really are.
  In too many cases, the report finds that JCAHO's high test scores 
mask a darker reality--that some accredited hospitals may be 
endangering the health of patients because they don't meet basic 
standards of care.
  The New York City report demonstrates widespread quality of care 
problems in 15 accredited City hospitals. For example, it finds: 
Inadequate supervision that can mean patients are left in pain; 
substantial delays in treatment of emergency room patients; outdated 
and broken equipment; overcrowded, understaffed clinics; unsanitary 
conditions throughout the hospital; incomplete and poorly documented 
patient charts.
  Clearly, when such conditions are present, JCAHO should respond with 
sanctions, not high praise. Yet only last year, JCAHO flunked fewer 
than 1% of hospitals. The organization says that it fails so few 
because it prefers to work with hospitals to ``correct'' any violations 
that are detected. But if its accreditation standards are low to begin 
with, then can consumers and plans really rely on JCAHO reports? This 
is a critical question for Medicare beneficiaries, since JCAHO-
accredited hospitals are ``deemed'' to have met Medicare's ``Conditions 
of Participation,'' a key proxy for quality of care.
  The weaknesses of JCAHO's current system are made plain in the New 
York report. Simply put, there are no surprise inspections, and little 
apparent follow-up of pro-forma walk-throughs. ``Simply investigative 
steps, such as unannounced visits, confidential employee interviews, 
and document audits'' could make a vast difference in what JCAHO 
actually found.

  To make matters worse, under the Joint Commission's arbitrary scoring 
system, hospitals with serious quality of care problems are often 
awarded high accreditation scores. In effect, JCAHO surveyors are 
encouraged to rank hospitals highly on each standard, even if the 
hospital is unable to meet that standard! This practice makes a mockery 
of the review process.
  In fact, almost all (98 percent) of the institutions surveyed in the 
New York City study received scores of 80 or better on a 100 point 
scale, and none had a score below 70! Mr. Speaker, I am astounded that, 
of the 18,000 institutions surveyed each year, none are judged to fail 
outright. Nearly all of them met JCAHO standards.
  These inflated grades are confusing and misleading. Although each 
facility is rated on individual standards, the highest score of 1 on a 
scale of 1 to 5 only indicates 91% compliance; a score of 2 indicates 
only 76% compliance.
  The results of such a skewed system are that public health 
authorities are left to do the hard work of sanctioning and shutting 
down facilities that are appalling deficiencies.
  In 1994, New York City's Union Hospital was reviewed by JCAHO and 
given a score of 92. Three years later, in March 1997, the hospital's 
score rose to a near-perfect 97. But later that year, the New York 
Department of Health concluded that hospital staff had failed to 
properly treat high-risk emergency room patients, including two rape 
survivors, and was using outdated and expired drugs. Nurses pointed to 
understaffing and a lack of experienced staff in the pediatric, post-
partum, and

[[Page E229]]

maternity departments and the emergency room. By October, public health 
authorities moved to partially shut the hospital, which has since filed 
for bankruptcy.
  In Brooklyn, New York, Interfaith Medical Center received a JCAHO 
score of 89 in 1995 that was raised to 94 a year later. Strange, 
because a 1997 Wall Street Journal article on Interfaith painted a 
picture of a badly deteriorated facility, with heating and plumbing 
systems in bad disrepair and non-functioning elevators. Hospital staff, 
the story found, had to stave off invasions of rats, mice, and flies. 
Even the hospital's president, Corbett Price, was quoted as saying, 
``This hospital is being held together by rubber bands and Band-Aids.''
  JCAHO's problems are not confined to New York. In Las Vegas, poor 
care at Columbia/HCA's JCAHO-accredited Sunrise Hospital generated 
numerous newspaper articles and television pieces in October 1996, 
ultimately causing JCAHO to place the facility on probation a year 
later.
  Just recently, JCAHO placed Columbia's North Houston Medical Center 
on preliminary non-accreditation status--but only because an employee 
called a hotline number to report that problems had been overlooked--
including a high level of incomplete patient records. After returning 
to North Houston in December, JCAHO downgraded the hospital's status.
  In other cases, where serious problems have been brought to light by 
state inspection teams, JCAHO has proved reluctant to downgrade a 
hospital's accreditation status.
  Given this spotty record, I am outraged by media reports that the 
Joint Commission is considering softening its already loophole-ridden 
review process. According to a leading trade publication, Modern 
Healthcare, JCAHO may move to allow hospitals that self-report a 
``sentinel event'' within five days of its occurrence will be put on 
accreditation watch. The definition of ``a sentinel event'' is one that 
could lead to the death or serious injury of a patient.
  The misguided scoring and lax oversight documented in the New York 
report suggests that another system of oversight is needed. I am 
cosponsoring two bills that would overhaul the current voluntary review 
process. The Accreditation Accountability Act of 1997 (H.R. 800) would 
require all Medicare-accrediting organizations to hold public meetings. 
One-third of governing board members would be members of the public.
  Second, the Medicare and Medicaid Provider Review Act of 1997 (H.R. 
2543) would levy user fees on hospitals and other health care providers 
to underwrite the costs of independent federal compliance and audits. I 
am happy to report that President Clinton included the heart of this 
bill in the budget package he recently sent to Congress.
  For too long, we've given JCAHO and the Health care industry the 
benefit of the doubt. Self-policing simply isn't working. The New York 
City report is all the evidence we need to show that patients suffer--
sometimes fatally--from substandard care provided by JCAHO-accredited 
hospitals. Let's put patients' needs first, back where they belong.

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