Investigative Report Finds Johns Hopkins Did Not Follow Its Own Safety Rules

The Tampa Bay Times reported on December 30, 2018: “Johns Hopkins touts itself as a national leader in patient safety. Its doctors invented a simple checklist credited with saving thousands of lives. They developed a system to reduce medical mistakes through teamwork and communication. They wrote one rule to follow above all: Listen to the frontline staff. But the renowned Johns Hopkins Hospital in Baltimore and its five sister hospitals haven’t always followed those principles.”

Johns Hopkins runs a network of six hospitals: four are located in Maryland, one in Washington, D.C., and one is located in St. Petersburg, Florida. Every hospital faced at least one recent allegation of a serious safety problem, according to the Tampa Bay Times.

The Tampa Bay Times reported: “In at least nine recent cases, the hospitals have been accused of making preventable errors or setting aside basic safety rules. Some serious problems continued long after frontline workers brought them to the attention of high-ranking executives … some of the incidents at Johns Hopkins hospitals stand out for their severity. Taken together, they illustrate the $6 billion health system’s struggle to consistently follow the principles its experts preach.”

Johns Hopkins is praised for developing its widely-used Comprehensive Unit-based Safety Program (“CUSP”) that is a method that can help hospital clinical teams make care safer by combining improved teamwork, clinical best practices, and the science of safety. CUSP trains teams of employees to prevent hospital-acquired infections, falls, medication errors, and other common problems. CUSP empowers nurses and other frontline workers to speak up if patients are in jeopardy.

Johns Hopkins created the Armstrong Institute for Patient Safety and Quality, which proclaims its goal “is to eliminate preventable harm to patients and to achieve the best patient outcomes at the lowest cost possible, and then to share knowledge of how to achieve this goal with the world … provid[ing] an infrastructure that, for the first time, oversees, coordinates and supports patient safety and quality efforts across Johns Hopkins’ integrated health care system.” The Armstrong Institute reportedly charges $3,495 for patient safety certification and $3,500 for on-site three-day workshops during which patient safety practices are observed. The Armstrong Institute reportedly also receives compensation to develop safety guidelines for the U.S. federal government. The Armstrong Institute reportedly has received at least $28 million since 2011.

But Johns Hopkins reportedly did not always follow what it preached. The former director of one of Johns Hopkins’ burn units reportedly stated under oath that he provided the chief executive of the Johns Hopkins Health System with “incontrovertible proof of children that were being mutilated in that department, and they did nothing but cover it up,” and further stated, “I think that they care more about the reputation of the hospital than they do the care of patients.” The families of five children treated in the burn unit reportedly filed medical malpractice lawsuits in 2016.

In one of its hospitals in Baltimore, Johns Hopkins Bayview Medical Center, a radiologist repotedly failed to diagnose a patient’s fracture in her spine that was shown on a CT scan, resulting in the patient remaining in pain for months. The original radiologist who failed to diagnose the fracture led the Johns Hopkins’ investigation into the incident. One year later, a radiologist at the same hospital reportedly failed to diagnose a patient’s life-threatening emboli on a CT scan.

In another Johns Hopkins hospital in Bethesda, Maryland, Suburban Hospital, investigators reportedly found unsantitary operating rooms, that two patients were operated on with surgical instruments that had not been sterilized, and that the patients were not advised.

In early December 2018, nurses from the Johns Hopkins Hospital and National Nurses United (NNU), a union of registered nurses, joined local politicians and community members for a town hall event in Baltimore during which the nurses gave a presentation called “Reputation vs. Reality,” arguing that Johns Hopkins Hospital does not live up to its worldwide reputation. During the presentation, NNU reportedly revealed three investigative reports, which alleged that the hospital was creating an unsafe environment for patients and nurses. The report highlighted understaffing of nurses, insufficient safety equipment and mandatory overtime as major issues.


In response to the Tampa Bay Times investigation, Johns Hopkins issued a statement that stated, in part: “The Tampa Bay Times has identified occasions where it is apparent that as an organization we failed to act quickly enough, we failed to listen closely enough and, in some instances, we failed to deliver the care our patients and their families deserve. This is unacceptable … [a]nyone who demonstrates that they are unwilling or unable to maintain our rigorous and exacting safety culture will not be a welcome member of our caregiving community.”

The Tampa Bay Times investigation cited the following nine patient safety incidents:

The Johns Hopkins Hospital, Baltimore: (1) Federal inspectors found that a surgical patient who died was given blood of the wrong type. (2) Faced allegations that doctors in its burn unit injured children and top administrators did not stop surgeries.

Johns Hopkins Bayview Medical Center, Baltimore: (3) Doctors did not note a fracture in a patient’s spine. Federal investigators cited the hospital for letting one of the doctors involved in the patient’s care conduct the internal investigation. (4) Inspectors found that radiologists missed life-threatening embolisms in a patient’s scan.

Howard County General Hospital, Columbia, Maryland: (5) Federal inspectors noticed some staffers not wearing protective gear and not washing their hands.

Suburban Hospital, Bethesda, Maryland: (6) Performed surgeries even though Johns Hopkins had learned the operating rooms were not being properly cleaned. (7) Surgical equipment that was not properly sterilized was used on two separate patients.

Sibley Memorial Hospital, Washington, D.C.: (8) Doctors did not give a woman medication she urgently needed because of an error in her blood type paperwork.

Johns Hopkins All Children’s Hospital, St. Petersburg, Florida: (9) The death rate for pediatric heart surgery patients tripled from 2015 to 2017, becoming the highest rate in Florida, a Tampa Bay Times investigation found. Several top hospital executives resigned after the report.


If you or a family member have suffered injury (or worse) that may be due to medical negligence that occurred at Johns Hopkins in Baltimore or elsewhere, you should promptly find a Baltimore medical malpractice lawyer (a Maryland medical malpractice lawyer), or a medical malpractice lawyer in your state, who may investigate your medical malpractice claim for you and represent you in a Johns Hopkins medical malpractice case, if appropriate.

Visit our website or call us toll-free in the United States at 800-295-3959 to be connected with medical malpractice attorneys who may assist you.

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This entry was posted on Monday, December 31st, 2018 at 5:20 am. Both comments and pings are currently closed.

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