Advance and contingency preparations meet changed inspection system.

o n one of my vacation mornings in January 2006, I received the call from the hospital. The College of American Pathologist's (CAP's) inspection team had just arrived, unannounced, to perform our biennial laboratory inspection — without me present! Several weeks earlier, I had been invited by CAP to voluntarily enroll our laboratory to become the first laboratory inspected under a trial program. Their goal for the trial was to assess problems that might arise from operating unannounced inspections. Planning and thorough preparation in our 220-bed teaching hospital for this inspection would make the difference between our laboratory's success or failure. All CAP had told me was that the inspection would take place after the first of the year, so the laboratory had to be fully prepared by January 3 — just a few weeks away and likely months ahead of what would have been a routinely scheduled inspection. Although our county hospital struggles with extreme California clinical laboratory scientist shortages and chronic budgetary restrictions that permit only the most basic of needs, we reasonably manage to keep current with policies, documentation, and compliance standards. Of course, laboratories always struggle with the typical last-minute rush to get final details in place. Are all of the policies up-to-date and signed? Are all of the reagents dated? Are expired supplies off the shelves? Was the last fire drill required by standards performed and documented? Pleasantly enough, that sense of last-minute urgency was largely missing because we had recently been doing what we should have been doing all along — continuous preparedness. Many months earlier CAP's Washington staff was abuzz with scandalous articles pumping from The Baltimore Sun following its exposé article in 2004. Maryland General Hospital, immediately post-satisfactory CAP inspection, was being inspected by the Maryland Department of Health for fraudulent laboratory practices involving HIV and hepatitis testing. Congress was launching hearings into accreditation by Centers for Medicare and Medicaid Services-deemed organizations that had been entrusted to assure healthcare standards and patient safety. CAP was distraught. Barry Ziman, director of CAP State Affairs, was heavily involved in CAP mitigation efforts and received heated attacks from the Maryland State Health Secretary, Nelson Sabatini, who accused CAP, The Joint Commission on Accreditation of Hospital Organizations, and other accrediting organizations of promoting lax compliance — and who vowed to reassert state control of standards compliance. Lost among the public uproar was the fact that fraudulent …