Joint Commission Fail: On the Record

Joint Commission On the Record

Tape recorder. Photo by darkday/Flickr

Our call to the JC Sentinel Event Hotline confirms our previous reporting about the ruse that is the Joint Commission International. “The standards are not the same. The standards are different. It’s a totally different manual.”

What’s so wrong is that the JCI cleverly set up a different set of standards than what JC hospitals are beholden to in America—a fact confirmed through our call. Read the full transcript below!

Santa Fe, New Mexico, 18 June 2015
By Dr. James Goldberg, Author of The American Medical Money Machine: The Destruction of Healthcare in America and the Rise of Medical Tourism

What if Your Life Was on the Line?

We have previously reported on the background and related matters of the Joint Commission (JCAHO or JC) which accredits medical facilities here and abroad. If you haven’t been following, please read our articles, “The Joint Commission Continues to Poison the Medical Spider Web” and “The Joint Commission’s Unpoliced Tax-Exempt Status Has a Staggering Effect on the Economics of Medicine”.

The JC’s group of interrelated organizations quietly exert enormous power over the trillions of dollars spent on healthcare in the US and abroad. They operate as a group of affiliated tax-exempt charities with 501(c)(3) designations. The tax paying public essentially gives them a free ride and indirectly pays their share of taxes which would otherwise be their responsibility.

Hiding behind the veil of being a charitable group of organizations, the hundreds of millions of dollars they generate annually pass back and forth through their web of companies, compensating their senior level executives apparently far beyond acceptable guidelines of reasonableness. Across all the JC conglomerates, at least 65 percent ($179,363,299.00) of their total revenue was spent on salaries in 2013.

Learn from History

To recap, these are the JC’s four public charities:

  1. Formed in 1951: Joint Commission on Accreditation of Healthcare Organizations (EIN #: 36-2229255) dba: The Joint Commission
  2. Formed in 1986: Joint Commission Resources, Inc. (EIN #: 36-3521721) dba: Joint Commission Resources International
  3. Formed in 1989: JCAHO Surveyor & QHR Consultant Corporation (EIN #: 36-3673595)
  4. Formed in 2008: Joint Commission Center for Transforming Healthcare (EIN #: 26-3020947) dba: Center for Transforming Healthcare

Only the first organization listed above, the JC, received authority in 1965 from the government to accredit American hospitals (limited to the US and its territories). None of the other three JC outfits existed at that time. They were all subsequently created in a type of shell game, making it very difficult to distinguish which monies flowed where and why and how much their executives actually received for running these charitable entities.

Brilliant? At Your Expense!

Please take particular note of #2, Joint Commission Resources (JCR), an educator, publisher and consulting company. Here is where the Joint Commission International (JCI) sits on their tax filings, operating as a DBA of the JCR, though in public they call their International arm a “division” of the JCR.

All four entities share logo symbols which vary only slightly. They all seem to be the same and to the uneducated eye, they all seem to bear the imprimatur of the US government, making it appear that all these organizations are blessed by the US government and carry the authority of law. But all JCs are not equal!

To generate significant additional revenue, the JC dreamed up the JCI to tap into international accrediting funds. Running slyly under the banner of the Joint Commission Resources in order to get that coveted tax-exempt charity status, they set up shop to accredit medical institutions around the world in more than 90 countries. By last account, this is more than 750 institutions and counting fast.

What’s so wrong is that the JCI cleverly set up a different set of standards than what JC hospitals are beholden to in America—a fact confirmed through our call (read transcript below). What the JCI sells to foreign hospitals seems to be a valued accreditation. World citizens are led to believe these foreign hospitals operate under the same regulations and responsibilities as JC accredited hospitals do. But that’s a fraud and fiction with serious consequences regarding patient safety.

JCI accredited foreign health care institutions appear to operate under supervision of the American-based JC. In other words, it looks as though JCI hospitals are policed by the US-designated JC in concert with the Department of Health and Human Services to receive Medicare payments—just the same way that a hospital in New York or Chicago or anywhere in the US is required by law to operate and be accountable. This is clearly a wrong assumption. International hospitals don’t need JC accreditation to take Medicare! Medicare coverage outside the US is taken in extremely limited situations (and why the AARP and UnitedHealth Group push Medigap-coverage).

You see, the JCI sells accreditation look-a-like approvals to these foreign hospitals without any obligation whatsoever for these foreign institutions to comply with the “rules” established by the JC. They only buy the JCI accreditation yearly to attract American patients who have cash or international insurance coverage. They bear no responsibility to comply with any of the “JCI rules” which they have purchased.

Sentinel Events: Matters of Life and Death

One of the key happenings which US accredited hospitals are honor bound to report are called Sentinel Events. The JC—a public charity—is all over Sentinel Events, just try a search. They are supposed to inform health care workers and the public about these events through Alerts.

A Sentinel Event is an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof. Serious injury specifically includes loss of limb or function.

The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

Such events are called “sentinel” because they signal the need for immediate investigation and response.

The JC has a Sentinel Event Hotline set up for this very special and important purpose. Is this charitable? We don’t think so since organizations which have not paid the JC do not get to report anything. Plus, reporting isn’t even required by US hospitals according to Health and Human Services!

Here is an HHS Inspector General’s report on reporting adverse events in hospitals. The Patient Safety Act requires HHS to establish a national network of Patient Safety Organizations (PSO) to accept voluntary reports of adverse events from hospitals. “Staff from 15 of the 26 States acknowledged that hospitals do not always submit reports when adverse events occur. However, staff from nearly all of these States were reluctant to estimate the extent to which adverse events go unreported, typically expressing that they could not know how many events actually occur.” The JC is once again duplicating and commingling HHS services with no charitable benefit.

Get Your Story Straight!

