It’s funny how hospital operations change when the Medical Marijuana Advocates come by for an inspection.
Reminds me of our family getting ready to have holiday guests.

Secret phone calls go out to everyone. High alert. High alert.
Half-filled coffee mugs sitting on the counter mysteriously disappear.
Charge nurses run ahead of the group with a bunch of keys making sure every bit of medicine in the hospital is on lockdown.
Things that don’t have a place to go get thrown into a closet, the closet gets locked, and a sign gets put up saying “Bathroom – Out of Order.”
All the “procedure” books are prominently displayed.
Everyone acts busy.

Then a little group of people with suits, bright white lab coats and clipboards comes trotting through the ED. One of the hospital administrators is walking behind them frantically motioning to the ED tech to take the patient chart off the counter and put it behind the desk.

Included within the group are several clipboard nurses and a few other unidentified surveyors.
The clipboard doc is the best. He’s about 70 years old and is a retired dermatologist. He looks kinda lost. He just walks around listening to people tell him what to do.
Out of all the safety measures in the hospital that they had to survey, we got dinged because one of the charts had an “unapproved abbreviation” and because there was a lidocaine bottle that wasn’t locked up after we got done sewing up a laceration. But Clipboard Doc, not to be outdone, dinged us because … we had holiday stickers up on the windows of the trauma rooms.


After all, those holiday stickers “have static electricity and could cause a fire.” In addition, they’re probably “teeming with bacteria and could be a source of infection.” These are the only words that came out of Clipboard Doc’s mouth. Forget the fact that the only thing near the “static electricity” in the holiday stickers is glass and an aluminum door frame. Now the heat generated in a static electricity spark is probably less than the melting point of glass (about 573 degrees Celsius) and the melting point of an aluminum door frame (about 660 degrees Celsius), but maybe someone will walk by the door, pass gas, and the gas will loft up, cause the holiday sticker to curl up and pull away from the door, releasing a spark of static electricity that ignites the methane gas and causes an explosion.

Hey – it could happen.

The infectious disease point is well-taken, too. I can’t think of how many times I’ve walked into a room and just had the urge to rub my hands all over the holiday stickers on the windows before touching a patient’s open wounds.

Then I thought of another point: The doors to the trauma bays are made of glass. Nearsighted retired septagenarian physicians might not see the glass and might walk into the doors, banging their heads and causing a subdural hematoma. Worse yet, the impact from the head bang could cause the doors to shatter and a piece of glass could fall off the frame, lodge between a patient’s ribs, and cause a sucking chest wound.

Damn. Not only did we have to get rid of the holiday stickers, now we’re going to need to replace these doors with plexiglass.

This little charade makes me wonder if these surveyors cite hospitals for silly random “violations” as a joke – just to see everyone run around and fix them. Doubt it, but I have to admit that it would be kind of funny if that really were the case.

By the way, someone sent me a picture of the JCAHO “Mother Ship” and figured that I would post it so everyone sees how little money is earned by creating reams of safety standards every year.

Look ma – no holiday stickers in the windows, either.



  1. So true about the holiday stickers. Yet our hospital imposes a double standard – festive decorations are apparently safe for use in the inpatient units, but not in the ER. Apparently we didn’t pass the competency on decorating.

  2. Yeah, it’s crazy when the JC comes to visit. They came to use last August.

    Thankfully I work the night shift, so I didn’t get drilled by the survey about what a Code Zebra, Threat Level Orange, and Paging Dr. O’Crappe meant.

    We only received one RFI (requirement for improvement) and that was because the doctors were cosigning the telephone and verbal orders but not dating their signature to indicate that they were countersigned within 48 hours.

