Chronic understaffing at Carlisle (PA) Regional Medical Center may have played a role in the deaths of at least two emergency department patients in June, a report from the Pennsylvania Department of Health says.
Executives at Naples, FL-based Health Management Associates Inc., which owns Carlisle Regional, dispute the state's findings.
On June 5, a critical care patient at Carlisle Regional died while undergoing a CT scan. An employee told state investigators that the patient was sent for imaging without a nurse because only four nurses were on duty to service the overflowing emergency department.
The employee, identified as EMP4, told state investigators the "that management was aware of the staffing situation throughout the hospital and ED nurses were told that they must be more creative in their care."
On June 11, a patient in the emergency department complained of chest pains, and light-headedness died at the hospital more than seven hours after a cardiologist recommended that the patient be transferred to Harrisburg Hospital for an aortic valve replacement.
The state report reviewed documents from the hospital and includes interviews with at least 18 unnamed employees who complained about poor and unresponsive management and retaliation against "troublemakers."
Several employees told state investigators that an emergency department supervisor who had repeatedly complained to management about the chronic understaffing was fired. "We all fear for our jobs because corporate will fire at will with no reason," a hospital worker identified as EMP9 told state investigators. Another unnamed worker said nurses were afraid. "This is an unsafe place to work and management is aware," EMP18 said.
John Kristel, CEO at Carlisle Regional Medical Center, said in a media statement that the hospital "takes the findings of a recent state Health Department report very seriously."
"However, we take great exception to the notion that the regrettable deaths of two patients may have been related to staffing issues at the hospital," Kristel said in a prepared statement. "We look at our staffing levels on a continuous basis and at this juncture we have no reason to believe that these deaths were in any way connected to staffing levels. Our deepest sympathies go out to the two families involved."
Kristel conceded that "like most other Pennsylvania hospitals, we face challenges with our staffing levels for nurses from time to time." He said the hospital recently hired more nurses, and "will continue to take steps to insure appropriate staffing."
The Health Department requires Carlisle Regional to file a response this week outlining the steps it will take to address concerns raised in the report and correcting any inaccuracies.
"The hospital will meet that deadline," Kristel said. "We will be providing the state a concrete plan of action -- part of which we have already begun to implement -- that we are confident will address the issues that have been raised."
In recent weeks there have been dizzying developments that will have an impact on job growth in the healthcare sector. The problem is, nobody really knows what that impact will be.
Let’s start with some favorable trends.
Healthcare job growth continues to be steady and strong, and one of the few bright spots in an increasingly grim economy. The Bureau of Labor Statistics monthly jobs report for July showed that the healthcare sector created 31,300 new jobs for the month, and 170,900 new jobs so far this year. Healthcare, everything from hospitals to ambulatory services centers to podiatrists’ offices, is responsible for 18.4% of the 930,000 non-farm payroll additions in the overall economy in 2011.
Why is this happening?
The easiest answer is simple demographics. We Americans are getting older, fatter, and sicker, all of which require more care. And there are more of us. The population was about 281 million in 2000, 311 million in 2010, and is projected to reach 392 million by midcentury.
The healthcare reform law is also a factor in job growth. Hospitals, physicians’ offices, and other providers across the nation are hiring for the expected ramp up of healthcare services created by the new law, which will add about 30 million Americans to the ranks of the insured in 2014.
Unfortunately, there are several issues out there that are creating uncertainty in the healthcare sector.
The most immediate concerns are the Medicaid cuts that almost every state government has imposed on their providers. In the past few months, media outlets have been full of stories about hospital layoffs—some of them involving hundreds of employees—acquisitions, mergers, or outright closures that were prompted by financial distress that hospital leaders often directly attribute to Medicaid cuts.
Even more ominous is this new 12-member, bipartisan Congressional “super committee” that will meet later this year to whack $1.5 trillion from the budget. Lawmakers insist that “everything” will be on the table and considered, and that includes Medicare, Medicaid, and other safety-net programs.
If this were all a one-shot deal, perhaps hospitals and other providers could be expected to take the hit and move on. However, it is becoming painfully obvious that the first recourse of many elected officials at the state and federal level is to cut safety-net programs like Medicare and Medicaid.
Causing more uncertainty is the speculation that we are on the cusp of—if not already in—a double-dip recession. The recent stock market dive has evaporated considerable wealth for a lot of folks, including healthcare providers. The last time the market crashed in 2008, it prompted a lot of workers to delay retirement because they couldn’t afford it. Will that happen again?
