California is noteworthy because it has a separate state government infrastructure in which state teams investigating complaints of serious harm in hospitals can impose immediate jeopardy citations under state laws that carry hefty fines up to $100,000. The concern is that in California, the same teams generally conduct similar investigations under federal rules – under contract with CMS – under a state infrastructure that already exists.
Perhaps in that situation, more complaints are investigated and referred to CMS for action because the state teams have already done most of the work.
For example, according to the California Department of Public Health's website, in the 18-month period from July 1, 2009 to Dec. 31, 2010, some 62 hospitals – roughly one in six acute care facilities in the state – received state immediate jeopardy citations.
But California state officials could not tell me how many hospitals that received state immediate jeopardy citations also received federal IJ citations.
"You are requesting data that does not exist within our system or a tabulation that does not exist. The Public Records Act does not require us to make that tabulation for you," Ralph Montano, public information officer for the California Department of Public Health, said in an e-mail.
Jack Cheevers, spokesman for CMS in San Francisco's federal Region IX, which includes California, also said in an e-mail, CMS "appreciates the hospitals concerns and will carefully consider them."
He says, however, "Our survey and certification database for hospitals doesn't track immediate jeopardy citations, so we can't provide any data on IJ citations of hospitals.
"Absent this data, we can't determine whether or not state-by-state differences exist in rates of citing immediate jeopardy."