  3. Oh holy crap. I’ve worked so hard to keep a clean home…bleach the heck out of anything and everything…scrubbing and washing till my skin falls offholiday stickers? Maybe THAT is why my daughter has been suffering inflamed tonsils for almost a month now…

    I am so thankful for this post, so thankful for the JCAHO…

    rushes off to remove holiday stickers from all glass surfaces in house

  4. William the Coroner on

    Why do you put up with this? Are there any evidence-based reasons for this crap, or are they pulling these out of their asses? Does JCAHO blessing actually MEAN anything measureable in terms of patient outcomes? It may mean something for billing, but it sounds like you have a yes, yes, we follow the rules this one time, ignore them the rest of the time mental-masturbation fest. It only costs money, so why?

  5. I don’t mean to be a problem.

    Has the JCAHO thouht to swab the doctors (and nurses, support staff, and visitors) to see if there are bacteria on him, his hands, his ears, eyglasses, or ID badge?

  6. Yeah, I'm not leaving a name on

    Andrew, what’s even cooler than swabbing is the special lotions and sprays that cause germs to fluoresce under UV light. Someone might want to suggest to JCAHO that the doctors and nurses should be thoroughly sprayed down to expose their degree of germiness. If anyone involved in patient care shows up more than X% (X being the scientifically-determined threshold for dangerous uncleanliness) phosphorescent, the department gets dinged.

    What do you think?

  7. Hilarious!

    I don’t so much mind the running around and shoving stuff into closets for a couple days. What I hate is that we were on high alert, sure that JayCoh would be coming at any minute FOR EIGHT MONTHS!.

    Yeah, 8.

  8. The f*cks visited us in September – pure chaos and extra hours for all those involved (I felt terrible for the charge nurses).

    They had a problem with 2 pieces of paper taped on the wall **in the resident work area**, nowhere near patient areas: one was a map and the other was a list of stupidest AMOD calls ever — “patient sat on his balls, should I do anything about it?” and- even better – “patient is requesting silk sheets” [um, sorry, the last clean set is on the AMOD call bed]

    They have a problem with the bacteria on the window stickers? Ever think about our white coats???? You know — the ones we wear around nasty MRSA VRE Klebsiella Pseudomonas patients 24/7 for weeks to months?

  9. Pingback: A word of thanks to my hospitalist colleagues « Dr. Bobbs

  10. What about an entire ED hallway and nurse’s station decorated for Christmas? The ED did a terrific job with a new theme every year.

    Pesky decals! I will be on the alert now and avoid such decorative facilities. 🙂

  11. Only in America would we have an organization that requires the most assinine things, and then, when you fail their inspection, will SELL YOU the things you need to get in compliance with them. Seriously. It’s really bad.

  12. mottsapplesauce on

    Heaven forbid if someone should let out a fart near the trauma room. I guess it’s either you take down the decals or keep your ass cheeks taped together.

  13. So OBArmydoc: you wear the same white coat for weeks or months without washing it? And you feel qualified to complain about “stupid rules”? Health and Safety rules are made for people exactly like you, but you’re too smart for rules, right?

    I also have a problem with the blatant age discrimination in this rant. Older people and older doctors just can’t be as sharp as you, can they WhiteCoat? They MUST be stupid, because you just know so.

    The cites as reported here do seem silly, but something makes me think we may not have heard the whole story. You’ll have to pardon me if I just don’t buy the sarcastic version of the inspection given in this typical doc-rant more aptly titled “How stupid everyone else is, but how wonderfully smart I am”.

    Get over the age discrimination BS. I said that he looked old. I didn’t refuse him a job.
    That is the whole story, and even if it were not, give me any rational reason that plastic stickers on a glass window would EVER be a safety hazard.
    If people want to make inane statements that have no scientific basis and are intuitively suspect, then yes, I am smarter than them.
    And if you buy their silly safety arguments on their face, then you need to learn how to do some critical thinking.
    Maybe you and the old guy can publish a paper about the safety risks of static cling.

  14. instarx i hope you’re never hemmorhaging out of every orifice and being unattended because everybody is to busy locking up saline flushes, making sure things are more than 18 inches fron the ceiling, trying to remember one or their 500 passwords to get meds blah blah blah. as for your age discrimination innuendo, the point is you should be at least remotely qualified to do inspections….how would it be if 747s’ were being inspected by owners of single engine cessnas..come to think of it, they probably are…

  15. “This little charade makes me wonder if these surveyors cite hospitals for silly random “violations” as a joke – just to see everyone run around and fix them. Doubt it, but I have to admit that it would be kind of funny if that really were the case.”

