A patient at Harrisburg Medical Center complained to the state that a bacterial infection spreading through the hospital had already killed one person and that nurses and doctors did not wear protective gowns and gloves.
How did Illinois officials respond? They declined to investigate.
At Adventist Bolingbrook Hospital, a patient was pricked by dirty needles, prompting preventive treatment for HIV.
State regulators chose not to pursue that case, too.
They also took a pass on allegations that a staffer at Streamwood Behavioral Health Center assaulted a patient, causing a possible spinal injury, and that a nurse misused an IV machine at Abraham Lincoln Memorial Hospital, leading to a near fatal overdose, a Tribune investigation found.
The Illinois Department of Public Health declined to investigate 85 percent of the 560 hospital complaints it received last year, even when the reports alleged violations such as patient abuse and inadequate infection control, records show. Some allegations of serious harm or death were not pursued even though federal law requires that such claims be investigated within 48 hours.
"These are serious complaints," said Lisa McGiffert, director of the national Consumers Union Safe Patient Project. "If the regulatory system is collecting these complaints and not responding, that is a massive failure of oversight."
Complaints can reveal crucial systemic problems, experts say. And when it finds violations, the state can order hospitals to make corrections.
But Illinois regulators say they don't have the funding to investigate. And the hospital industry has fought proposals to pay for the investigations with fees that amount to pennies a day per hospital bed.
Complaints about the same hospital can pile up without any investigations, according to thousands of records reviewed by the Tribune.
During a six-week period last fall, regulators received four complaints alleging that patients at Greater Peoria Specialty Hospital were being left in their feces and that sores caused by neglect were becoming infected.
One complaint came from a hospital staffer who said patients "are not given appropriate care … not bathed or given oral care … have wounds from not being turned and changed."
Public health department spokeswoman Melaney Arnold said the department works to address serious allegations.
But it "does not have the funding needed to investigate complaints, to conduct routine hospital surveys and ensure the health and safety of patients," she said in an email.
Feds rarely investigate
The state agency spent $498,000 on hospital oversight in 2010 — half from the federal government, half in state matching funds.
Federal officials said they would have investigated some of the complaints highlighted by the Tribune had the state brought them to their attention.
"We are working with the state agency to improve the complaint triage process going forward," said Elizabeth Surgener, spokeswoman for the Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Services.
But it's rare for the federal agency to investigate on its own. And it has declined to fund some investigations sought by state regulators, records show.
When regulators don't investigate, those who complain can feel helpless.
"They just glaze over them like it's not important. Even if there's something not safe to the patients, they don't do anything," said a nurse at West Suburban Medical Center in Oak Park, who declined to be identified for fear of being disciplined by her employer.
The nurse submitted a complaint in 2009 when the hospital was under different ownership, alleging that nursing levels in the newborn unit were far below state requirements, only to be told the regulators would not investigate.
In its response, the public health department stated it would forward her complaint to the organization that accredited the hospital but said by law it could not give her name to the group.
Regulators refer many complaints to accrediting organizations, but these private groups are not required to investigate allegations, disclose whether they do, or share findings with public health officials.
Other hospital employees saw their allegations go uninvestigated as well, records show.
Among them was a complaint from a former staff member of Franciscan St. James Health, who said the south suburban facility overlooked health records of employees, including results of an employment physical that showed a new hire had tuberculosis.
"It's negligence," said Jeanine Thomas, of Willowbrook, who began advocating for hospital safety after nearly dying of an infection acquired in a Chicago hospital. "These complaints can reveal real problems. If the state doesn't investigate, the problems will repeat themselves over and over."
Making hospitals pay
Illinois Guardianship and Advocacy Commission officials gradually realized with dismay that regulators were not pursuing some of their allegations that hospital employees abused patients, said Teresa Parks, director of the watchdog agency's Human Rights Authority.
Parks said she was upset to learn from the Tribune that other complaints of this kind were not investigated, including one labeled "employee to resident sexual abuse" at Evanston Hospital. Family members said the hospital could not explain why the genitalia of a patient suffering from dementia became severely bruised during a stay.
