Prime Healthcare Hospital appeal September 26, 2011 Page
Basis for Appeal
Pursuant to Health and Safety Code Section 1280.5, the CDPH may accept, consider,and resolve written appeals by a licensee or health facility administrator of findingsmade upon the inspection of a health facility. All four hospitals appealed thesedeficiencies using the same arguments:1. CDPH is basing the deficiencies on an evaluation of clinical judgment of thetreating physicians, over which CDPH has no authority. Moreover, hospitalmedical staff are independent and autonomous from the Hospital Corporation.2. CDPH based the deficiencies on improper coding of diagnoses, over whichCDPH has no expertise or authority.3. CDPH did not accurately identify documentation of sepsis by treating physicians,so is erroneous in designating the records as inaccurate. The criteria that CDPHsurveyors used was not consistent with guidelines in the medical literature.4.
Finally, the hospital’s representative argued that this written appeal must be
considered and resolved by a physician that was not involved in the originalreviews or surveys.
This review was completed by Dr. Howard Backer, MD, MPH, FACEP. Dr. Backer isBoard certified in both Emergency Medicine and Preventive Medicine Public Health. Hepracticed medicine full-time for 25 years, primarily emergency medicine, but also familyand sports medicine in various settings, including urban, suburban, and rural hospitals.For the past 10 years, Dr. Backer has worked for the California Department of PublicHealth as Chief of the Immunization Branch and for the California Health and HumanServices Agency as Associate Secretary for Emergency Preparedness. Twice, he hasserved as Interim Director of the Department of Public Health and the California StateHealth Officer. Dr. Backer was recently appointed Director of the Emergency MedicalServices Authority.During this assessment, Dr. Backer reviewed the following documents:
Initial report and analysis of Septicemia at Prime Hospitals from SEIU-UHW
Letter of complaint from Senator Alquist dated August 17, 2010
Deficiencies issued via a Statement of Deficiencies and Plan of Correction, StateForm 2567 which is issued to providers for violations
Four Hospital’s State 2567s with Corrective Actions in response to deficiencies
Letters of Appeal from all four of the Prime Healthcare Service hospitals
Patient records noted in the deficiencies and response, supplied by hospitals toCDPH
Pertinent literature on the definition and clinical criteria for sepsis
Coding guidelines provided by Prime Healthcare and available on-line
Available records referenced in the deficiencies issued and the hospitals responsewere reviewed, not to make clinical judgments of the care, but to evaluate the