State health investigators in Massachusetts said last week that they found serious problems at 273-bed Newton-Wellesley Hospital in Newton. Although improvements are being made, they said, the investigation will be extended into other areas of the hospital.
The deficiencies found "have been determined to be of such serious nature as to substantially limit your hospital's capacity to render adequate care," Margaret Leoni-Lugo of HCFA said in a letter accompanying the state report.
Federal and state government officials warned the hospital it could lose its accreditation and the right to get federal Medicare payments if the deficiencies are not corrected soon.
The investigators said the hospital didn't meet federal standards in staffing and quality assurance.
State Public Health Commissioner David Mulligan said the investigators' findings were "incredibly serious," but "if we thought Newton-Wellesley wasn't a safe place, we wouldn't allow the public to go there. We think what they're putting in place will make this a much tighter place."
The three-week investigation looked into the deaths at the hospital of four patients-two women after they gave birth in May, a 20-year-old patient who died of a heart attack in June while having a CT scan, and a woman who died two years ago after giving birth.
"We could not determine specific cause and effect for any one of the four patient deaths we looked into," said Nancy Ridley, assistant commissioner of public health, who was in charge of the investigation. "We did, however, find serious deficiencies that could have contributed to those outcomes.
"We cannot say any of these deficiencies actually caused a patient's death. Sometimes it's easy to be a backseat driver and say if things had been done differently, maybe the person would still be here. It's possible," she said.
She said the hospital already has taken steps to improve.
"(The changes) probably make it safer than most institutions. It is tragic that some of them weren't put into effect earlier," she said.
The report said there were deficiencies in the hospital's systems for resuscitating patients who have cardiac arrests and for handling high-risk maternities. It said there had been a 10-minute delay in starting resuscitation on one mother who died last May, and that it took five minutes to begin resuscitation in the other case.
Investigators also said the hospital relied too much on interns and residents affiliated with Tufts Medical School and did not have enough staff doctors to provide supervision.
They also said that in some situations the hospital did not have a plan to ensure coordination of patient care between doctors and nurses or ensure proper treatments were ordered and provided.
They said that in some situations patient-care plans were not followed or treatment upgrades were not verified.
Among steps taken or planned by the hospital are the hiring of a full-time doctor and full-time nurse to be in charge of quality and a doctor to oversee the dispensing of medicine.
"Having senior staff available all the time is unheard of at teaching hospitals," said Mark Belsky, M.D., president of the hospital's medical staff. Belsky said that move "is more than is needed," but the hospital will do it anyway.
Ridley said her staff will check on changes being made and extend the investigation to nine areas not included in the report.
She said the investigation to date had been into quality assurance, medical staff, nursing and governance.
"We have received over a dozen other complaints about the hospital. We've done a preliminary review, and we are going to look into seven or eight of the other cases," she said.