Health officials in two other states have released reports criticizing the staffing levels at Columbia/HCA Healthcare Corp. hospitals.
The Kentucky Health Services Department released the results of several recent inspections of Columbia Audubon, Columbia Suburban and Columbia Southwest hospitals, all in the Louisville area. At Suburban and Southwest, state inspectors found instances where regulatory requirements for nurse staffing weren't met.
The California Health Services Department is investigating a patient death on May 10 at Columbia San Jose (Calif.) Medical Center. The patient died in the emergency room on a night when three nurses were caring for at least 16 patients, the state found.
Consumer groups, nurses and labor advocates have contended for some time that Columbia reduces staffing to unsafe levels at its hospitals in an effort to control costs.
The Kentucky Health Services Department released the results of its inspections at the request of the Nurses Professional Organization, which is trying to organize the three Louisville-area hospitals.
"We have requested many more investigations than we have reports on," said Kay Tillow, an organizer. "This is confirmation of the truth of what nurses in our organization have been saying, that there is massive understaffing."
The Kentucky inspections, undertaken on behalf of HCFA, found that on certain units at certain times there were not enough qualified nurses. In some cases, the low staffing levels affected patient care but no adverse incidents occurred, the state said. Inspectors were unable to substantiate several of the nurses' allegations.
Tracy Rogers, chief executive officer at Columbia Suburban, said: "Generally, we don't disagree with the state's issues. (However), many of the findings were isolated or anecdotal, or system improvements we had already identified (as necessary)."
It's important to view the reports in context, she said. The hospital was in the midst of a labor organizing drive, and nurses flooded the state with requests for inspections. Numerous inspections were carried out between November 1996 and February 1997, of which only a handful resulted in substantiated deficiencies. The hospital addressed those issues, and increased staffing where appropriate.
When the state came back for its annual mandated licensing survey in May, it found no deficiencies, Rogers said.
At Columbia San Jose, the hospital had reduced its nursing staff to 218 at the end of 1996 from 251 a year earlier, said hospital Chief Executive Officer William L. Gilbert.
The state survey found that patients who should have been treated in the intensive-care unit were stacked up in the emergency room because of a shortage of trained nurses in critical-care units.
The emergency room should have diverted some patients to other hospitals, said Carla Framiglio, the state health district manager in San Jose. On eight other occasions in May the hospital ER, a major trauma center, was closed to ambulances because of insufficient staffing in critical care.
"Hindsight is 20-20," said Gilbert, the CEO. "They should have closed. It was a busy night. But providers felt keeping it open was the best thing for the community." The policy on diversions is now being enforced, he added.
-With Associated Press reports