Stung by three medical mishaps since February, University Community Hospital in Tampa, Fla., sustained another blow last week when the Joint Commission on Accreditation of Healthcare Organizations took steps to strip the facility of its accreditation.
University Community, which also faces further state and federal sanctions, has 20 days to appeal the JCAHO's ruling. During the appeal, 424-bed University Community retains its accreditation.
In a brief statement announcing the sanction, the JCAHO didn't specify why University Community failed to meet accreditation standards.
But in an unprecedented request, the American Medical Association called for the JCAHO to immediately alert all hospitals of University Community's mistakes so that preventative steps could be taken.
"We know (the events at University Community) may be extraordinary, but we cannot take any chances," wrote James S. Todd, M.D., the AMA's executive vice president. "We will use all of our communication mechanisms to inform physicians of the situation and of the processes which apparently broke down."
University Community officials were unavailable for comment at press time.
However, a spokesman for the American Hospital Association said the association is concerned that the AMA is suggesting that University Community should take the brunt of the blame for the medical errors instead of physicians.
Richard Wade, the AHA's senior vice president of communications, said quality assurance is a shared responsibility between hospitals and physicians.
"This doesn't justify a national alert," Wade said. "I'm concerned that it could touch off finger pointing between hospitals and physicians."
A JCAHO spokeswoman said no decision has been made on the AMA request.
Even before the JCAHO issued its ruling, Ken Lightfoot, University Community's chairman, said the board would consider offers to sell the hospital.
Tampa General Hospital officials said they are planning to make an offer to acquire University Community, which operates two acute-care campuses. And a Columbia/HCA Healthcare Corp. executive in Tampa said the chain might be interested in purchasing the hospital if it were for sale.
Since April 8, University Community has been prohibited from conducting elective surgeries after state health investigators found patient care to be a "threat to public health or safety."
Elective surgeries were expected to resume after University Community's surgical staff completed additional training in quality-assurance procedures, a hospital spokeswoman said. But the state said late last week that it would not lift the ban immediately. The hospital conducts about 300 surgeries a week, which generate some $210,000 in revenues.
The ban was prompted by three medical mistakes in a 16-day period from February to March (March 20, p. 10). They included the death of a patient after a hospital employee mistakenly removed his respirator, a surgical mistake that led to the amputation of the wrong foot of a patient and arthroscopic surgery on the wrong knee of a patient.
In an inspection last month for HCFA, the Florida Agency for Health Care Administration found that University Community is understaffed, undertrained and undersupervised in the surgical- and respiratory-care departments.
HCFA has given the hospital until April 20 to correct its problems or lose Medicare and Medicaid funding, which account for 30% of the hospital's $150 million in annual revenues. University Community has implemented a corrective plan that hospital and federal officials say should improve problem areas.
As part of its plan, University Community has hired several operating department safety nurses and now requires the head nurse of the respiratory-care department to monitor assistants.
New quality-assurance procedures also require University Community's 326 surgeons to verify the type of operation, the patient and the location of the surgery before work begins.
John Andreas, a University Community spokesman, said the hospital isn't understaffed. But he said it has beefed up quality controls.
Of the hospital's respiratory therapy department, the state-conducted report for HCFA said: "There was not a single entity or individual that was identified as the coordinator of patient care. Departmental care was fragmented and not interdisciplinary, and there was no system in place to prevent missed treatments."
The JCAHO made unannounced visits to the hospital on March 31 and April 3.
The hospital received a three-year accreditation in 1993. A JCAHO spokeswoman said the facility was accredited with a recommendation that improvements be made. She could not specify what the improvements were but did say they had been made.-