Some of Hawaii’s medical providers haven’t had safety inspections for as long as four years as the state struggles to keep up with oversight responsibilities with a shortage of health inspectors.
Federal and state laws require facilities such as care homes, laboratories and surgical providers to be inspected periodically to ensure businesses are complying with government standards for patient safety. The Health Department has been trying to catch up on a significant backlog that resulted in federal health officials threatening to fine the state in 2014.
Since then, the Department of Health has placed care homes — skilled nursing and intermediate care facilities — as the highest priority and are up to date with the unannounced checkups. But inspections of other facilities, such as stand-alone surgery centers, have been delayed for up to four years. The last review of the Surgical Suites and the Endoscopy Center in Honolulu, as well as Aloha Surgical Center in Kahului on Maui, was in 2010, DOH records show.
Nineteen of Hawaii’s 23 so-called ambulatory surgery centers are overdue for their two-year licensing inspection. DOH said it has extended the licenses of those 19 centers, so they can continue to operate until an inspection can be conducted. Roughly 12 percent, or about 60 of the 485 licensed adult residential care homes, also are backlogged. DOH didn’t immediately know the delays in inspections of other types of providers.
“No amount of delay is desirable, as it places those being cared for at risk,” said Keith Ridley, chief of the DOH Office of Health Care Assurance, which conducts the inspections to ensure that facilities are complying with quality and safety standards such as hiring credentialed staff and properly sterilizing equipment and managing medication. “The whole point of that is to ensure public safety and welfare in health care facilities.”
Ridley said he is not aware of any “significant change in patient care” or an increase in public complaints against medical facilities that haven’t been inspected in years, but said that the state doesn’t have a system in place to collect that kind of information.
The department is hoping to begin collecting licensing fees for the first time next year and use that money to build an electronic reporting system to monitor consumer complaints, Ridley said.
“Licensing requirements require them to really provide care in as optimal a way as possible,” he said. “Without having data support based on the numbers of complaints, we don’t really see or aren’t aware that care has become substandard.”
The program oversees about 20 different types of businesses — including adult day care facilities, clinical laboratories, outpatient rehabilitation and dialysis centers — and conducts biannual, yearly or two-year state licensing inspections and Medicare certifications. It also investigates complaints and public concerns.
New health care facilities, which are low on the priority list, have waited up to a year for an inspection. In the meantime, they are unable to take patients, forcing some to delay their opening dates.
The situation was so urgent for dialysis centers earlier this year that the state brought in inspectors from Arizona to help clear the backlog. DOH spent $140,000 to bring in half a dozen inspectors from March to May to complete delayed Medicare certifications for 11 dialysis centers.
“Other states have resources that allow them to specialize their inspectors; Hawaii does not,” Ridley said. “Part of this is due to the difference in the number of facilities within the state and taking advantage of economies of scale. Hawaii’s Medicare facilities’ inspectors inspect all types of Medicare facilities and must prioritize surveys based on Medicare requirements and resource availability.”
Hawaii’s Health Department has 23 inspectors for nearly 1,800 health care facilities, or one inspector for 78 facilities. By comparison, Arizona’s Department of Health Services has 81 inspectors and roughly 7,000 providers, or one inspector for 86 facilities.
Ridley said Hawaii needs at least seven more staff to catch up with inspections.
The Legislature provided funding last session for two additional inspectors, but they still need to be hired and trained, a lengthy process that takes six to eight months before they can start conducting surveys. DOH expects the new inspectors to begin in late 2017 and plans to request three additional positions in the next legislative session. The starting salary for a nurse inspector is $96,000 and for a non-nurse inspector is $51,000.
“Inspections are very detailed and complex, sometimes involving two to four inspectors over several days (to observe day-to-day care and interview patients and families),” Ridley said, adding that licensing and certification requirements are constantly changing. “These survey inspections we do are very comprehensive and take a significant amount of effort. It’s not like taking your car in for a safety check. This is very intensive, detailed, comprehensive labor-intensive work.”
DOH also has been struggling to post the most recent inspection records online with its current workload and existing staff.
To find records for a Hawaii health care facility, go to health.hawaii.gov/ohca/inspection-reports.
A senior citizens advocacy organization is suing the Health Department for failing to post inspection reports online for care homes that serve seniors and the disabled. Kokua Council, which filed the lawsuit in First Circuit Court in July, is claiming that DOH might not actually be inspecting all the homes, violating federal and state laws. DOH and Kokua Council officials declined to comment on the pending lawsuit.
The department said it will seek funding for a full-time office assistant position at next year’s Legislature to ensure the records are posted in a timely manner.
“We never know when we’re going to need care and when we need (the care), it won’t be there,” said Larry Geller, a board member of the Kokua Council. “The licensing of these facilities is a requirement of state law. The failure to inspect is not just DOH’s responsibility, the Legislature has refused to fund them. It’s a question of patient protection.”
DUE FOR INSPECTION
Health care facilities that need to be inspected by the state Health Department:
>> Adult day health centers
>> Adult day care center
>> Case management agencies
>> Community care foster family homes
>> Clinical laboratories
>> Comprehensive outpatient rehabilitation facilities
>> Developmental disabilities domiciliary homes
>> Dialysis centers/end-stage renal disease
>> Home health agencies
>> Hospice
>> Intermediate care facilities for individuals with intellectual disabilities
>> Adult residential care homes
>> Expanded adult residential care homes
>> Assisted living facilities
>> Intermediate care facilities
>> Nursing facilities
>> Rural health clinics
>> Skilled nursing/intermediate care facilities
>> Special treatment facilities
Source: Hawaii Department of Health