July 20,2004

Chairman Grassley releases a new report on oversight of hospital patient safety and unveils bi-partisan, bi-cameral legislation to empower the federal government to do more to help improve hospital patient safety

Statement of Sen. Chuck Grassley of Iowa
Chairman, Committee on Finance
News Conference with Rep. Pete Stark of California
Ranking Member, Committee on Ways and Means Subcommittee on Health
Report of the Government Accountability Office on Hospital Accreditation and Patient Safety
Tuesday, July 20, 2004

Congressman Stark and I are here to release a report that we requested from theGovernment Accountability Office (GAO-04-850, available at www.gao.gov) and to describe ourlegislative response (bill text follows this statement).

This GAO report examines the quality of work done by the Joint Commission onAccreditation of Healthcare Organizations. The Joint Commission accredits most hospitals thatparticipate in Medicare. The GAO concluded that to better protect the safety of hospital patients,the Centers for Medicare and Medicaid Services should have additional oversight authority overthe Joint Commission.

The Joint Commission has unique statutory authority to accredit hospitals. Congressexpects the Joint Commission to be a consumer watchdog on behalf of patients. However, basedon what the GAO found in this new report and what an Inspector General found in 1999, we needto make sure the Joint Commission isn't a lapdog.

Approval from the Joint Commission is supposed to be the gold standard, not a rubberstamp. The bill we're introducing today in the Senate and House of Representatives would givethe federal government the same oversight authority for the accreditation of hospitals that it hasfor all other health care providers. Our bill says Medicare can restrict or remove the JointCommission’s authority if a problem is detected.

Our bill is well-founded. The GAO reviewed 500 hospitals that received the JointCommission’s seal of approval over a three-year period. It found that serious problems weremissed in too many of those hospitals.

These serious deficiencies are problems that can't be dismissed as one-time incidents.

They're the kind of problems that may put multiple lives at risk. The GAO report details how avalidation survey of 157 accredited hospitals done by the federal government found between oneand six serious deficiencies in each of those hospitals. And a single serious deficiency can limita hospital's capability to ensure patient safety.

An example of a worst-case scenario resulting from a serious deficiency was found inRedding, California at a hospital owned by Tenet Healthcare Corporation. The JointCommission accredited Redding and its renowned cardiac care department in 1999 and againJuly 2002. Redding was a hugely profitable hospital for Tenet. It boasted about high scores fromthe Joint Commission. In October 2002, Redding was raided by federal agents. Among otherallegations of fraud, doctors at Redding were accused of performing medically unnecessary heartsurgeries. Many highly profitable, but unnecessary open-heart surgeries were performed atRedding dating back to 1999.

The Joint Commission never identified the systemic problems at Redding. A statesurveyor found that there was no physician review of heart surgery patients who hadcomplications or died there. The medical staff at Redding were not held accountable by theirpeers or by Tenet. We don’t know exactly how many patients suffered unnecessarily at Redding,but hundreds had medically unnecessary heart surgeries or procedures.

It's important to understand that the GAO’s analysis of the validation surveys done by theCenters for Medicare and Medicaid Services can't be generalized to all hospitals accredited bythe Joint Commission. The vast majority are undoubtedly good hospitals, and that's a tribute totheir hardworking administrative and medical staffs. The government needs a better way toassess how well the Joint Commission detects serious deficiencies. Even so, over the three-yearperiod studied, the Joint Commission denied accreditation to only three hospitals.

The Joint Commission recently overhauled its accreditation process in response to critics.The changes might find and correct more deficiencies. Nevertheless, the federal governmentneeds greater authority to hold the Joint Commission accountable and, if necessary, restrict orremove its hospital accreditation authority. The bills we're introducing today, and Sen. Baucus isco-sponsoring the Senate bill, would give the Centers for Medicare and Medicaid Services thatauthority and that responsibility.

Now I'll turn the podium over to Congressman Stark, who deserves a lot of credit forworking on this issue for a long time. He first brought up these hospital accreditation problemsat a hearing in 1990, and again in 2000 and 2002. He introduced legislation five years ago toincrease public representation on the governing boards of national accrediting entities and torequire those entities to have open meetings. And, the GAO review we're talking about today isthe third GAO report requested by Congressman Stark on the Joint Commission.

NOTE: Refer to the printer-friendly version of this release for the bill text of the "Medicare Hospital Accreditation Act of 2004."