gkbet Are there bedbugs and busted equipment at your Florida hospital? What inspectors found

Updated:2024-10-14 02:38    Views:98

Steward Health is selling all 31 of its U.S. hospitals, including its five South Florida hospitals, after filing for bankruptcy protections. Miami Herald staff READ MORE Hospitals in trouble

A large national healthcare company has filed for bankruptcy. A look at how Steward’s situation is affecting hospitals in South Florida. gkbet

Expand All

Bed bugs. Broken equipment. Staffing challenges. Fewer patients. And a pile of hazardous waste.

These are just some of the problems spotted by patient care ombudsmen during visits to Florida hospitals owned by Steward Health Care System and now up for sale.

Suzanne Koenig and Susan Nielsen Goodman were appointed by the U.S. Trustee to represent patients and monitor care at Steward’s hospitals in Florida and other states during the health giant’s Chapter 11 reshuffling.

While the inspected hospitals show signs of disrepair, Koenig, in a recent court filing, said she “does not believe the security, safety, or care of the hospitals patients are presently at risk.”

Goodman also did not see any risk for patient care though she describes the operations of Steward’s Florida hospitals as “fragile and fluid.”

Koenig is a senior living facility operator and is also the founder and CEO of SAK Management Services, a healthcare management and consulting services firm with more than 30 years of experience. Goodman is a licensed healthcare attorney and registered nurse in Arizona who has served more than 60 ombudsman appointments in her career.

Part of their job is to monitor Steward’s hospitals for any decline in patient care and give the court updates at least every 60 days.

In South Florida, Steward owns Palmetto General Hospital in Hialeah, Coral Gables Hospital, Hialeah Hospital, North Shore Medical Center in North Miami-Dade and Florida Medical Center in Lauderdale Lakes. The healthcare giant, which is under federal investigation for possible corruption, is trying to sell all 31 of its U.S. hospitals to help thin its debt.

READ MORE: ‘Elaborate Ponzi scheme.’ CEO of Miami-area hospitals to get subpoena, part of new probe

“For me, what stood out was the concern, not about immediate patient safety, but about the downward trajectory that these hospitals are facing and the high likelihood that they could close and then you have the worst-case scenario for patients, which is they’re going to be missing a hospital in their community,” said Caitlin Donovan, who reviewed the reports for the Miami Herald and is the senior director of the nonprofit Patient Advocate Foundation, which offers free financial assistance and case management services in English and Spanish to patients with chronic, long-term conditions.

Some Steward hospital employees expressed concerns to the patient care ombudsmen over the future of Steward’s Florida hospitals and whether the hospitals will be sold, close or remain in the health giant’s care. Steward Health has previously indicated that it wants to emerge from bankruptcy as a more stable company focused on its Florida market.

South Florida hospital workers in previous interviews with the Miami Herald have also expressed similar closure concerns, as well as worries on what will become of the hospitals if they remain in Steward’s control. Fear recently became a reality for more than 1,000 employees in Massachusetts after the health system announced layoffs with plans to close two of its hospitals in the state that failed to find buyers with “qualified bids.”

“If there is no longer a hospital in the community, not only do you make it harder for patients to get there, but also for their loved ones, their family, their caregivers and that has a dramatic impact, not only on patient satisfaction rates, but also on the communication between patient providers and patient families,” said Donovan, noting that transportation problems are one of the most frequent reasons why people contact the nonprofit for help.

The bid deadline for buyers interested in Steward Health’s Florida hospitals has been pushed back to Aug. 26, with a court hearing to finalize the sales set for Sept. 10, court records show. In South Florida, the hospitals for sale are Palmetto General, Coral Gables, Hialeah, North Shore and Florida Medical Center. Other Florida hospitals on the market are Melbourne Regional Medical Center, Rockledge Regional Medical Center and Sebastian River Medical.

