California Legislature oAngnensnany vo iuen SENATE COMMITTEE ON HEALTH PETER HANSEL ELAINE KONTOMINAS ALQUIST nocen BUNETAN Cain Secamne nore August 17, 2010 Kathleen Billingsley Licensing and Certification California Department of Public Health PO Box 97399, MS 0512 Sacramento, CA 95899-7377 Re: Septicemia Rates at Prime Healthcare Services Hospitals Dear Ms. Billingsley: | am writing to request that you investigate septicemia rates in hospitals operated by Victorville-based Prime Healthcare Services, Inc. (Prime). My office's review of data from 2008 provided by SEIU-UHW's healthcare analysis team indicates that there are abnormally high rates of septicemia reported among Medicare Patients treated at hospitals operated by Prime. As the author of the 2008 law that requires hospitals to reduce hospital acquired infections (HAls) (SB 1064) and the 2006 law that requires reporting of adverse events (defined as including patient death or disability due to a contaminated drug, device, or biologic provided by a health facility - SB 1301), | am troubled to leamn that five of the top six septicemia hospitals in the United States in 2008 were operated by Prime. Furthermore, the four California hospitals with the highest rates of septicemia among Medi-Cal patients in 2008 were all operated by Prime ‘As you know, septicemia is usually bacterial and can originate with localized infections such as pneumonia, urinary tract infections, surgical site infections, or venous catheters. Frequently, such infections occur in a healthcare setting Upon comparing the septicemia rate for Medicare patients at more than 2,900 hospitals throughout the country, the SEIU report found that Prime's rate was 15.7%. That figure is 70% higher than the second-highest hospital system in the nation (9.2%). The national median was 4.1%.The SEIU report offers two possible explanations for the high rates: 1) Up-Coding First, the extreme infection rates may reflect a pattern of up-coding by Prime. This theory is bolstered by the exceptionally low mortality rate among Prime's reported septicemia patients, indicating that diagnoses of septicemia may not have been warranted in many of the cases. If this explanation is true, Prime may have been overpaid around $18 million by Medicare in 2008 alone, according to the SEIU analysis. 2) Real Infections Due to a High Community Infection Rate or Poor Quality of Care at Prime Hospitals A second possible explanation is that the infections are real, resulting either from high infection rates in the communities around Prime hospitals or poor quality of care at the hospitals. In either case, at least some of the infections should be reportable adverse events under my SB 1301. This raises the question of whether Prime is failing to report adverse events as required by law. Whether caused by system wide up-coding or by a real infections crisis, SEIU's findings are deeply concerning. Prime is a fast-growing system and continues to pursue new hospitals, including one that was licensed within a week's time in November 2008 - Shasta Regional Medical Center. I request that you take all appropriate steps to ensure that whatever is happening at Prime or the communities in which it operates is not permitted to grow into an even larger problem. Most urgently, | request that your Department investigate Prime and support other state and federal investigations of Prime's practices. As you can see from the attached, both the Office of the California Attorney General and the Inspector General of the United States Department of Health and Human Services also have been informed of SEIU's findings. Until all these investigations are complete, | request that you withhold approval of any additional facility licenses for Prime or Prime-related entities. Sincerely, 7 Senator Elaine Alquist Chair, Senate Health Committee Enclosures EKAsr