At some point, regardless of what the stock market does, these folks will have to retire. They may have to adjust to a lower standard of living, but they aren’t getting younger.
In the past few months I’d been hearing from HR professionals across the country who said they believed that many of their staff were feeling confident enough to consider to retiring. After the stock market blood-letting of late last week, is that is still the case?
And finally, how will the prospect of a double-dip recession impact provider operations. In the most-recent recession, providers complained they were being required to make huge increases in the amount of charity care they provided, as the newly unemployed sought essential healthcare services. Will that happen again?
And, given this uncertainty about the economy, will that dampen any enthusiasm for capital improvement projects like new hospitals, or expansions, or delay employment of new staff?
Throughout the last recession, the healthcare sector showed that while it wasn’t recession proof, it was recession resistant. People need healthcare in good economic times, and bad. If we are double-dipping into another recession, we may soon find out how much that resistance was been worn down.
Sanford Health has made public the construction plans for its new $60 million Sanford Thief River Falls (MN) Medical Center and Clinic.
Ground breaking will be next spring, and construction should be completed by late 2014. The new hospital will centralize care, with clinic and hospital services on one campus, Sanford Health said in a media release.
Sanford has had a presence in Thief River Falls since 2007, operating the existing 25-bed, critical access Medical Center that was built in 1932. More than 540 Sanford Health employees work in the town, located in northwestern Minnesota, about 80 miles northeast of Fargo, ND.
The project will also include remodeling of an existing clinic that will house and expand behavioral health inpatient and outpatient services, dialysis services, and a wellness center.
If the existing hospital building in downtown Thief River Falls isn’t sold, it will be torn down and converted into a green space.
Sanford Health is headquartered in Fargo, ND and Sioux Falls, SD and is the largest, rural, not-for-profit healthcare system in the nation. The integrated system has a presence in 111 communities in eight states, including 32 hospitals, 111 clinics and more than 900 physicians in 70 specialty areas of medicine.
More than one in four of the 117,000 new jobs created in the U.S. economy in July were in healthcare, according to preliminary figures from the Bureau of Labor Statics
Healthcare created 31,300 new jobs for the month and 170,900 new jobs in the first seven months of 2011. The healthcare sector has accounted for 18.4% of the 930,000 non-farm payroll additions in the overall economy so far this year, BLS preliminary data show.
A further breakdown of BLS preliminary data shows that within the healthcare sector, hospitals gained 14,000 new jobs for July, despite widespread reports of layoffs due primarily to state Medicaid cuts. Hospitals lost 2,000 jobs in June, but have created 47,800 new jobs for the first seven months of 2011. By comparison, in the first seven months of 2010, hospitals created 10,300 new jobs, BLS data and preliminary data show.
Ambulatory services created 14,100 new jobs in July, after posting 13,700 new jobs in June, and has been responsible for 55% (94,000) of new jobs in healthcare in the first seven months of 2011,. Ambulatory services created 95,000 new jobs in the first six months of 2010, BLS data and preliminary data show.
Physicians' offices reported 6,300 payroll additions in July and 30,600 new jobs so far in 2011. Physicians' offices created 9,400 new jobs in the first seven months of 2010, BLS data and preliminary data show.
Some smaller subsectors in the healthcare industry saw job losses in July. For example, outpatient care centers and nursing care facilities each reported 500 payroll reductions, BLS preliminary data show.
BLS data from June and July are preliminary and may be considerably revised in the coming months.
The healthcare sector accounted for nearly 14.1 million of the nation’s jobs in July, with more than 4.7 million jobs at hospitals, more than 6.1 million jobs in ambulatory services, and more than 2.3 million jobs in physicians' offices, BLS preliminary data show.
Nonfarm job growth in the larger U.S. economy gained slightly in July, with 117,000 payroll additions reported. The nation's unemployment rate remained essentially unchanged at 9.1%, with 13.9 million people unemployed.
The number of people unemployed for less than five weeks fell by 387,000 in July. The number of long-term unemployed—people jobless for 27 weeks or longer—was 6.2 million in June, and represented 44.4% of the unemployed, BLS preliminary data show.
A Michigan physician faces 20 years in prison after pleading guilty to four felony counts involving drug trafficking, taking kickbacks, and healthcare fraud, federal prosecutors said.
Gwendolyn Washington, MD, admitted to running a lucrative and diversified criminal enterprise from her Southfield, MI, offices.
