Public access to health care inspection reports filled with delays, redactions

Always Investigating

Changes are in the works to better protect our kupuna in the wake of a backlog of inspections at health care facilities.

It’s an issue Always Investigating looked into and learned state inspectors are about a year behind on doing annual inspections of facilities.

More inspectors are being hired to get things back on track, and also to get the system into an electronic age instead of on paper.

When facilities finally do get their annual inspections, how transparent are the results to the public?

We dug into the long-term care reports to track the trends of the most common violations, and found extensive blackouts on most of them, but solutions from a lawsuit to high-tech efforts could result in a change.

In 2013, lawmakers passed a bill to make the state Department of Health post health care facility inspections online, even gave them plenty of ramp up time to get started.

“The law requires them to post the inspection reports within five days of completion, starting Jan. 1, 2015, and they did not do it,” said Larry Geller with Kokua Council, which advocates on behalf of critical senior issues such as long-term care.

The Kokua Council sued. That’s still a pending case, and meanwhile, just recently a substantial number have been posted.

“The people who really need to be able to see the reports are family members that are being pressured by hospitals to move their loved ones out of hospitals and into long-term care facilities,” said Kokua Council’s attorney, Lance Collins. “We’re talking about like 24, 48 hours type of short period of time.”

The department that licenses and inspects facilities is behind not just on the visits, but on getting all their findings up online as well.

“It’s quite a challenge. We are using current staff,” said Keith Ridley, chief of the Hawaii Department of Health’s Office of Health Care Assurance. “We have a good 88 percent approximately of the adult residential care homes, for example.”

If 12 percent of them are missing, when will the public see those remaining 12 percent?

“We do afford the operator the license, an ability to provide us — in fact we require them to provide us — with a plan of correction,” Ridley replied.

The department is waiting until they can merge both the findings and the response then it goes public.

What does get posted leaves a lot to imagination. An inspection of the state’s own facility, Maluhia, for example, includes 14 pages of deficiencies, another seven pages of rebuttals and fixes. But much of it is blacked out. We don’t know really what happened, only that they violated a section, and that’s about all that’s described.

When asked why, Ridley responded, “The information that we’ve decided to redact is, for the most part, personal health information.”

This pattern repeats itself time and again on hundreds and hundreds of the postings.

“The findings, the deeper you look the blacker it gets,” Geller said. “Why post something like this if there’s nothing for the public to learn? Twenty pages like this.”

“Is this health care entity working in good faith? Have they had terrible outcomes? That should be public,” said Sen. Josh Green, D, Majority Floor Leader and an emergency room physician himself.

Everything but the description of rule broken, but not how it was broken, is completely black front to back. More can be seen from the facility’s responses about how they’ll fix the problems, though the deadlines appear to vary and if there’s a consequence for not fixing it quick enough, it could be blacked out too.

We went through the state’s nearly 50 skilled nursing facilities reports to look for trends in the deficiencies.

Infection control was a major problem for most of the sites. Food handling and food-related sanitation was also in violation at a majority of facilities. Most also got dinged for not meeting standards on comprehensive care plans, and proper drug documentation and storage was a common error.

While many of these things are typical findings in the industry nationwide, Hawaii’s skilled nursing facilities are caught with violations far more often than the national average for those infection control and food-handling issues — double the rate of facilities have housekeeping and maintenance problems and safe operating equipment, and five times the rate of facilities were caught without sufficient 24-hour nurse staff per their care plans.

The state wants to be able to dig out this level of detail about deficiency patterns from all care facilities, but they don’t yet have a database system to track the trends. New inspection fees they’ll propose in draft rules coming out in a few weeks will cover the costs of such a system.

“We can begin identifying those sorts of things and go out to the industry and require the industry to address those issues and make changes on an industry-wide basis,” Ridley said.

Meanwhile the public waits for the state to get staff hired up to catch up with inspecting, reviewing, and posting all not just most of the required-by-law reports.

“There are enough that have violations that it’s not fair to make families play Russian roulette and hope the bed that is available at that moment, they have to just go to it and hope their family member will be cared for properly,” Collins said.

We’ll keep tabs on the state’s progress in filling positions it plans to hire in the coming months, as well as those rules to expand licensing and pay for the database they want to better track inspections and trends.

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