READ MORE: Is your Miami hospital up for sale? What these next steps mean for patients and care

Koenig and Goodman, the patient care ombudsmen, recently filed their first reports to bankruptcy court on the conditions of the hospitals after visiting the facilities, reviewing records and interviewing executives and staff. Goodman, through an attorney representing her during the bankruptcy process, declined to answer questions from the Miami Herald, including whether the visits to the hospitals were unannounced. Koenig did not respond to emailed questions. Steward Health did not respond to the Miami Herald’s request for comment.

Overview of Steward South Florida hospitals

Koenig and at least one nurse representative from her company inspected Steward’s Miami-Dade hospitals in July, with visits four to eight hours, depending on the size and complexity of the hospital. Goodman visited Steward’s hospitals in Broward and other parts of Florida between May 20 and July 22.

Goodman, a seasoned patient care ombudsman, noted in her report that the extended clinical and operational challenges that Steward’s Florida hospitals faced before bankruptcy was “unprecedented and has blurred the lines” on what should serve as a “normal operations” benchmark to compare the hospitals’ pre- and post-bankruptcy conditions.

Staff at Steward’s hospitals told the ombudsmen that supply shortage issues stemming from delays in payments to vendors had mostly been resolved since the healthcare giant filed for bankruptcy in May, the report states. All hospitals said they are sharing supplies and equipment with each other to reduce the supply strain. Hospital pharmacies say they have enough supplies, too, with the exception of certain medications that are on national back order, and are also coordinating with other Steward pharmacies to share supplies. Some hospitals including North Shore Medical Center and Florida Medical Center are still experiencing supply issues.

Hospitals saw an exodus of employees, including doctors and executives who resigned, even before Steward declared bankruptcy, due to maintenance and financial problems at the health system, according to the reports. And Florida Medical Center appears to have been the hardest hit, with Goodman describing the Lauderdale Lakes hospital as the one that “experienced the most significant amount of pre- and post-petition bankruptcy attrition” in Florida.

Some Steward hospitals are also seeing fewer patients, fueling employee concerns over the future of the hospitals. And all inspected hospitals had broken equipment that needed to be replaced or repaired, including elevators, chillers and, at some hospitals, medical equipment. As for creepy crawlies, the bat infestation at Rockledge Regional Medical Center on Florida’s Space Coast and a delayed bed bug extermination for some rooms at Florida Medical Center in Broward County have since been resolved, according to Goodman’s report.

What were the problems found at your South Florida hospital? Take a look:

Palmetto General Hospital

Koenig visited Palmetto General Hospital in Hialeah on July 1. Key takeaways:

▪ Supply shortages: Palmetto executives and staff say they are no longer experiencing supply shortages, a dire problem that recently drove physicians away from the hospital even before Steward Health declared bankruptcy. A urologist, for example, moved patients to another hospital because of inability to obtain implants, cardiologists were unable to obtain cath supplies, and other surgeons could not get robotic supplies, Koenig wrote in the report. Supply shortages were fueled by delayed payments to vendors, a problem that Steward in bankruptcy filings said it would fix with the new influx of money it was getting during the bankruptcy restructuring.

▪ Broken equipment: Two of 10 operating rooms were closed during her visit due to A/C issues. Broken equipment at the hospital included one cardiac cath lab, two elevators, three ovens, and one steamer that had been nonoperational “for quite some time.” The ovens had stopped working a week before her visit, but repairs were underway shortly after, the report states.

▪ Maternity: More babies are being born at Palmetto General Hospital than usual, but the hospital is seeing a decline in elective and emergency surgeries from the emergency room.

▪ Hygiene: The hospital has not had a central line infection for a year, the report states. Koenig’s report stated that many “direct caregivers” had artificial nails, a violation of the hospital’s hygiene policy.

▪ Summary: “The President/CEO has made significant changes for improvement. ... The Hospital was clean and well run ... and on a clear path to success.”

Florida Medical Center

Goodman visited sometime between May 20 and July 22. Key takeaways:

▪ Shut-down services: Fewer patients have sought care at the hospital, so the hospital did “unit consolidation” and closed its cardiovascular care and telemetry units. It is renting space to a hospice provider. Before bankruptcy, the hospital had also closed its inpatient psychiatric and wound unit. And its orthopedic and bariatric surgery certifications have “lapsed.”

