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JPS hit with two surprise inspections

JPS Health Network got hit with two surprise inspections this week — one by state investigators and a rare one by the Joint Commission, an agency that sets healthcare standards nationwide to ensure patient safety.

As a result of the Joint Commission inspection, JPS has already been told of a number of deficiencies that must be addressed by certain deadlines, interim Chief Executive Robert Earley said.

The recommendations won't be formal until a report is issued next week, but Earley said the inspectors "didn't indicate in anything today that there would be a suspension of accreditation."

The state inspection is ongoing, and if it uncovers violations, it could also force changes in the way the hospital and its clinics operate, said JPS Sr. Vice President Kristin Jenkins.

Both inspections were prompted by recent Star-Telegram articles that highlighted potential infection risks, ineptitude and chaos among a multitude of problems at the taxpayer-supported network.

"You can't have six days of stories and not have regulatory agencies want to come in and review what is going on," Earley said.

Administrators cleared their calendars as the first investigators arrived Monday, and physicians were interviewed as the inspections continued Wednesday.

The process alarmed some staff members. Dr. Rajesh Gandhi, JPS director of trauma services, said he hoped that the network won't be closed down as a result.

"That would be disastrous for the county," Gandhi said. "My whole thing is in quality improvement. I hope they give us areas to improve, so we can move on and improve our quality."

Earley said he was trying to assuage such concerns.

"I told our nurses and doctors that whatever their report is, that's what we will work on and fix. They are truly here to make this a better institution," Earley said.

The nonprofit Joint Commission, which accredits hospitals nationwide, is focusing on three broad standards for its unannounced visit, spokesman Ken Powers said. Those are:

■ Provision of care, treatment and services.

■ Improving organization performance, which deals with a hospital's self-monitoring, data collection and analysis.

■ Leadership, which includes how the hospital is governed.The agency was acting as a result of a complaint, Powers said, and decided to send a team to investigate rather than ask for written responses from JPS.

The team included a doctor and nurse who followed the progress of several patients through the system Tuesday and Wednesday, Jenkins said. The commission conducts routine reviews of hospitals for accreditation — the last full on-site review of John Peter Smith Hospital was in March 2006 — but an unannounced visit is unusual, she said.

JPS is also being inspected by the Texas Department of State Health Services, which will stay on-site the rest of the week, Jenkins said.

The specific concerns that brought state scrutiny of JPS are less clear. Department spokesman Doug McBride said he could only confirm that a survey has been under way since Monday.

Dr. Fernando Garcia, a trauma surgeon who has criticized JPS' system of co-payments as being unfair to the poor, said state surveyors spoke with him Wednesday about several issues.

State officials asked him about so-called travelers — temporary nurses and other fill-in medical workers — nurse shortages and overflowing trash cans, he said.

The situation has improved recently, he said. JPS fired its environmental services company, Crothall Healthcare Group, late last month after the newspaper's reports.

"Yeah, there was trash overflowing in the OR," Garcia said. "Is it the prior company's fault ... or is that maybe you need administrators who walk the halls every day and actually know what is going on in their hospital?"

But Garcia said that nurses deserve kudos for their work and that JPS' new patient tower may address some problems. He said he is also encouraged by Earley's openness with physicians.

The Joint Commission and the Texas Department of State Health Services are oversight bodies that are supposed to ensure that the healthcare system meets certain standards. Yet a 2006 survey of JPS physicians and a series of 2007 reports by a consulting firm, InSight Advantage of Houston, detailed numerous problems that would concern oversight agencies, experts told the Star-Telegram.

InSight found that medical records went missing, crucial lab results did not reach doctors for days and some patients with infectious diseases were not isolated. Nurses had to leave surgery to find instruments that doctors needed, and blood, bone and fat globules were found in operating rooms that nurses thought had been cleaned.

To make matters worse, the JPS board was left in the dark about the reports, for which administrators spent $801,673, including expenses.

JPS board members were notified about the inspections this week.

Board Chairman Steve Montgomery said he hopes that the district has already addressed problems.

"We are trying to usher in a new era of transparency, to trust transparency whatever the risk," he said.

Montgomery also said he hopes that the inspections will restore the public's faith in the healthcare system. "There are a lot of things we are doing right at JPS, despite some problems here and there," he said. "And we are constantly trying to improve."

Dr. Bernard Rubin, chairman of the JPS board's quality committee, said he plans to discuss the findings from this week's inspections at a later meeting.

"We will take this all very seriously and deal with it in a straightforward and public manner," he said.