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February 26, 2001
St. Louis Post-Dispatch
STATE hospital inspectors saw a psychotic man wandering nude through a hallway. Suicidal patients had access to bleach and other materials that could have been used to end their lives. A psychiatric patient with a history of arson got his hands on a cigarette lighter. He used it to set fires in three patients' beds -- while the patients were in them.
You might expect hefty fines for such shocking breeches of federal and state regulations. You might expect heads to roll at SouthPointe Hospital, where it all happened in the psychiatric ward. You might expect the hospital's psychiatric unit to be shut down, at least for an hour or two. You might, but most hospital administrators wouldn't. They know better.
Faced with serious violations of federal Medicare and state licensing regulations, state inspectors have just two options: Close the hospital, or go along with its plan to correct the problems. The problem is that shutting down the hospital would displace hundreds of patients, including perhaps 100 with severe psychiatric illness who would have difficulty finding care elsewhere. So in cases like SouthPointe, where inspectors found serious problems that threatened vulnerable psychiatric patients, they almost always opt to accept the plan of correction.
SouthPointe is owned by Tenet Healthcare, the nation's second largest for-profit hospital chain, and one with a history that includes serious patient abuse at psychiatric hospitals owned by a predecessor company.
Officials at SouthPointe have promised to resolve the problems. But the same economic pressures that helped create dangerous conditions at SouthPointe are also evident elsewhere in the region. Every hospital is scrambling to fill vacancies on its nursing and support staff. Every hospital is forced to slash expenses -- including staffing costs. All too often, they do so by asking nurses to care for ever larger numbers of patients, often with the help of poorly paid "patient care assistants" with minimal skills, training or experience. That is a recipe for disaster.
Gov. Bob Holden and the Legislature should ensure the state Health Department has enough staff to make regular, unannounced inspections, and to follow up at hospitals where problems are found. Last year, the Legislature approved so-called intermediate sanctions -- a hefty fine, or restrictions on hospital admissions. Those sanctions would not displace current patients but would last until problems are resolved. But regulations spelling out the new sanctions are still incomplete. They should be finished and implemented without further delay. Congress should pass a similar law for Medicare. It will, too, if voters insist.