Health & Science

Baylor St. Luke’s Medical Center Vows To Correct Deficiencies Found By Federal Review

Lack of cleanliness, administrative irregularities and insufficient nurse training are some of the problems reported by the Centers for Medicare & Medicaid Services.

Baylor St. Luke's Medical Center.
Baylor St. Luke’s Medical Center.

Baylor St. Luke's Medical Center submitted a plan this week to correct multiple deficiencies found by the Centers for Medicare & Medicaid Services (CMS).

Baylor St. Luke's lost federal funding for its heart transplant program in 2018 following a Houston Chronicle and ProPublica investigation into surgical complications at the hospital. Subsequent investigations by the news organizations revealed problems within the hospital's lung and liver transplant programs.

The hospital's problems led to new leadership and T. Douglas Lawson was named president at the beginning of the year.

In January, an inspection found Baylor St. Luke's out of compliance on three CMS requirements: patient rights, quality assurance and performance improvement, and nursing services. Findings from that inspection triggered CMS to order an unannounced full-scale review. It found "remaining housekeeping, maintenance, and patient safety issues" according to an open letter signed by Lawson.

Among other deficiencies, CMS experts found that the kitchen’s sewage was backing up into the patient food production areas and that staff didn't properly disinfect transvaginal ultrasound transducers between patients. There were also administrative irregularities, such as not following the hospital's own policy on informed consent.

Lawson said they have already started working on the corrections through the hospital's "internal quality program." Some of the corrections are reinforcing nurse training on hemodialysis procedures, increased inspections to identify areas in need of repair, new kitchen equipment and additional training on sterilization of medical equipment.

Lawson's letter said the hospital expects CMS will conduct another review.

You can read Baylor St. Luke's Action Plan Summary by clicking here.

You can read CMS' review by clicking here.

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