Protecting the patients

A medical watchdog tells why assisted-living facilities scare her, and how the health system failed her family

Q&a : Carol Benner


Patient safety and health care quality are still largely overseen by doctors and hospitals.

Physicians are disciplined or exonerated, mostly in private, by panels made up of their peers. The government still cedes oversight of certain health care organizations to accrediting agencies that have ties to those they are charged with policing.

But the government in recent years has responded in some ways to the public's demand for more diligent oversight of nursing homes, hospitals and other health care organizations, and to demands for more information about their quality.

In Maryland, hospitals and nursing homes are required to submit quality information that allows consumers to compare them online. And the state last year began requiring hospitals to tell patients or their families when they have been injured by a medical error or other adverse event.

Carol Benner, 52, is the self-described "career bureaucrat" who has been Maryland's top patient safety official during much of this transformation. A one-time laboratory supervisor and hospital quality assurance director, Benner capped her career with 17 years atop a state department now known as the Office of Health Care Quality. She retired late last month, warning in this parting interview that - despite changes - troublesome gaps in oversight remain.

Tell me about your career. When I first took the job [managing oversight of hospitals and doctors] it was right in the very beginning of federal nursing home reform. I went back and found out what the track records of what all the nursing homes were. Then we did a very deliberate effort to clean up nursing homes in the state, and in the very early '90s,we closed nine nursing homes in Maryland. Dukeland was the first one. Dukeland was where there were mice actually living in someone's contracted hand.

What oversight does your office have of group homes?

With group homes, there's several different kinds. We have group homes for the elderly, which are assisted living, and I have repeatedly said that what is happening in assisted living is a ticking time bomb. We need desperately to strengthen regulations, especially in the larger assisted-living programs.

There is no requirement in assisted living for awake overnight staff. So you can have 150 people in an assisted-living home.We know that two-thirds of those residents will have some form of dementia. One of the symptoms of dementia and Alzheimer's is wandering at night, and there's no awake overnight staff.

Who oversees other kinds of group homes?

Right after I took over the job, the Maryland Disability Law Center actually sued the department for failure to adequately monitor group homes for persons with developmental disabilities. And quite honestly, when I evaluated the program, the MDLC was correct in saying a lot of what they did. It used to be the Developmental Disabilities Admini-stration did the funding, did the placement and did the regulation. So right after I became acting [director], they split the regulatory component away from DDA and gave it to [what is now the Office of Health Care Quality]. So we put an arm's length distance between the two.

In the other two agencies [the Department of Juvenile Services and the Department of Human Resources, both of which oversee group homes for children], the programmatic function sits next to the regulatory function, so it makes it much more difficult.

I personally think it would be a disaster to consolidate oversight of the group homes in this office right now.We are short-staffed.We've lost ... 40-some people in the last couple of years. It would take that many people to start up a new regulatory program. So before the legislature gives this department a new program, my hope would be that they would make the office whole, so it could do the job it was mandated to do.

Last year, [we were] 56 positions short. Right now, it's taking us 30 days to investigate nursing home complaints. I don't think that's what the public expects or wants.

Unfortunately, sometimes before people give a government agency the staff to do its job, there has to be something horrible that happens. I think that may happen with assisted living. Your history - correct me if I'm wrong - is not one of crusader who identifies different areas and persuades those above you to make changes. Oftentimes, things are outlined in the media or in a report, and your history has been to look at it and say, "Gee, you're right." Or, "Here's what we need to do to fix that." Is that right?

No, that's what you hear. But I've been complaining about assisted living for years, and saying, just in the words I said to you, that it's a ticking time bomb.

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