The Dallas Morning News REPORTS HERE that "life-threatening problems persist at Parkland Memorial Hospital and are more widespread than previously known, enabled by a “business as usual” culture that has kept it from fixing serious breakdowns, according to a report obtained by The Dallas Morning News."

"The report by the Alvarez & Marsal Healthcare Industry Group details hundreds of problems in 'nearly every aspect of the system.' The monitors were installed last November as a condition of continued federal funding."

"Among the findings: Patient rooms were found to contain overflowing trash bins, excrement and blood. Hundreds of medications were improperly administered to patients. Dozens of beds remained empty despite crushes of patients seeking emergency care. Senior leaders kept critical information from the hospital’s board of managers. One patient died, apparently after receiving a drug without doctors’ orders."

"Parkland, citing fear of lawsuits, has refused to release a copy of the report, which The News obtained separately."

“Last September, CMS ordered a rare form of safety oversight after Parkland failed a series of inspections prompted by the death of an illegally restrained psychiatric patient. Failures in infection control and emergency services placed patients in “immediate jeopardy,” the agency said."

"Parkland hired Alvarez & Marsal to investigate and help remedy problems."

"To avoid losing hundreds of millions in federal funds it needs to operate, Parkland must show a pattern of safety compliance during its 19-month probation period."

"But the hospital is far from compliance, the report makes clear, citing violations of more than 50 CMS standards — roughly half of all CMS rules governing federally funded hospitals."

"In examining Parkland’s daily operations, the monitors also found fault with faculty doctors from UT Southwestern Medical Center , the hospital’s academic medical partner. UTSW’s faculty comprises most of Parkland’s physician workforce and supervises the resident doctors-in-training who deliver much of the care at the teaching facility."

"Unsupervised residents botched several invasive procedures, for example, including draining chest fluid from the wrong site."

"The main charge of Alvarez & Marsal’s work is to expose the underlying causes of problems at the 118-year-old facility that keep resurfacing. Among them: a culture that has failed in accountability, from top to bottom. The focus has at times strayed from putting patients first, shifting to other priorities such as Parkland’s new $1.2 billion hospital under construction as well as other distractions, the report said."

"That was among the conclusions reached by monitors after posing this question to staff: “Why do these events continue to occur?” Among the responses: Hospital leaders have been “desensitized or numb” to the challenges of its vulnerable patient population. The leaders consider their special role as a safety hospital unique in its challenges — such as a crush of patients with complex problems — and resistant to change."

"Monitors also observed clinicians in the OR failing to wash their hands or use hand sanitizers. The U.S. Centers for Disease Control and Prevention says hand-cleaning is the “most effective means” of reducing the spread of germs."

"Among the most serious and common violations cited in the report were medication and surgical errors."

"The 250 reports of improper drug administration represented one of the most prevalent forms of safety errors throughout the hospital — about 10 percent of all errors, the report said."

"The report was intended to examine Parkland but also found fault with UTSW. The residents are degreed doctors completing their real-world training under supervision, as required by the hospital, education and safety best practices and medical billing rules. Because the residents deliver most of Parkland’s patient care, the monitors wrote, “it is essential to have a close and effective supervision of the care” by UTSW’s faculty."

"Yet, while the monitors said they did not personally see residents working without proper faculty oversight in the emergency, general medicine or surgery-related departments, reports of lax supervision nevertheless arose during their study period."

"An unspecified number of residents, for instance, botched invasive procedures, including one who failed six times to insert a peripheral arterial line. One urology case in the operating room went more than two hours before the faculty surgeon arrived; the faculty denied having received several phone calls and a page to show up, although “he was in his office.”

"The monitors also cited instances of residents using poor hygiene, making mistakes in patient records and behaving poorly. Two residents, described as “indifferent to patient privacy and a sterile environment,” used cellphones to photograph a patient in surgery. Another was “inattentive to a patient in distress while he finished his lunch.”

“We believe that the current operation of Parkland’s resident training program is contributing to the hospital’s deficiencies in meeting all standards” to remain eligible for Medicare funding, according to the monitors’ report."