    Just like our rants about “stupid things patients say,” the auditors keep a running list of most obnoxious thing they dinged someone on during an audit so that when they get together they can all laugh about it. I can imagine it now at the weekly re-programming sessions:

    “You should have seen them scurry when I told them the window decals were a safety violation!” laughter ensues
    “No Bob, that was good, but did I tell about how I was able to get tape outlawed…”

    The things they ding people on makes me think this isn’t far from the truth!

  16. Instarx must be a jacaho inspector wanna-be or medical administrator; at the very least he/she likely doesn’t regularly take care of patients for a living. Thus he/she obviously doesn’t know how a hospital REALLY functions (or doesn’t because of all the useless rules & regulations “the jc” forces on it…

  17. WC, my condolences for having to deal with the monkey squad.

    Instarx, why are you so defensive? Did someone hide your clipboard? Or did you misplace it due to an age related issue?

  18. Moronic inspectors….thought I left them in the military. At least in the military they had to reference every stupid thing that came out of their mouth to a regulation (sorry, ‘instruction’, an inanity that slipped through) and an absolutely valid defense was the book didn’t say what they claimed.

    However, with the dope-smokers, there is no book: whatever gasseous emanation escapes a sphincter becomes a new policy demand: at least until the next inspection and inspector.

  19. To “Yeah, I’m not leaving a name” :

    It would be fun to spray the nurses with fluorescent dye and examine them for bacteria. Anything to reduce hospital infection. (smile).

    Bureaucracies operate off of lists of past incidents, not necessarily capturing the central point of each one.

    Possibly, a sticker somewhere tested positive for MRSA, or a box of supplies was placed high on a pile, just below a dusty air vent. One time, maybe a visitor grabbed a syringe from a treatment table.

    These things live on in the bureaucratic memory. The golden rules are:
    (1) “I can’t anticipate anything that hasn’t yet happened. I’m not responsible.”
    (2) Never let the same bad event occur twice, no matter the cost.

  20. “safety risks of static cling. ” Ha ha ha ha ha ha! 🙂

    Um…that’s not true…r-i-g-h-t??? 😉

    Only if you’re standing underneath a plastic sticker on a window and you bust butt.

  21. In reference to the prior post about is there any data on patient outcomes: A few years ago I was staffing cases in the OR at a VA hospital. It was about 2 weeks before we were moving to a different state and I wasn’t real scared of JCAHO when they came to the OR. While the resident was prepping the patient I was talking to the MD clipboard (it sounds like the same one that visited White coats establishment) and told him I was interested in JCAHO (I had a mask on so I didn’t need to keep a straight face). I asked about references and publications showing how JCAHO improved patient care/outcomes. He said the website for JCAHO is full of information but he didn’t have any specifics off the top of his head. I have searched the website for such data, and to date I have found nothing.

  22. I dispise JACHO. Everyone runs around like a chicken with no head (?turkey?) buffing charts, polishing the floors, and then BOOM! as soon as JACHO leaves, it’s back to normal. Either we need to run a hospital as JACHO wants or we don’t. I hate the pretension we all go through when JACHO comes. What a bunch of BS.

  23. And yet they didn’t ding your for dirty door knobs or handles? Door knobs have much more bacteria than a toilet seat, and are almost never cleaned.

    Now you know why a dog drinks out of a toilet, but doesn’t lick the door knob.

  24. Apparently JCAHO does not need to follow the laws of physics. Every arm chair physicist knows you can’t start a fire with a typical static charge found in the home. It has a lot of volts, but not much heat. Ever try to start a fire with one of those firesteels? It’s not so easy if you don’t know what you’re doing. You have to angle the steel just right, get it real close to the tinder because the heat from the spark only lasts a fraction of a second, and you must have the right tinder.

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