The Joint Commission Can Kiss My Ass

I hate the Joint Commission.  I always have hated the Joint Commission.  I worked for three different hospital systems in my life and this organization always caused an uproar whenever their supposed appearances were threatened.  It was one of the few times administrators were seen throughout the hospital (where these administrators came from and why there were so many is another story).   It was as if they were the supreme leader of the Dark Force was about to arrive, at any moment you could be choked out if you said anything wrong.  The Joint Commission confuses people into thinking they are some government organization but they are a third-party, independent organization that has the green light by our government to do their bidding.  What they say goes.  No one questions them.  I remember having to remove Christmas cards, from patients, taped to my office door because it was a Joint Commission violation.  They felt it was a fire hazard as if they could spontaneously combust. No one ever checks them to see if what they are measuring was ever useful.  It is their rules and everyone obeys them. Why am I bringing this up?  Well, because the Wall Street Journal did a nice investigation on them and found them to be a scam.

Hospital Watchdog Gives Seal of Approval, Even After Problems Emerge

The Joint Commission, which the government relies on to accredit most hospitals, rarely withdraws its approval in the face of serious safety violations

Some keep points from the article:

  • The Joint Commission is the accrediting organization for almost 80% of U.S. hospitals, including those for veterans, the Federal Bureau of Prisons and the Indian Health Service, giving it a sweeping quasi-governmental role overseeing medical care.
  • This certifier of hospital quality, however, typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations, according to a Wall Street Journal database analysis of hundreds of inspection reports from 2014 through 2016.
  • In 2014, about 350 hospitals found in those reports to be in violation of Medicare requirements had Joint Commission accreditation at the time, the Journal found. More than a third with accreditation went on to have additional violations later in 2014, 2015 and 2016.
  • A result is that hundreds of hospitals with safety problems could continue to display a “Gold Seal of Approval” and promote their accredited status. The Joint Commission provides hospitals with an accreditation publicity kit, and a consulting arm of the organization sells “We Are Accredited!” pins and stickers. A brochure it prepared for patients reads, “Whenever and wherever you receive health care, look for The Joint Commission Gold Seal of Approval.”

Once again, this proves the term “quality” is so ambiguous that it should NEVER be used, especially in any payment model, but I digress.

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So why do hospitals use the Joint Commission in the first place?

Hospitals can use state inspections to prove their compliance but have the option of hiring a private, federally approved accrediting organization such as the Joint Commission.

Did you know they had other options?  I didn’t.  I’ll bet you dollars to donuts (you know, the ones lying around the hospital administrator meetings) that the damn Gold Seal of Approval is the only reason the Joint Commission is used.  Administrators want a prize in their Cracker Jack box!  They want a gold star to show off like they are 5-year kids. It’s pathetic.

But, wait, there’s more!

Twenty of the Joint Commission’s 32 board members are executives at health systems it accredits or else work at parent organizations of such health systems. Some other board members are named by health-care lobbying groups, such as the American Hospital Association and the American Medical Association.

It’s like the fox watching the hen house!  The inherent conflict of interest is more than disturbing. I also find it hysterical that the Joint Commission is non-profit, once again proving this term is a joke.  They also paid their CEO over $1 million a year as they pulled in $142 million a year.  It’s a racket!

So, what didn’t this article mention?  I believe that the Joint Commission had a hand in the opioid epidemic.  This from an older WSJ article:

In 2001, the Joint Commission, which accredits U.S. hospitals, issued new standards telling hospitals to regularly ask patients about pain and to make treating it a priority. The now-familiar pain scale was introduced in many hospitals, with patients being asked to rate their pain from one to 10 and circle a smiling or frowning face.

The Joint Commission published a guide sponsored by Purdue Pharma. “Some clinicians have inaccurate and exaggerated concerns” about addiction, tolerance and risk of death, the guide said. “This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.”