Another uninvestigated complaint came from the family of a patient receiving psychological treatment at Gateway Regional Medical Center in southern Illinois, which said that on two occasions, a nurse choked and pushed the patient to try to force medication.
"A chokehold? I have no idea why they wouldn't investigate something like that," Parks said.
The health department said there's a solution to the problem that does not involve taxpayer money.
It wants Illinois to adopt an approach common in many other states: charging hospitals fees that fund the investigation of complaints and broader inspections. Other health-care facilities in Illinois pay such fees, but hospitals do not.
Public health officials say the nearly $2,000 annual fee paid by nursing homes allows them to inspect every nursing home each year and to investigate every complaint.
Under the state agency's proposal, hospitals would be charged at most $50 a bed, roughly $45,000 a year for the largest hospital.
"Everyone else is paying their fair share of fees. It's only fair that hospitals do likewise," said state Rep. Mary Flowers, D-Chicago, who introduced legislation that would impose the fee.
But the Illinois Hospital Association has blocked the measure.
The lobbying group says hospital internal controls and public reporting requirements help ensure quality of care. Imposing a fee when hospitals are being squeezed by cuts in Medicare and Medicaid payments would be unfair and misguided, spokesman Danny Chun said.
"Of course we take complaints about serious incidents and situations very seriously, and we would and do want those types of situations investigated," Chun said.
But, he said: "Anytime you impose a fee, it's going to drive up the cost of health care. At a time of health care reform when everyone is trying to be cost-efficient, increasing costs by imposing a new set of fines or fees is not going to help that."
Ronald Davidson, of the University of Illinois at Chicago, who has conducted government-funded reviews of hospitals across the country, said lack of money may be only one reason state regulators are not investigating complaints.
"There is always a so-called resource issue with regard to funding and manpower," Davidson said. "In Illinois, however, the problem is more often the political lack of will by certain state agencies to aggressively go after substandard or even dangerous hospitals."
What happens to hospital complaints that state regulators decline to investigate?
The Joint Commission, the largest hospital accrediting organization, said it reviews all complaints it receives, including those referred from Illinois regulators. But the group would not say how many referrals of this kind it received or how it responded to them.
Hospitals said some allegations were examined internally or by other officials.
Abraham Lincoln Memorial Hospital in Lincoln, Ill., said another regulatory agency examined the complaint alleging a near-fatal medication overdose and closed it without further action, although the hospital would not say which agency. It said in an emailed statement that the hospital was "committed to providing safe, effective, high-quality patient care."
Asked about the allegation of abuse involving the patient with dementia, Evanston Hospital released a statement saying that it treats every issue with utmost attention and urgency and that "in this case, we were notified internally and immediately and thoroughly addressed it."
Adventist Bolingbrook Hospital said that it was aware of the patient pricked by dirty needles and that it conducted an internal investigation immediately.
"We spoke with the patient on numerous occasions and provided additional treatment to prevent any further complications," the hospital said in a statement.
Streamwood Behavioral Health Center said local authorities investigated the allegation that a staff member assaulted a patient and determined the complaint was unsubstantiated, but it would not specify which authorities looked into it.
Greater Peoria Specialty Hospital declined to address the allegations of patient neglect but released a statement saying that when made aware of an issue or complaint, it conducts an internal investigation and takes appropriate measures to ensure quality of care.
Gateway Regional Medical Center said it was never aware of a complaint that a staff member choked and pushed a patient to try to force medication. The hospital said in a statement that "though a complaint about the safety or well-being of our patients is extremely rare, when brought to our attention, whether through our own monitoring, or by a patient or regulatory agency, we promptly conduct an internal investigation."
Franciscan St. James Health declined to comment on the allegation that it did not address employee health problems, including a contagious disease.
Vince Ashley, chief executive officer of Harrisburg Medical Center, said no one investigated the allegation that patients were acquiring serious infections as a result of failed controls. He said the allegations concerned him as hospital staffers are required to wear gloves and follow strict hand-washing standards.
"We're going to dig out the file, check it out and investigate it ourselves," Ashley said.