Auditor, health agency at odds over checking out complaints

JEFFERSON CITY, Mo. -- The state auditor and health department are at odds over the criteria for responding to complaints from nursing homes and hospitals.

The auditor's office, in a report Thursday, said the Department of Health and Senior Services spends too much time investigating complaints that are unfounded, thus wasting staff time and resources.

Auditor Claire McCaskill suggested the department change its policy.

Department officials say their policy is in the best interest of patients and will not be changed.

The audit found that 55 percent of the 491 "less serious" complaints investigated over 27 months were groundless.

A policy in the department's Bureau of Health Facility Regulation calls for an investigation of nearly every complaint from a nursing home resident or hospital.

That policy "needs to be evaluated since less than half the investigations result in cited deficiencies," the audit said.

The audit recommended the department establish a system in which the potential risks are gauged before investigations are launched.

It also suggested that hospital quality assurance staff, an ombudsman or local health department conduct preliminary investigations to substantiate complaints.

"This approach would free up staff time and allow more timely investigations of serious cases," the audit said.

The audit did find the health department has been doing a better job of responding to high priority complaints, because it shifted resources.

Not willing to change

In it's response, the health department said it was not willing to change its policy of investigating complaints.

The investigations include observations of facility operations, record reviews and staff interviews.

"We will not support a system that could put Missouri citizens at risk," the department said. "If one patient in the state of Missouri has the potential to be harmed or receive poor quality of care due to a risk-driven approach, then it is not a viable alternative to our present system."

The department said that, in some cases, incomplete information received on the phone can often lead to situations where "the findings are much more serious than was first realized."

The department also objected to using outside help to aid in investigations for several reasons, including confidentiality concerns and potential costs.