The U.S. Attorney’s Office in Detroit offered a long summation of the conviction plea accepted by Washington, 67, who will be sentenced on Oct. 5 in U.S. District Court.
First, Washington admitted that between 2004 and 2010, she performed unnecessary ultrasounds, nuclear cardiac stress tests, balance tests, sleep tests, and nerve conduction tests on patients, who were told to come back every few months for repeat tests, even though initial results were normal. Washington billed Medicare and Blue Cross and Blue Shield more than $5 million for these tests, some of which were potentially harmful to patients. Nuclear stress tests, for example, use intravenous injections of radionuclide, which emits radiation.
Second, Washington falsely certified patients as being homebound, in return for kickbacks from home healthcare agencies of $200 to $500 per patient. Washington got $350,000 in total kickbacks. Medicare paid $2.8 million to agencies receiving the bogus referrals. Washington got another $250,000 directly from Medicare for false certifications of patients for home health services.
Third, Washington admitted to two drug offenses. In February 2010, when Medicare stopped paying Washington—resulting in a drastic reduction in her income—she began writing prescriptions for tens of thousands of doses of OxyContin, Opana ER, and Roxicodone.
She sometimes wrote prescriptions for people who were not her patients, without an examination or determination of medical necessity, and without a diagnosis or entry in a patient chart. Washington gave the illegal prescriptions to Virginia Dillard, a co-defendant, who filled the prescriptions at area pharmacies and sold the drugs to dealers. The prescriptions sold for $1,000 to $2,200 apiece, and Washington and Dillard shared the money. Dillard pleaded guilty earlier this week.
In an unrelated charge, Washington recently pleaded guilty in a public corruption case involving Detroit Public Schools and she is awaiting sentencing on that charge, prosecutors said.
The nation’s hospitals are getting poor reviews for their efforts to encourage new mothers to breastfeed their infants, and that failure could worsen the childhood obesity problem in this country, according to a Hospital Support for Breastfeeding report from the Centers for Disease Control and Prevention.
“Most U.S. hospitals have policies and practices that do not conform to international recommendations for best practices in maternity care and interfere with mothers' abilities to breastfeed,” the CDC said, adding that “suboptimal breastfeeding in the United States annually results in an estimated $2.2 billion in additional direct medical costs.”
CDC conducted a national survey in 2007 and 2009 of more than 2,650 obstetric hospitals and a handful of birth centers to determine how many were providing maternity care practices that were consistent with the Ten Steps to Successful Breastfeeding guidelines. Those guidelines are part of the Baby-Friendly Hospital Initiative created by the World Health Organization and the United Nations Children’s Fund.
In 2009, the survey found that staff at 93% of hospitals provided prenatal breastfeeding education, 89% taught mothers breastfeeding techniques, and 82% taught feeding cues. However, only 14% of the hospitals had model breastfeeding policies, 22% limited breastfeeding supplement use, and 27% provided post-discharge support. From 2007 to 2009, the percentage of hospitals with recommended practices covering at least nine of 10 indicators increased only slightly, from 2.4% to 3.5%.
CDC recommended that hospitals providing maternity care adopt evidence-based practices to support breastfeeding. “Because nearly all births in the United States occur in hospitals, improvements in hospital policies and practices could increase rates of exclusive and continued breastfeeding nationwide, contributing to improved child health, including lower rates of obesity,” the CDC report said.
The Ten Steps to Successful Breastfeeding include:
Existence of a model breastfeeding policy;
Staff competency assessment;
Prenatal breastfeeding education;
Early initiation of breastfeeding;
Teaching breastfeeding techniques;
Limited supplementation of breastfeeding infants;
Rooming-in;
Teaching feeding cues;
Limited use of pacifiers;
Post-discharge support.
The majority of hospitals were implementing three to five recommended practices (60.5% in 2007 and 54.3% in 2009), with only 2.4% of hospitals implementing at least nine recommended practices in 2007, and 3.5% in 2009.
Less than 1% of hospitals implemented all 10 policies and practices either year.
“For women who intend to breastfeed, the hospital experience is critical. These data illustrate the persistent use of practices that are inconsistent with best-practice standards and do not support breastfeeding. To give infants the best start in achieving a healthy life, including reduced obesity, mothers must be supported immediately after birth to establish breastfeeding,” the report said.
Cogent HMG, the nation's largest private hospitalist provider, announced Tuesday that it has acquired The Intensivist Group, a Lake Zurich, IL-based provider of hospital critical care services.