Why is no one prosecuting or suing the Joint Commission?  They published a guide sponsored by the makers of Oxycontin!!!  Doctors were threatened to be punished if pain meds weren’t pushed.  Hospitals needed that Gold Seal of Approval so doctors couldn’t reject patients demands for narcs.  In fact, the pain scale card was pushed into every hospital room and that card was produced by Purdue Pharma with their name at the bottom. This from a New Yorker article:

Yet Purdue, according to a report issued by the U. S. Government Accountability Office, helped fund a “pain-management educational program” organized by the Joint Commission; a related agreement allowed Purdue to disseminate educational materials on pain management, and this, in the words of the report, “may have facilitated its access to hospitals to promote OxyContin.”

Can you see the trail of guilt by the Joint Commission?  Yes, they somehow have been absolved of all this. Why?

For these reasons I want the Joint Commission to kiss my ass.  I am sure I am not alone.  Please comment with your experiences with the Joint Commission below.  I want to show the world how idiotic they are.  And please share this post!

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Douglas Farrago MD is the author of four books, one of his most recent is Diary of a Drug Rep.

 

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  16 comments for “The Joint Commission Can Kiss My Ass

  1. Mamadoc
    September 16, 2017 at 9:24 pm

    JCAHO absolutely had a major hand in the opioids epidemic. I watched it happen when they started all that twaddle about pain as the 5th vital sign and put up those stupid face charts. After 30 Years our group no longer goes to the hospital, but my strategy for JACHO invasion was to be elsewhere. They don’t make anything better and I’m happy they’re being outed as the scam I always suspected they were.

    2+
  2. Michael Moore
    September 14, 2017 at 12:32 am

    I’ll through my “JCAHO last-straw” event out there . . . I’m a pharmacist in home infusion and we had jumped through the JCAHO hoops many times. This time my boss is pretty nutty about getting “100% with Commendation” or some other participation-trophy like piece of paper to hang on the wall.

    The auditor inspects our training and documentation and facilities and so on and so on. Then the auditor cracks open one of my charts (a pediatric patient) and starts “TSK TSK’ing” me. “Where are you documenting your pediatric patients’ immunization schedule compliance?” Befuddled I asked, “Huh?” She clarified, “How do you know if the patient you are providing 7 days of IV antibiotics has had their scheduled MMR immunizations?”

    You see, after these jokers run through your facility a few times and after the word spreads about what they are “looking for” everyone wises up and fixes those things. They begin to realize this as everyone is passing and they have nothing to do. So they just make up more shit to insist is absolutely essential to every patient’s safe existence (like Christmas cards on the door).

    I hate JCAHO. Like unions, they have served their purpose and need to go.

    6+
  3. John
    September 13, 2017 at 10:16 pm

    Sounds like the ABIM!

    1+
  4. David Grant
    September 13, 2017 at 9:08 pm

    Just today I got an email from the Journal of Palliative Medicine, alerting me to Joint Commission’s new attention to pain management and/or the problem of addiction to pain medicines. I no longer treat hospital patients so I didn’t even try to read through their gobbledygook, but here’s a link for anyone with a stronger stomach and a higher BS tolerance:
    https://www.jointcommission.org/assets/1/18/Joint_Commission_Enhances_Pain_Assessment_and_Management_Requirements_for_Accredited_Hospitals1.PDF
    Long, long ago, the hospital where I worked suffered a Joint Commission ding about PRN pain medicine orders that basically left the dose to the nurse at the bedside. As I was told by a very intelligent RN, any nurse who can safely dose opioids at all can safely titrate the dose. I waited until the hospital got a warning, and then got a Gold Seal on the Joint Commission re-inspection months later; then I challenged the rules the inspectors had pulled out of wherever (their favorite bodily orifices?). It took months, but I got a US Senator to punt to state authorities, and then a state senator to ask for chapter and verse on the alleged “rule”. There was nothing.
    Of course, the “RN”s who work for Joint Commission are the ones who looked good on paper but were a disaster doing real patient care. That’s why they got kicked upstairs until they ended up working for Joint Commission.

