By WHITECOAT, MD

The clock is ticking for Parkland Memorial Hospital in Dallas.

Earlier this month, 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 …

WhiteCoat’s Call Room is a collaborative blog from Emergency Physicians Monthly, where this post originally appeared.