Ombudsman Does Not Find Patient Care Decline At Hutcheson Under Bankruptcy, But Cites Physician Shortage

  • Saturday, April 4, 2015

An ombudsman appointed to monitor patient care at Hutcheson Medical Center in Fort Oglethorpe while it is under bankruptcy said she has not observed a decline in patient care, though she said there have been some physician shortages.

Susan N. Goodman, who is both a registered nurse and an attorney, submitted her second report on the hospital's condition.

She said she "did not observe patient care decline or compromise this reporting period. Staff morale is status quo to slightly more hopeful. Physician coverage, particularly the adequacy of hospitalist coverage, remains a concern. The ED also periodically lacks some specialty coverage, which has resulted in patient transfers to other facilities.

"Physicians also reported a consistent desire for increased senior leadership transparency and interaction relative to the reorganization proceedings as well as real concern regarding the chronicity of issues grounded in cash-flow challenges. PCO has interacted on a regular basis with the “Operational Leadership Team,” consisting of the Vice-Presidents of Patient Care Services and Operations (individually, “VPPCS” and “VPO,” and, collectively, “OLT”). This team has been available, engaged, and responsive to PCO feedback.

"During this reporting cycle, three key resignations occurred: Director of the Emergency Department, Director of Physician Relations, and Education/Quality/TJC Manager. Two of the three openings were quickly filled through promotion of mid-level management staff. Both the new ED Director and the new Director of Physician Operations (“DPO”) have quickly gained respect in their new roles. PCO has interacted with both individuals and looks forward to their positive impact. While the Quality Manager position is yet unfilled, the former Quality Manager did not leave Hutcheson; rather, she moved to a full-time mid-level position at the facility.

"Additionally, a number of positions were eliminated this reporting cycle, including the closure of two physician clinics. While most of the reduction in force was related to these clinics, several hospital positions were also eliminated including leadership roles in radiology and house supervisor areas.

"PCO is recommending consistency in the current visit schedule with unscheduled visits every 60-90 days. During this last reporting cycle, PCO had regular phone contact with the OLT. PCO will continue this regular, remote engagement, adding calls to DPO. Moreover, the DPO is creating a physician communication tool through a secure, encrypted cloud-based share file to facilitate reporting of equipment concerns, sharing key reorganization information, and posting important data such as spare equipment storage locations.

"Shortly after PCO’s initial visit, TJC was on-site to investigate environment of care complaints related to trash removal and roof leaks. OLT quickly responded to these concerns, and before the follow-up PCO visit, TJC resolved the complaint. The facility team had received some monies needed for parts since the first reporting cycle and also completed some of the annual life safety testing requirements (generator load test, sprinkler test).

"Moreover, VPO reported that all elevators are now up and functional and roof repairs are budgeted and ongoing. While additional supplies such as light bulbs and air filters were outstanding as of last PCO site visit, PCO’s concerns in this important patient safety area were largely addressed. The facility team did stumble upon the realization that the alarm system at the Parkway had been turned off for non-payment when running the quarterly fire drill. The VPO quickly addressed and resolved this issue within one day of notification. Of note, VPPCS did send photos of the 2015.1 alternate postings in the doorway entrances to the ED and main lobby areas. Clinical Care Team.

"PCO checked in the emergency department, med/surg, ICU, respiratory, ambulatory surgery, cancer therapy, and radiology staff covering day, evening, and midnight shifts. Overall, staff morale is status quo to more hopeful compared to PCO’s initial visit. The VPPCS has been transparent regarding use of agency staff, management needing to go “in ratio” to provide patient care, and quality metrics. These are all status quo compared to the first reporting cycle with no concerns noted.

"Open positions, when normalized for the opening of the labor and delivery unit in late December, are also status quo. Disposable supply concerns have lessened with equipment challenges predominately unchanged. Unfortunately, the central sterile (‘CS”) washing machine, which was previously working sporadically, is down. While the CS team is using the ultrasonic tub as an interim solution, this method cannot be employed long term as it is too hard on the surgical instruments. Again, the OLT is engaged and working through the process of obtaining estimates to repair the dated equipment. One of the previously non-operational x-ray machines was returned to function this reporting cycle. MRI, CT, and portable fluoro equipment status are unchanged from last reporting cycle.