    3+
    • Steve O'
      September 14, 2017 at 8:10 am

      Aided and abetted, of course, by our Quislings in the Ivory Tower. Our British friends discovered that medical errors are the #3 cause of death in the United States! (Note that they do not criticize the NHS at home in the UK. It’s probably perfect.) Medical errors are, of course, “any action “that does not achieve its intended outcome” or any planned action that, for whatever reason, is not done “that may or may not cause harm to the patient.””

      See BMJ 5/4/16. The Ivory Tower notes that the number of deaths annually caused by medical error may be as high as 251,000—more than respiratory disease, accidents, stroke, breast cancer, and Alzheimer’s. They comprise, in fact, an estimated 9.5 percent of deaths overall. By comparison, 10,265 people died in alcohol-impaired driving crashes.

      This article has done more to swell the population of the fix-it police than since the IOM publication To Err Is Human: Building a Safer Health System. Committee on Quality of Health Care in America, Institute of Medicine.

      The supervisory set operate on the erroneous assumption that you are stupid, and they are not. They can notice Christmas Card fire hazards at a glance. You, the dummy, walk right by them – every day!

      The problem of the increasing bureaucratization of everything is that the return on investment stopped being positive a long time ago. Now, every dollar spent on “oversight” not only is not spent on the delivery of care, but IMHO, worsens care. The faster it worsens care, the more shrill the advocates become to increase oversight.

      Obviously, according to the BMJ, the biggest mistake in medical care is the ATTEMPT TO TREAT. Without such an attempt, there is no possibility of error, or doing something that may – or may not – cause harm to the patient. By my reading of the phrase, that includes everything someone ATTEMPTS to do to the patient.

      Long ago in the Paleolithic times, members of our species left evidence of the attempt to mitigate and treat injuries and illnesses. It appears to be time to refute that approach, and substitute “LOOK AWAY – WALK AWAY.” Let nature take its course. The rest of the animals do. Why try to do better?

      2+
  5. politovski
    September 13, 2017 at 4:45 pm

    dr. doug doubleplus ungood duckspeak. big brother and JCH doubleplus good!!!

    2+
  6. Hal Dall MD
    September 13, 2017 at 1:14 pm

    My first experience with JOCKO was in residency and I learned all I needed to know about them.
    One item involved a basement paint locker with an elaborate ventilation system to bring in outside air, then vent it back outside (where the winter temps were often below zero). This was declared a fire hazard to be urgently remedied. The paint locker had been unventilated until the previous Jocko inspection deemed it a health hazard for workers who could be overcome by the fumes, so the hospital spent a fair piece of change to add the ventilation system to comply with the commissars.

    3+
  7. September 13, 2017 at 11:38 am

    They told me they had to find something wrong or else how would they justify their job. That’s an obvious point to us, but I was shocked they admitted it out loud. They are worse than the government because they pretend they are “peers”.

    2+
  8. Allen Lapin
    September 13, 2017 at 11:15 am

    The greed of big pharma is matched by banks and insurance companies. Brilliant essay, Doug-thank you. Put CEO’s in jail and maybe they would pay more attention to customers and less to shareholders.

    1+
  9. Eric Marsh
    September 13, 2017 at 11:05 am

    At my first JCAHO preparation meeting in 1998 the nurse/administrator introduced the “5th Vital Sign” concept. I completely rejected it immediately. I spoke up at the table with, “pain is simply not a vital sign.” My Department Chair glared at me and the Administrator gave the bogus “new standard of care” excuse. I held my tongue for the rest of the meeting — and from then on all my patients had zero pain as I refused to ever chart a numerical value for pain.

    2+
  10. Pat
    September 13, 2017 at 9:06 am

    The parallels between the Joint Extortionists and the ABMS mob bosses are notable. Both award periodic seals of approval that prove absolutely nothing, and are required to stay in business. it would be far better for the Joints to just present a bill to a given hospital every two years, pocket the loot, certify, and get the hell out of the building. More examples of how medicine is one of the most dishonest industries around.

