Parkland Hospital Audits Raise Troubling Questions

The CMS report may be viewed here. 
The Texas report may be viewed here.

As HealthLeaders Media's Margaret Dick Tocknell pointed out last week, the sweeping deficiencies among nine broad categories at Parkland include:

• Failure to dispose of soiled gloves and gowns and wash hands after treating patients
• Failure to properly dispose of infectious waste, including used syringes, body fluids, used respiratory equipment and used suction equipment
• Lack of stabilizing treatment in emergency department before a transfer to another acute care facility
• Lack of ER screening by a qualified medical professional
• Failure to identify or assess emergency severity index
• Medical residents unsupervised during clinical care by either an attending physician or faculty member
• ER patients in a high level of pain provided with maps and directed to go to other parts of the hospital for treatment without benefit of any other assistance
• Failure to provide 24-hour nursing services
• Failure to change bed linens between emergency room patients
• Failure to dispose of expired medications

These deficiencies were not incidental mistakes that can not be explained away as regrettable, but understandable oversights at a major safety net hospital which is understaffed, underfunded, and stressed to carry out its mission.

Sadly, the audits paint a picture of a major health system in complete disarray. After reading these findings, it appears that a significant number of staff at Parkland simply have stopped caring. How else can we explain such fundamental flaws?

These aren't just violations of safety standards. These are violations of common sense and compassion. Nothing says "I don't care" like unwashed hands and soiled bed sheets. If Parkland Hospital had been a fast-food restaurant, inspectors would have closed it down and strapped the doors shut with yellow biohazard tape.

It is encouraging that Parkland's executives have accepted responsibility for the shortcomings, and have vowed to revamp hospital operations. It is also sad that it took allegedly at least one patient death, government audits, volumes of negative publicity, and the threat of the loss of about $417 million in Medicare and Medicaid funding before a correction plan was unveiled last week.

The Parkland audit raises larger questions about the quality of care at our nation's safety net hospitals. If it happened in Dallas, what's to say that it isn't happening elsewhere?   

The audit adds weight to uncomfortable assertions about the economic tiers in U.S. healthcare delivery, and the perceived lower standard of healthcare for society's most vulnerable – the poor, the uninsured, the indigent. Those stubborn assertions might not be fair, but they are understandable, and they can't be dismissed.

Audits such as these also undermine assertions that "frivolous" medical malpractice lawsuits are driving up healthcare costs. It's a hard sell for hospitals to claim they're the victims of opportunistic trial lawyers when hospital workers aren't doing something as basic as washing their hands. Before asking patients to surrender their right to legal redress, healthcare needs to clean up its act.

A detailed study of the workplace culture at Parkland Hospital should be conducted to determine what led to this breakdown in fundamental operations, chain-of-command, accountability, and employee engagement. It is important that we know why because what happened at Parkland could happen -- and has happened -- elsewhere.

There must be caring, compassionate and competent healthcare professionals at Parkland. So, where were they? How could staff allow such wholesale chaos to occur? Were attempts to bring these potentially lethal threats to patient health and safety to light ignored or discouraged by hospital leadership? Or were the systemic failures at Parkland so great that staff simply gave up trying?

What would drive a considerable number of educated, competent, compassionate and decent healthcare professionals at Parkland to ignore the safety and well-being of their patients? How did these healthcare professionals get to this painful point?