Financial terms were not disclosed.
"We believe this partnership is happening at the right time," Stephen Houff, MD, CEO of Brentwood, TN-based Cogent HMG, said in prepared remarks. "We feel certain reform will bring an even greater need for our services, as hospitals will increasingly need to both improve oversight on outcomes and align with their medical staffs."
The Intensivist Group, created in 2001, employs more than 30 physicians, with services and consultation in more than 20 hospitals in Pennsylvania, Missouri, and Illinois, according to the company profile.
"This opportunity provides our physicians, clinical staff, and especially our patients and hospital clients with greater resources, leadership, and additional technology," Jay Cowen, MD, president/CEO of The Intensivist Group, said in prepared remarks.
On April 12, Cogent Healthcare and Hospitalists Management Group announced plans to merge and become Cogent HMG, the largest, private hospitalist management company in the nation, with services and consulting in more than 100 hospitals nationwide.
Online job listings for healthcare practitioners, technical workers, and healthcare support staff fell in July, the fourth straight month of declines, according to The Conference Board Help Wanted Onlinereport.
Online job listings for healthcare practitioners and technical occupations fell by 61,200 listings in July to 487,500 and have fallen by 125,100 listing since January. Occupations that saw declines in July online listings included registered nurses, and physical and occupational therapists. However, even with the decline, there were still more than two advertised job vacancies for every skilled healthcare professional in search of work last month, with pay averaging $34.27 an hour, The Conference Board reports.
Online vacancies listed for healthcare support workers fell by 11,900 in July to 116,500. There were two healthcare support workers for every online job listing, with pay averaging $12.94 an hour, The Conference Board reports.
The board's Help Wanted Online Data Series tracks more than 1,000 online job boards across the United States.
In the overall economy, on line job listings fell by 217,000 listings in July, which follows a decline of 100,000 in June and a flat period in April and May. The Conference Board estimates that there were just over three unemployed people for every online advertised job vacancy in July.
"The national trend in labor demand, while positive in the first quarter of 2011, turned negative in the second quarter. And with the July loss, monthly labor demand is now 54,000 below the January level," said June Shelp, Vice President at The Conference Board.
In May, demand for healthcare practitioners and technical occupations fell by 3,400 listings to 565,100. The drop was led by declines in advertised vacancies for speech-language pathologists, occupational therapists, and physical therapists. Healthcare support positions grew by 4,100 new listings to 133,200, even though there were declines in openings for physical and occupational therapist assistants, The Conference Board reported.
In April, labor demand for healthcare practitioners and technical occupations fell by 28,600 listings to 568,500, while support positions fell by 11,400 new listings to 129,100 for the month. In March, healthcare practitioners and technical occupations grew by 3,700, and healthcare support positions posted 4,400 new listings, with the primary demand coming for physical therapist assistants, home health aides, nursing aides, and medical assistants, The Conference Board reported.
In January, The Conference Board reported 78,500 new listings for healthcare practitioners and technicians, and 16,600 new ads for healthcare support jobs, as healthcare jobs led a strong first month of 2011. However, February saw online job ads for practitioners and technical occupations drop by 4,300 owing largely to decreases in advertised vacancies for registered nurses and occupational and physical therapists, while support positions posted a decrease of 4,200.
The American Hospital Association and National Nurses United are criticizing the $2.4 trillion debt ceiling and deficit reduction package that they believe could mean hundreds of billions of dollars in cuts to Medicare, Medicaid, and other safety net programs.
The House passed the deficit reduction package bill by a 269-161 vote Monday evening. It is expected to clear the Senate Tuesday.
"America's hospitals find it difficult to support a debt ceiling proposal that could negatively affect Medicare for our nation's seniors," AHA President Rich Umbdenstock said in a prepared statement. "Hospitals have repeatedly demonstrated a willingness to accept shared sacrifice and do what is best for our country, but our first commitment is to patients, whose access to care could be curtailed by further cuts to Medicare funding for hospital care."
The proposal Congress approved Monday is expected to slash about $2.4 trillion from the national debt from 2012 through 2021. About $917 billion in cuts would be identified in the budget process, and $1.5 trillion in reductions would be found by a special, 12-member, bicameral, bipartisan commission. That committee would meet later this year, and its recommendations would be subject to a single up-or-down vote in the House and Senate.
Medicaid and Medicare are not expected to be impacted in the first round of cuts, but they are expected to be targeted by the 12-member committee, which has yet to be named.