In late May 2015, one of our researchers called the JC Sentinel Event Hotline to ask about reporting a Sentinel Event that happened at a hospital overseas. Following is an excerpt from that conversation and you can read the entire transcript here.

JC: Hotline, may I help you?
TAMMM: Yes, hi, I was wondering if you knew if this is the same line to report a Sentinel Event at a JCI hospital.
JC: Yes it is.
TAMMM: Okay, so one in the same, right, for either way?
JC: Yes
JC: Is this for a hospital overseas?
TAMMM: Yes, that is what I was asking. See, this won’t let me do it except for the United States. I was asking for a JCI Sentinel Event.
JC: Ahhhh, International.
TAMMM: Yes, yea, sorry.
JC: I’m sorry. That is a good question and I’m not sure how to answer that one. Ummm…
JC: Well, that process, I don’t handle that, I don’t know if they do, but the information you just read to me, that would be the best way to go. To my knowledge, Joint Commission International does not have a process for reporting a Sentinel Event.
TAMMM: I mean, that would be the most, you know, critical thing for American patients being treated abroad, right?
JC: Well, I don’t think that the Joint Commission International is set up the same way it would be here in the United States.
JC: The standards are not the same. The standards are different. It’s a totally different manual.
TAMMM: Okay. So the accreditation, really, when it’s a JCI accredited hospital, let’s say in, you know, Costa Rica or you know, anywhere else, that’s not really the same as a JC accredited hospital here.
JC: Correct.
TAMMM: Oh, it makes it seem like it is though.
JC: Well, it’s international, so….
JC: The licensures and all kind of things would be, it’s a different entity, it’s a whole different arm of our company. We have four arms of our company; it is one arm of the company, Enterprise-wide.
TAMMM: Besides how it’s structured, I mean, the Joint Commission International is a DBA, doing business as, of the Joint Commission Resources. But the Resources…
JC: No, no, no, no, no, no, no. I don’t believe so. Not to my understanding, it’s a separate entity.
JC: That… well, when you just mentioned the Joint Commission International, it had an area for you to report a Patient Safety Event. Correct?
TAMMM: Well, it’s not a Patient Safety Event. It says report a Quality and Safety issue. That’s something… it doesn’t say anything about a patient.
JC: Well, that’s what it’s really referring to.
JC: Right. Is this a billing issue?
TAMMM: No, no. It’s about a patient who died at a JCI hospital.
TAMMM: Okay, as the patient, because the hospital… I can’t find out whether or not the hospital is going to report it or not. That’s what I…
JC: And they’re not. They probably may or may not tell you, even an American hospital may or may not tell you.

Right. Even an American hospital may or may not tell the JC if there are any patient safety concerns at their location because they don’t have to! It’s not required, it’s only “strongly encouraged” by the JC.

The JCI has no Sentinel Event Hotline and no requirements to report patient safety events or issue Alerts which the world’s medical community closely monitors so that they may avoid repeating events which can and do endanger the lives of the world’s population. Charity? They take in millions, pay no taxes, pocket the money and stick the public with the argument that they are tax exempt!

Here is the JCI’s 2015 Policy on Sentinel Events (PDF). You’ll note reporting an event is only on the basis “if an organization wishes to,” meaning there is no obligation. And with no hotline or portal for patients, families or caregivers to report an international event, how is the JCI even going to know about one?

What’s worse, here in the US, only a handful of Sentinel Events out of thousands of hospitals have ever been reported and investigated by the JC since they initiated their Sentinel program in 1996.

As far as we can determine, no JCI accredited hospitals have ever reported ANY Sentinel Events.

One must ask, what is the function of a public charity organization?

The World Health Organization (United Nations) Blasts the JC and Its Partners

Interestingly, the JC and the WHO (World Health Organization) have a cooperative relationship.

These quotations from the 2005 report, “WHO Draft Guidelines for Adverse Event Reporting and Learning Systems” require little explanation! For example, the JC recently released a Sentinel Event alert concerning wrong site surgery when the rate of reports it received increased substantially over a two-year period. However, it acknowledged that only a small fraction of events are reported, so the data may not be representative. On top of that, reporting organizations must pay to even be considered as a participant in Sentinel Event Reporting!

The Joint Commission on Accreditation of Healthcare Organizations implemented a Sentinel Event Reporting System in 1996. The system is designed to facilitate identification and learning among healthcare organizations of sentinel events and their prevention strategies. The system is voluntary and confidential. Accreditation status is not penalized for any organization that reports an error and applies due process to its future prevention.

The most important function that a large reporting system can perform is to use the results of investigations and data analyses to formulate and disseminate recommendations for systems changes. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has performed this function using a relatively small number of thoroughly investigated incidents reported to its sentinel events monitoring programme.

Using their database and collaborating with experts, JCAHO periodically chooses a reported event type and develops a Sentinel Event Alert describing the events, causes, and strategies gathered from organizations for prevention. Publications began in 1998; to date 34 issues of Sentinel Event Alert have been published.

We are talking about the safety of every person on this planet. For medical professionals and patients, this can often be a matter of life or death. Keeping Sentinel Event information secret from the public is akin to the Church not providing Bibles to its congregation.

Up Close and Personal

As my regular readers are aware, my son, Joshua, died in 2006 under suspicious circumstances at one of the JCI accredited hospitals—Bumrungrad based in Bangkok, Thailand. Shortly after his death as I was still reeling from the shock and anger, the JCI promised me a Sentinel Event investigation. I was assured by Karen Timmons, then CEO of the JCI, that they would provide a full report. It never came.

About two weeks ago I asked again for the report with results of this supposed investigation by calling this number at the Joint Commission International:  (630) 268-7432. Ann Watt, Associate Director, Performance Measurement Clinical Support, promised to get back to me within 48 hours.

I am still waiting!