    1+
  11. Thomas Guastavino
    September 13, 2017 at 8:59 am

    Guastavino’s 15th rule of medicine: “Never trust anyone whose job it is to find fault with you”
    In our Surgicenter the prospect of a JCAHO inspection initially brought fear and trepidation. What we did is to purposely create an obvious minor, non patient threatening violation. Then when JCAHO found it they stopped looking. We apologized and promised to fix it. Everyone walked away happy and we got a good laugh.

    5+
  12. John Parkin M.D.
    September 13, 2017 at 8:27 am

    How about all the time and money wasted on preparing for inspections ? My favorite is the “mock inspection” to practice for the real thing. This is usually done by previous inspectors who can make a nice chunk of change to waste more of our time.

    Another huge problem is that they can establish rules without any proof of effectiveness which can have negative impact like the pain scales. A pet peeve is the DVT prophylaxis protocol ordered by the Joint Commission on all admissions. In the past year I have personally seen 2 deaths from intracranial bleeding driven by the DVT prophylaxis protocol mandated for all hospital admissions. Is Lovenox behind this mandate ? Why isn’t the Joint Commission required to medically justify their various requirements and held accountable for complications ?

    2+
    • Randy
      September 14, 2017 at 10:46 am

      I had the same experience with a patient dying from a bleed due to DVT prophylaxis. When I talked to the nurse in charge of JCAHO compliance she was surprised to hear that there is a risk to using Lovenox.

      1+
  13. Steve O'
    September 13, 2017 at 8:14 am

    Perhaps more harm is done to the public health by the modern superstitions surrounding “quality” than all the dread diseases combined. To determine the quality of a thing, one needs reason, scrutiny, experience, subjectivity and opinion. The Jihad of Technocracy seeks to crush these things out of existence ,subject to the universal law of Technocracy that all human enterprises can be done better by IT, computers, automation, rules – the list of what they worship is extensive.
    Happiness turns out to be an activity of the rational soul, conducted in accordance with virtue or excellence, or, in what comes to the same thing, in rational activity executed excellently. Stanford Encyc. Philosophy on Aristotle and excellence.
    This classical approach has been aggressively cast into doubt by Technocracy. Over the last few decades, there has been a fear of inability of humans to be self-directed to determine or follow what is called “quality,” but should correctly be called “excellence.”
    The love of the practice of medicine is correctly called professional happiness – rational activity executed excellently. It is no coincidence that the concept of the love of practice of medicine is becoming as empty a concept as love of a job of telemarketing.
    As per Technocracy, only machines – bundles of rules such as the JCAHO represents – can determine quality while the humans only take objective measurements. The paradox of objective quality is that those things which yield up the most certain objective measures have nothing to do with quality. Those measurements which require the least familiarity with the field, those which can be performed and entered by everyone, are taken as relevant.
    Once a cluster of meaningless tests is assembled, which is called a “quality survey tool” or some such dreck, a set of pompous and self-important low-level bureaucrats are certified in their ability to render absolute, unchallengeable decisions as to whether something or another fulfills the “quality measure.”
    For example I was once asked by a JCAHO auditor to close my eyes and point to the nearest fire extinguisher. I was not in a patient care area at the time. The rationale was that if the room was so filled with smoke, I might not see my way about the premises well. I pointed off somewhere. But I was not allowed to give the correct answer which was GTFO – leave. I “failed” the test as the auditor decided that I was not pointing in a vector close enough to a fire extinguisher to find without using vision.
    When a society turns authoritarian, it is never at a loss for finding enough petty and cruel people to fill the ranks of overseers.
    Today, only the label of the machine is trusted – AMA approved, AAFP Certified, what have you. The superstition is that machines don’t err, only humans. Only pilot error causes crashes, they say. The problem therefore dies with the incident.
    Beware of “quality.” It is the incorrect excuse for many wicked and wrong things.

    1+
  14. Sir Allya Gotta Do Is...
    September 13, 2017 at 7:36 am

    Must be a great way to make money. They must have a secret, behind closed doors meetings with other agencies that make money in similar fashion. Ransom agencies. Like ABMS and MOC.

    1+

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