Rose Ann DeMoro, executive director of the 170,000-member National Nurses United, said the massive cuts to social and healthcare programs that will likely be prompted by the proposals would only make matters worse in a faltering economy, and inflict "deep pain in Main Street communities across the nation."
"What this latest deal does is make those who vote for it a full partner in the discredited theory that our economy is in freefall because of public spending on programs that help people, and kicks the can further down the road on real solutions that are needed to promote genuine recovery," DeMoro said in a media release.
"President Obama could avoid this current high wire act by invoking the 14th amendment to raise the debt ceiling, as many have proposed, and start this process over with solutions designed to address the real economic problems facing American families," she said.
Umbdenstock says the cuts would come just as more seniors are turning to hospitals for their care. "Funding reductions for hospital services translate into decreased access for our nation's seniors. That's why the total Medicare program – including caregivers – should be exempt from "sequestration." Cuts to Medicare funding for hospital care could overload emergency rooms, shut down trauma units and reduce patient access to the latest treatments."
The AHA president said hospitals recognize that Medicare needs to be modernized, but that it shouldn't be done "on the backs of providers who care for our nation's most vulnerable."
"We want to work with the new congressional committee to identify real reform that will secure Medicare for future generations rather than continued ratcheting of providers," he said.
The National Labor Relations Board is considering proposed changes to rules governing union organizing practices that some critics believe could dramatically shift the balance of power towards labor.
"It is probably the most liberal, pro-labor board in the 30 plus years I've been doing this," says James G. Trivisonno, president of Detroit-based IRI Consultants, who predicts that the board will adopt most – if not all – of the proposed changes. Those changes, he says, provide organized labor with side-door access to many of the provisions unsuccessfully sought when the Employee Free Choice Act fizzled in Congress last year.
One proposed change, Trivisonno says, would require employers to provide to union organizers before an organizing vote a list of employees, their worksite locations, the shifts they work, and their job classifications.
Another proposed change would facilitate organizing smaller "specialty" bargaining units. "For example, a group of lab techs may want to organize versus an entire group of technical employees at an acute-care facility," Trivisonno says.
The biggest proposed rule change, Trivisonno says, would reduce to a matter of days the amount of time between an announced organizing campaign and a representative election. In effect, he says, union organizers could spend months quietly laying the groundwork for a representative election, before "springing" an election notice on unwitting employers.
"The unions' approach is to surprise the employers with a petition and have the elections in a few weeks before the employer has had a chance to react," he says. "With quicker elections it is easier to get a group of employees revved up about an emotional issue and have an election in two or three weeks. The employers disadvantage is about communicating the rest of the story."
If the proposed rules are approved, Trivisonno says, employers must be even more vigilant and proactive about communicating their arguments against unionization to employees, even doing so ahead of any organizing effort. If you wait until you get a notice of election, it's probably already too late.
"The way that employers prepare for organizing drives and the way they conduct counter union organizing campaign is going to be very different under these regulations," Trivisonno says. "If you have a large acute-care facility, to get a letter drafted, approved, run through legal, operations and public relations sometimes can take a week. You may have nurses who only work once or twice a week. How do you communicate with these people? The unions can make claims that don't have to be accurate and the employer has to correct them."
"So, to the extent you can, you should have those documents done in advance and your positions thought out should you receive a petition," he says.
More and more, he says, social media, including Web sites, Facebook, Twitter, blogs, and employee intranet portals are going to play a critical role in getting the message out. "The unions are well ahead of most employers on that, way ahead, because that is where the battle is going to be fought down the road," Trivisonno says. "National Nurses United and Service Employees International Union have been out front on that for years, but a lot of employers, a lot of consultants, don't get it yet."
He suggests creating an ominous sounding "dark Web site" that provides the employers counterpoints to union arguments, to be activated at the first whiff of an organizing effort. "Keep it in your back pocket should you need it, so you can drive information that way. Establish Facebook and social media channels now because they are going to help you when you need them," he says.
Of course, the best defense against a union organizing bid is to engage your employees, treat them fairly, ensure that they are safe, happy and satisfied at work, ask for their input and act on what they say, and address their concerns. If your hospital is the subject of a "surprise" notice for a representative election, it's your fault and not the union's. It's hard to sneak up on hospital leaders who – on a daily basis – sincerely engage the people they work with as professionals, colleagues, and friends.
As I have said before, employers get the unions they deserve.
