Report: Overloaded nurses, dangers at U of L Hospital
Triggered by a surgeon’s complaint that University of Louisville Hospital is dangerous, a state inspection found deficiencies in nursing services specifically endangered three patients.
A dozen nurses and doctors also told state inspectors that nursing and other staff shortages put patients at risk, according to the state's 30-page report released Monday by KentuckyOne Health, which manages the hospital.
The company’s chief operating officer, Lisa Shannon, said in a Courier-Journal interview that the hospital is safe and that KentuckyOne already has made “tremendous improvements.”
But the report from the Cabinet for Health and Family Services office of inspector general presents an unsavory picture of a facility in which nurses are overloaded with patients and patients who should be treated in intensive care are backed up in the emergency department.
One nurse told inspectors that medications are passed out late and dressing changes passed on to the next shift, creating infection concerns; another said nurses frequently had to go from room to room searching for equipment because rooms aren't stocked with emergency equipment.
The hospital’s president, Ken Marshall, who was forced to resign last month for reasons the company wouldn’t disclose, told inspectors that in 2013 he was told to cut the budget by 20 percent and that layoffs of 60 nurses and other staff created a “culture of fear” and drove off many experienced nurses.
In the interview with the CJ, Shannon and the hospital’s chief medical and nursing officers said none of the three patients whose care was found deficient suffered “serious injuries or loss of life.”
“We believe our nurses work exceedingly hard to provide safe care to our patients,” she said.
But the report seemed to confirm the allegations in a June 9 story in the CJ in which Dr. J. David Richardson, a prominent surgeon and current president of the American College of Surgeons, said cuts in nursing and other staff had caused a “major patient safety issue” for seriously ill and injured patients.
The inspection was prompted by his comments, which were echoed by other physicians, including Dr. Susan Galandiuk, who said that layoffs and cuts have forced the hospital to rely on temporary “traveling nurses” unfamiliar with procedures
Chief Nursing Officer Shari Kretzschmer said in the briefing that the hospital hired 55 nurses in May and June but still has 70 openings, all of which have been posted.
The inspection was conducted June 14 to 21 by the state, which works with the federal Centers for Medicare & Medicare Services to ensure that hospitals that collect federal reimbursements meet patient standards.
The report hasn’t been publicly disclosed yet by the state, but KentuckyOne elected to release it to a reporter so it could talk about its improvements and commitment to patient care.
The report cites deficiencies in the care of three of 24 patients who were reviewed.
In the one that appeared the most serious, a critically ill patient who should have been treated in intensive care instead was seen in a regular emergency department room, and when he began to vomit during an intubation, no suction equipment was available in the room. The report said a nurse had to scavenge in other rooms for the device, wasting precious time.
The room should have been restocked after the previous patient by an ER technician, but there was no technician working that day, according to the report.
A physician said the patient’s safety also was compromised because the nurse could not provide appropriate monitoring because she had to care for three other patients and because the emergency department was very busy. The director of nursing services in the department said the incident had been investigated by the hospital, but the inspectors found no documentation of it in the patient’s electronic record.
According to the report, a second patient who had undergone a hernia repair and colostomy reversal had to wait more than an hour before receiving pain medication. The patient also said he became incontinent after he “waited and waited,” to no avail for help going to the toilet. When a nurse finally came in, the patient was told to use an “incontinent brief,” the report says. The patient also said he had not been “walked” according to doctor’s orders because the staff was too busy.
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A third patient in a critical care unit fell out of bed and suffered minor cuts to his mouth and head because his bariatric mattress was flush with the bedrail. The report said a contributing factor was that the unit was down a nurse because one assigned to it had accompanied another patient to a CT scan.
In the interview, Shannon, the COO, attributed problems at the hospital to a nationwide nursing shortage and to “unintended consequences” of the reduction in force after KentuckyOne took over. The company also laid off another 500 employees in Kentucky in 2014.
She also cited challenges in integrating the former university-run hospital in the KentuckyOne Health system.
KentuckyOne is a unit of Denver-based Catholic Health Initiatives, which lost $125.9 million in the last quarter of 2015 and has run up $9 billion in debt, but Shannon said the parent company has not prevented it from hiring as many nurses as it needs.
“We remain very committed to exceptional care,” she said. “We believe our nurses work exceedingly hard to provide safe care to our patients.”
Mark P. Pfeifer, an internist who practices at the hospital, said, “I wouldn’t care for patients in an unsafe setting.”
He said he held no grudge against Richardson or Susan Galandiuk for their complaints.
“Their passion for the hospital is reflected in their comments,” he said. “We are seeing an improvement but it is not quick enough for some of our patients.”
But at least one of the unidentified physicians quoted in the June inspection report said things are not getting better.
In an interview last month, Richardson said the problems are so great that the only solution is to “unwind” the 2013 agreement in which the state turned over day-to-day management of the hospital to KentuckyOne Health.
Shannon, however, said KentuckyOne is committed to the partnership.
Reporter Andrew Wolfson can be reached at 502-582-7189 or awolfson@courier-journal.com.