▪ Supplies and services: Supply shortages and delayed payments led to an exodus of resignations. Like at Steward’s other hospitals, not paying for supplies on time led to supply problems, with surgeries “particularly impacted.” Not paying its staff on time, along with bankruptcy worries, led to workers leaving, including in radiology, plant operations and lab workers. Unpaid clinicians stopped providing on-call services to the ER. “Without the availability of physician specialists and/or procedure-related supplies,” the hospital had to divert ambulances away from its facility for patient safety, the report states.

▪ Maintenance: The hospital is a fixer-upper and needs repairs and replacements.

- Three of the hospital’s 18 rooms in the ER were out of service and sealed due to “bed bug exposure while the team awaited exterminator services,” with one of the room’s door’s also having a latch problem, leaving it partially ajar and not sealed. As of the site visit, there had been a three-week extermination delay, the report states. After concerns were raised by the ombudsman team, extermination treatment was reportedly completed within the following week.

- Various inpatient rooms are closed due to plumbing issues, broken call light systems, malfunctioning monitoring equipment and bed repairs. Some operating rooms are closed due to A/C problems. Two of four cardiac catheterization laboratories are not working due to A/C problems and electrical panel issues, respectively. And the tube system that lets the emergency room deliver blood samples directly to the lab for testing was reported out of service for at least six months, at the time of the site visit.

- During the site visit, surveyors saw an accumulation of “red box” hazardous waste, secured in a locked area, and other debris in the back of the hospital. Surveyors presume this buildup is related to service interruptions caused by lack of payment to vendors, the report states. The interim president was notified and at the time of the court filing, hospital leadership said some of the debris buildup was fixed.

- The hospital has broken elevators, lab equipment, and floors that are chipped, cracked and appear dirty due to age staining. Surveyors recommended deep cleaning in some areas of the hospital. Some lab testing is being outsourced due to supply and equipment challenges.

▪ Summary: “FMC was the Florida location that experienced the most significant amount of pre- and post-petition bankruptcy attrition.”

North Shore Medical Center

Koenig visited July 2. Key takeaways:

▪ Staffing: A records review indicates that the hospital has a staffing challenge though none of the registered nurses interviewed by Koenig admitted to staffing issues. An ICU nurse described the staffing situation as “okay.” The hospital has also seen turnover. It lost 54 full time registered nurses and 26 “per diem” registered nurses between January and May. The average headcount for full-time RNs was 255 and per diem RNs, 101.

▪ Maintenance: Broken equipment included four scopes for endoscopy, two chillers, one boiler, a lift pump station, four elevators, and a dishwashing machine (repair is scheduled). North Shore is renting a 250-ton carrier chiller, a 550-ton trane chiller and a lift pump station. ICU nurses are also concerned over the broken “tube system,” which sends collected specimens to the lab. Because the system is broken, nurses say they have to walk to the lab with the specimens. It’s an eight-minute walk.

▪ Supplies: Staff indicated that they don’t have supply issues, with the exception of surgeries. The director of the hospital’s operating room told Koenig it has been “extremely difficult” getting necessary equipment for procedures and is taking longer then usual since requests need corporate approval. Because of the hospital’s history of not paying vendors, suppliers are demanding the hospital pay cash on delivery, “which isn’t feasible since the Hospital itself does not have the ability to pay for equipment at the time of delivery,” the report states. Credit holds are also affecting the hospital’s ability to obtain necessary scopes needed for endoscopy cases. Four scopes are broken. A medical supplier is working with the hospital.

▪ Medical: A review of data shows that the hospital has not had any blood stream infections related to central lines or foley catheters this year. They have also reduced the use of central lines and foley catheters. There has also been no hospital-acquired pressure ulcers (bedsores), C-Difficile or MRSA.

