Uninspected, understaffed: State says lack of manpower prevents timely safety checks

KAILUA-KONA — While ambulatory surgical centers across the state continue to operate without requisite inspections, the state’s Office of Health Care Assurance and management at a local surgery center say that’s no reason to believe the centers aren’t safe for patients.

Two residents though say that isn’t enough and that inspections are the only way for patients to be sure they’re safe.

The OHCA is responsible for all state licensing at Hawaii health care facilities. That also includes legally mandated inspections that affirm facilities are complying with the law and regulations.

Ambulatory surgical centers are supposed to be inspected for their state licensing every two years, said Janice Okubo, public information officer for the state Department of Health. But some facilities haven’t been inspected for years — a Kona surgical center was last inspected in 2012, for example.

But officials say that doesn’t mean the facilities are unsafe, and the office tasked with taking care of those inspections say they’re working to get the job done.

“We’re in the process of catching up,” said Keith Ridley, chief of the Office of Health Care Assurance. “But it is a catch up.”

Ridley said the office has a “lack of manpower” that is the reason behind the lag in inspections. The office has 10 inspectors responsible for about 183 facilities statewide.

Inspections at those facilities, he said, take time and people. Inspection of a skilled nursing facility, for example, would require sending a team of four for about four days. Inspection of an ambulatory surgery center might take a team of two a span of two days.

“That’s the kind of time and effort that goes into these inspections,” he said.

At the beginning of this year, the office added two new inspector positions, but those positions would still need to be filled and the hires trained before they can go out into the field.

That training involves both internal training as well as training with the Centers for Medicare and Medicaid Services. New hires also take time shadowing current inspectors to observe and learn processes.

All told, he said, it can take eight months or longer before new inspectors are out leading inspections or working on their own.

And even with those two new positions, Ridley added, the office could still use additional staff, saying they’d likely need an extra three to five inspectors to keep up with the workload.

In fact, he said, they submitted a request to do just that, but funding for additional positions didn’t make it into the governor’s budget.

“We will continue to try,” he said.

Another issue complicating matters is the priority other facilities have over ambulatory surgical centers.

The Centers for Medicare and Medicaid Services provides 80 percent of the the funding for Medicare inspections, said Okubo.

“CMS has directed the department to prioritize the inspections of skilled nursing facilities and conduct inspections of (ambulatory surgical centers) when resources and time permit,” she said.

In the meantime, Ridley’s office is extending facility licenses to allow them to stay up and running.

“We do extend licenses when necessary,” he said.

Ridley added that their job isn’t one they take lightly.

“We are well aware of the need to continue to inspect facilities,” said Ridley. “We take that responsibility very seriously.”

But extending the licenses without performing the mandated inspections goes against the whole point of the law, say Tom and Christine Russi.

“Whether or not they have the resources isn’t the issue here,” said Tom Russi. “The issue is ‘Are these facilities safe?’ And if you read the law, they say the only way they can be safe and the only way they’re supposed to renew their license is to inspect them.”

The couple is of the position that if the facilities can’t be inspected, they should be shut down because they can’t be guaranteed safe.

“They’re jeopardizing the safety of the public; it’s just that simple,” he added. “No one can say, ‘If we renew your license, you’re good.’ No, that’s not what the lawmakers said.”

Ridley said the office would be receptive to hearing any complaints about health or safety at any health care facility and, if they received one, they’d check it out.

“Off hand, I don’t recall we’ve received any of those,” he said.

The Russis acknowledged that their position in favor of shutting down uninspected clinics is “pretty tough,” but Tom Russi argued it’s impossible to actually know whether the facilities are safe as long as they go uninspected.

In particular, he identified the Kona Ambulatory Surgery Center, which was last inspected by the office in 2012.

But, he noted, as a member of the public, he wants every facility in the state held to the same standard.

“I’m a taxpayer and these are medical facilities,” he said. “We have every right as taxpayers to make sure these facilities are safe.”

They’ve also brought up the issue with the governor.

“The OHCA/DOH’s excuse, that they do not have the resources to inspect them and considers renewing a license is as good as an inspection, is ludicrous,” they wrote in a letter to Gov. David Ige.

But Deb Sundberg, director of the Kona Ambulatory Surgery Center, said there is nothing to suggest or indicate that the facility isn’t safe.

“We take it very seriously,” she said of their own infection control and standards. “We monitor it on every case we do.”

And so far, she said, there haven’t been any complaints alleging poor health or safety standards there.

“Zero, none,” she said, adding that in the 12 months of 2016, they had a zero-percent infection rate as part of their infection control.

In fact, she said, they eagerly look forward to a state inspection. The facility currently has an extended license valid through June 30.

“We hope that the state gets here just as fast as anybody else,” said Sundberg. “We are ready and prepared to have our state inspection completed.”