Hospital is put on probation


A national hospital accreditation agency has put Anne Arundel Medical Center on probation, faulting it for moving too slowly to correct problems after three newborns accidentally were drugged with morphine at the Annapolis hospital earlier this year.

The Joint Commission on Accreditation, which conducted a surprise inspection at the hospital March 3, gave the medical center this week a "conditional accreditation," a ranking shared by only 1 percent of 5,300 hospitals nationwide.

The hospital has 30 days to submit a plan to correct the problems cited in the commission's inspection report. The hospital then has four months to make changes or risk losing its accreditation, which would jeopardize its government reimbursements for Medicaid and Medicare.

Martin L. "Chip" Doordan, president of Anne Arundel Health System, the hospital's parent company, said he was "astonished" by the harsh decision.

The commission has issued similar sanctions against only three Maryland hospitals in the past five years, said Carol Benner, director of licensing and certification programs for the state Department of Health and Mental Hygiene.

The private, nonprofit accreditation commission, which certifies most U.S. hospitals, reviewed 26 medical centers April 12 and put four on probation. Others included the Dana-Farber Cancer Institute, where a Boston Globe health writer died of heart failure Dec. 3 after she was given four times the maximum safe dosage of a highly toxic chemotherapy drug.

The commission also revoked accreditation of University Community Hospital in Tampa, Fla., where a patient had the wrong leg amputated.

The commission said Anne Arundel Medical Center had "poor" in-service training programs and outdated oversight procedures. The hospital moved too slowly to improve its licensing verification system and internal training programs in the pharmacy, the commission said.

Mr. Doordan said every problem pointed out in the commission's report had been corrected within days of the incident in the critical-care nursery.

"It's like in a bad dream," he said. "The documentation, in our judgment, doesn't lead to the conclusions that were reached."

The hospital fired pharmacist Susan E. Kron after the Jan. 31 incident, in which Ms. Kron was accused of filling at least six syringes with morphine instead of heparin, a common blood thinner used to flush intravenous tubes.

Ms. Kron was charged with reckless endangerment and practicing without a license. The babies, who were placed on ventilators after suffering breathing problems, since have been sent home, hospital officials said.

Immediately after the drug incident, the hospital started an internal system to track pharmacy licenses, tightened storage guidelines for neonatal medications and solutions, locked narcotic solutions in separate refrigerators and began an orientation and continuing competency program for new pharmacists.

Mr. Doordan said the hospital would "repackage" the changes it already has documented and re-deliver the material to the commission.

State inspectors in February called the problem at the hospital an isolated incident and said all the problems had been corrected.

Ms. Benner, the state's licensing director, said she believed the commission's rating was unfairly punitive and that she has no plans to send inspectors back to the medical center.

"I have never in my life seen a report like this that has resulted in conditional accreditation," Ms. Benner said. "We don't think this report represents a poor hospital."

The hospital's defenders have turned their ire against the commission, which they said was punishing Anne Arundel Medical Center to advance its image as a tough safety enforcer. The commission suffered rare public criticism in December when the American Hospital Association complained of a "crisis in confidence" in the organization's inspection policies.

Yesterday, Nancy Fiedler, a spokeswoman for the Maryland Hospital Association, said her organization has "some concerns that the Joint Commission's activities are somewhat of an overreaction based on the politics of the situation."

Dr. John Helfrick, chairman of the Joint Commission's accreditation committee, denied the charge. "The commission takes these reviews very seriously," he said. "We felt there was an opportunity for them to improve the care of their patients."

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