▪ Cutbacks: The report does not mention the layoffs and cutbacks the hospital has experienced this year, including the closure of its behavioral health, neonatal intensive care, and maternity ward. It also doesn’t mention that the FDA ordered the hospital to halt mammograms earlier this year after a review found images taken in the past two years failed to meet quality standards.

READ NEXT: Is your mammogram wrong? Miami hospital ordered by FDA to halt service over concerns

▪ Summary: “There are a lot of equipment and physical plant issues that need to be fixed.”

Coral Gables Hospital

Koenig’s representatives visited July 2. Key takeaways:

▪ Patients: The hospital is seeing a decrease in admitted patients, a factor hospital executives say is related to Steward’s financial situation. Hospital leadership said another contributing factor is that the hospital is focusing on “increasing appropriate patient admissions,” an effort that has led to more outpatient care and discharges from the emergency room instead of admitting patients for situations that would have been “inappropriate and possibly not covered by a payor source.”

▪ Surgeries: The operating room director during the site visit said the hospital has seen a decrease in surgeries, especially procedures that require costly supplies, such as robotics, and in patients admitted through the emergency department. The director, along with staff members in other departments, said the hospital is not experiencing other supply or staffing issues.

▪ Maintenance: Broken equipment includes boiler, a chiller, an ice maker, a service elevator and multiple rooms are closed due to plumbing issues or call light outages.

▪ Satisfaction: The report described the hospital’s environment as “cheerful” and noted that the hospital is doing well in various metrics, including pain assessment, reassessment, and patient satisfaction. The hospital said it has 100% patient satisfaction, due to hourly rounds by staff, and because it can give more patients private rooms, a benefit of having fewer admitted patients. Hospital leadership also said that Coral Gables hospital has the highest scores in Steward’s healthcare system for the following emergency room quality measures: patients that left without being seen, how long it takes for a physician to see a patient, and patient satisfaction scores. All of the hospital’s metrics are above the 90th percentile, according to the report.

▪ Summary: “The pride of ownership for this small community Hospital is apparent. ... It was a real joy to visit this team and to see the wonderful care they are giving to their community.”

Hialeah Hospital

Koenig’s representatives visited July 3. Key takeaways:

▪ Staffing: Hospital staffing issues are improving. A heavy reliance on staff agency nurses two years ago worsened the hospital’s quality metrics and patient satisfaction scores but the hospital has worked to improve, executives told Koenig. “The Hospital worked diligently to eliminate all agency nurses except for three Steward travel nurses. Two of the travelers are converting to permanent staff positions in the emergency room,” the report states. Staffing has also improved in the ER.

▪ Length of stay: The hospital has reduced the average length of stay for patients to 3.61 days, exceeding its goal of 3.67. Leadership says the improvement is partly due to the hospital’s initiative of having a multidisciplinary team do daily rounds. Hialeah Hospital is also doing well with infection control and has seen improvement in the emergency room. The report notes ER’s metrics, including patient satisfaction and the average time it takes for a patient to be seen by a physician, is “excellent.”

▪ Maintenance: Broken equipment includes: Endoscopy machines, similar to at other Steward hospitals, dish washing machine, a warmer that broke a few days prior to the site visit, a freezer (currently replaced by a rental unit), and four out of six ovens, one of which has been broken for years.

▪ Supplies: With the exception of endoscopy equipment Hialeah staff, like at other Steward hospitals, have “denied” supply issues and supply areas looked fully stocked. The operating room director said during the site visit that the hospital has about 200 surgeries a month and has not had problems obtaining supplies and equipment, but if they do need equipment, they will ask other Steward hospitals to share equipment. Leadership says the hospital’s central supply manager has a good relationship with vendors, which has helped the hospital get necessary supplies despite its financial challenges.

▪ Summary: “The hospital is clean. The floors were shiny and without damage. The hallways were free of clutter and the workstations were all in patient rooms.”

Editor Note: An earlier version of this story had an incorrect spelling of Susan Nielsen Goodman’s name.

This story was originally published August 12gkbet, 2024, 5:00 AM.

• are
• and
• gkbet
• There
• bedbugs