"The VPPCS is working to fill the open quality management position. The former manager was filling that role as a 0.6 FTE. The replacement position is posted for a full FTE, which should provide additional quality support once filled. In the interim, PCO has reviewed the robust infection control data from the February 2014 meeting. Data analysis and detail reporting is unchanged post bankruptcy, and infection rate increases identified in the data appear unrelated to the bankruptcy process4 noted. Open positions, when normalized for the opening of the labor and delivery unit in late December, are also status quo. Disposable supply concerns have lessened with equipment challenges predominately unchanged. Unfortunately, the central sterile (‘CS”) washing machine, which was previously working sporadically, is down. While the CS team is using the ultrasonic tub as an interim solution, this method cannot be employed long term as it is too hard on the surgical instruments. Again, the OLT is engaged and working through the process of obtaining estimates to repair the dated equipment. One of the previously non-operational x-ray machines was returned to function this reporting cycle. MRI, CT, and portable fluoro equipment status are unchanged from last reporting cycle.

"The VPPCS is working to fill the open quality management position. The former manager was filling that role as a 0.6 FTE. The replacement position is posted for a full FTE, which should provide additional quality support once filled. In the interim, PCO has reviewed the robust infection control data from the February 2014 meeting. Data analysis and detail reporting is unchanged post bankruptcy, and infection rate increases identified in the data appear unrelated to the bankruptcy process.

"In addition to the infection control data, VPPCS provided PCO with quality steering committee, nurse practice counsel, and patient care meeting minutes. No concerns were noted. Additionally, VPPCS has created a spreadsheet to help clinical staff report supply needs/issues as well as document resolution of concerns. The sheet is up-to-date and consistent with the engagement PCO observed in the OLT. Physician Interviews. Much of PCO’s site visit was consumed by physician interviews. The clinicians requested the time to discuss their concerns. Again, PCO was consistently impressed by the level of commitment from this important group despite frustrations with coverage, payment, and equipment.

"Of primary concern was hospitalist coverage. Again, as covered in the first report, traditionally Hutcheson had four full-time hospitalists working in two-person teams with every-other-week coverage schedules and a single night-shift hospitalist provided via a locum tenens vendor. One of the four hospitalists departed Hutcheson before reorganization and has not been replaced, leaving one team short a physician. Additionally, the locum tenens vendor stopped providing clinical coverage post bankruptcy due to arrearages. While Hutcheson worked to fill all open shifts with community physicians, gaps have occurred whereby a mid-level provider is on site with on-call physician support. Moreover, while most community physicians offering coverage on a per diem basis are comfortable in the role, one family medicine doctor struggled to manage typical acute-care algorhythms such that a hospitalist had to be urgently called in to avoid patient safety concerns.

"Lastly, physicians who were providing regular per diem coverage expressed concern regarding payment delays. Importantly, OLT appropriately identified hospitalist coverage as the top operational priority. By the end of PCO’s site visit, two locum tenens contracts were before the leadership team, and hospitalist applicants were being considered. Leadership has assured PCO that the physician who struggled to provide acute-care coverage will not be used going forward.

"Further, PCO has recommended that monies owed to physicians be tracked or viewed as a unique line-item expense to better monitor physician concerns that payments are delayed. Each physician interviewed had some sort of “close call” experience to report either related to equipment, supplies, or staffing. All were concerned about the sustainability of the current trajectory coupled with personal/practice liability concerns if “close calls” become the norm.

"After the PCO site visit, physicians did report positively on the attendance of senior leadership at the medical staff meeting. PCO also received positive feedback regarding the new DPO. Patient and Family Interviews. PCO interviewed multiple patients and families on the med/surg unit. Not unlike the first reporting period, patients were quick to point out the importance of Hutcheson to them and the overwhelming desire to see the hospital succeed. No care concerns were noted. Family members felt positive about the care their amily members were receiving and the explanations of care provided by the clinical team.

"This second interim reporting period included remote monitoring and engagement with the OLT and an unscheduled visit to the main hospital Parkway campuses. PCO did not observe any material compromise or decline in patient care related to the bankruptcy as described under 11 U.S.C. §333. PCO’s visit was heavily weighted with physician interviews, per the request of the clinicians. The OLT is actively engaged and attempting to deliver solid solutions on many fronts, and, in particular with the hospitalist coverage issue. The new Director of Physician Operations has been well-received and has quickly engaged with PCO offering ideas to improve clinician transparency and communication. PCO will continue to monitor the hospitalist coverage and equipment issues—staying engaged at the current level given ongoing liquidity and clinician concerns, and the patient care risks associated with them."

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