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Obscure group inspects many hospitals despite questions about conflicts

Filed by KOSU News in Feature.
May 1, 2013

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Yesterday, I detailed the conditions inside Tulsa’s St. John’s hospital, where they completely lost power on June 30th of last year. Intensive care patients needed help breathing from nurses because they didn’t have enough battery powered machines, an ER arrival had to be resuscitated in an atrium because it was the only area with light, and one patient was held out of surgery. Today, as I wrap up my series 6 months after Superstorm Sandy hit the East Coast, a look at the most prominent group that inspects and accredits hospitals with the blessing of Medicare and Medicaid…the Joint Commission.

St. John’s in Tulsa is Joint Commission accredited. So is Mercy in Oklahoma City. And hospitals in the Integris system also allow the inspectors in their facility. In fact, nearly 60 hospitals in Oklahoma get a visit from the nonprofit at least every three years. George Mills is Director of Engineering for the Joint Commission.

“We spend several days on site reviewing different docs. We do have life safety code surveyors and who look at emergency systems and electrical systems. On site for at least two days.”

A Joint Commission inspection can run a hospital anywhere from about $1,500 to nearly $40,000. They show up unannounced, and their standards are constantly evolving.

“One of the things we’ve learned is the requirement, they must run their generators for four hours. Lessons learned generate new standards and requirements.”

That came after previous incidents where generators failed because they were only getting tested for 15 minutes at a time. And with the latest incidents in New York, the Commission is also putting together a conference to evaluate what needs to change in the future.

The Joint Commission was founded in 1951, but really became a player in health care in 1965, when Congress made it the de facto inspector for the Centers for Medicare and Medicaid. Since then, it has become almost a necessary stop for top level hospitals. Besides the feds, many states recognize Joint Commission accreditation because it’s often more strict than the state’s own standards.

“Oh yeah, when they come in, the first thing they’ll ask you is show me your generator logs. We want to make sure they can handle a load.”

Around the medical community, there’s a sense that the Joint Commission is thorough and unbiased. That was Larry Dander, Power Plant Supervisor at Mercy Hospital in Oklahoma City. Up in Tulsa, you hear the same from Lisa Medina, Vice President of Quality at St. John’s:

“I would say yes. JC has really evolved over the past couple years and they’re out on the floors, asking questions, facilities guys usually here for two full days going through every every.”

So hospitals find the inspections valuable.


But questions remain unanswered about the organization of the Joint Commission. The same parent company also owns Joint Commission Resources, a consulting firm that helps medical facilities through the inspection process. Gail Wineberger, director of accreditation at the Joint Commission, insists the two are as independent as they can be,

“Although we do have a subsidiary  it is totally separate, we do not know who they work with. Nor do they have any accreditation information other than what’s on our website.”

The United States Government Accountability Office found the arrangement acceptable in a 2006 report, but also urged continued scrutiny. Yet the president of the Joint Commission – Mark Chassin – sits on the Board of Directors for Joint Commission Resources.

“I honestly will not comment on that because I don’t like to comment on what other people may view. From my perspective, and the Joint Commission’s perspective, there is no conflict.”

Craig Jones, the director of the Oklahoma Hospital Association, is another member of the Board at Joint Commission Resources.

Getting inspected by the JC isn’t a requirement. And in Oklahoma, state inspectors also check around for issues at hospitals, as some standards differ between the state and the non-profit. Wineberger says that proves just how respected JC is in the medical community.

“So the fact that an organization asks us to come in and evaluate them, I would assume that they wanted us to come in.”

She says they’ll work with organizations to correct any problems, and in most cases, rely on voluntary reporting. But that can sometimes leave out critical failures. There’s no requirement to report the power outage at Saint John’s in Tulsa because no patients died or were injured as a result. In that case, it was only after Saint John’s stepped up and asked for help.


One Response to “Obscure group inspects many hospitals despite questions about conflicts”

  1. PX Eliezer says:

    I wouldn't call the Joint Commission (previously known as JCAHO) obscure. Every single person in healthcare knows about it, and many knowledgeable people outside of healthcare.

    Of the 3 groups that the US Government recognizes for hospital inspections (the other two are HFAP and DNV Healthcare) the Joint Commission is the largest and most prestigious.

    This is NOT to defend it. But calling it "obscure" is not accurate. The word "opaque" is probably closer to the truth.

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