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The state attorney general’s office filed legal documents this week arguing that hospitals are required to file monthly reports on infections related to 29 types of surgeries, defending a legal challenge from the California Hospital Association.
The legal filing was the latest in a skirmish between the hospital association and state health authorities over the enactment of a 2008 state law that requires hospitals to file detailed reports on infections that arise after surgeries. Hospital-acquired infections kill an estimated 12,000 Californians each year.
The California Hospital Association filed the first legal papers in May, asking a San Francisco Superior Court judge to stop the state Department of Public Health from enforcing an “all facilities letter” asking hospitals to file monthly reports on 29 types of surgeries.
The letter at issue [PDF] replaced a prior letter [PDF] that called for reporting on two surgeries: hip replacement and open-heart surgery. A state advisory committee with heavy representation from hospitals had approved the two-surgery reporting scheme but did not ratify the plan to report on the longer list of procedures.
The hospital association said it supports public reporting of reliable data on hospital infections, but it is seeking to stop the state from issuing an “underground regulation” that requires more work than what's laid out in the law.
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Rather, the association said it would like to see the Department of Public Health go through the formal rule-making process to determine which surgical infections should be reported and how.
“That’s the crux of the lawsuit; the state didn’t follow their own requirements,” said Jan Emerson-Shea, a spokeswoman for the hospital association.
The state attorney general’s office, which represents the Department of Public Health, however, argues that it did not need to go through the rule-making process to ask hospitals to file the reports.
In a legal memorandum filed Monday, attorneys say the reporting request was based on the 2008 law and was the only “legally tenable interpretation.”
The state also argues that it represents “the broader public interest,” noting there are about 200,000 hospital-acquired infections each year in California, at a cost of about $600 million.
The Center for Health Reporting has written about bumps in the road to implementing several laws that require public reporting on a variety of infection problems in hospitals. While some sections of the laws apply to certain strains of bacteria, such as MRSA and C. difficile, one applies specifically to surgery.
Reporter Deborah Schoch found that the state is considering throwing away the surgery data collected so far without making it public. The hospitals wound up reporting inconsistent sets of information that do not lend themselves to a fair comparison.
For its part, the hospital association has argued that the latest reporting request [PDF] is so complicated that it would “divert time and resources away from other important patient care responsibilities.” The association estimates that the state’s hospitals would need to hire 500 people to complete the reports.
Debbie Rogers, vice president for quality at the hospital association, said the reporting request covers 900,000 different surgeries within the 29 categories and changes the reporting requirement from the quarterly reports described in the 2008 law to monthly filings.
“By doing that broad of surveillance, you’re not showing which ones are highest risk, and we want to focus on the ones that are highest risk for patients,” Rogers said.
Lisa McGiffert, director of Consumers Union's Safe Patient Project, said the legal tussle only delays the reporting of meaningful information that will help people make decisions about their health care.
Under the law, public reports on surgical infections were to be reported on the Department of Public Health website starting Jan. 1, 2012, a milestone that’s appearing unreachable.
“It’s an evolving process, and, unfortunately in California, we’re at the very beginning,” McGiffert said. “Consumers Union has been working in California on this since 2004, when the first law passed and was vetoed. It’s been a long, long haul. We thought we were on our way in getting this out of the way to the public arena, but we have another hurdle.”
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