Sutter Medical Center of Santa Rosa, a facility in California's wine country that is vying for a trauma center designation, has been cited by HCFA for failure to maintain a sufficient nursing staff and for inadequate record-keeping.
The Sept. 14 report, officially called a "statement of deficiencies," was prompted by anonymous complaints about several trauma-related incidents. One last spring involved an injured motorcyclist who had to have his leg amputated after nurses allegedly neglected to inform doctors about the injured man's complaint that he lacked sensation in the leg.
Although HCFA issued the report, it was based on an investigation this summer by the California Department of Health Services, which is responsible for licensing and regulating the state's hospitals. Sutter Santa Rosa initially objected to the investigation's findings. Regulators said not to quibble about the report but to fix what needed fixing, hospital officials said. "You don't question; you just deal with it," said hospital spokeswoman Sarah Miller.
Although federal regulators did not penalize the 175-bed medical center, the report clearly came at a sensitive time for the facility. Sutter Santa Rosa, which affiliated with the Sacramento, Calif.-based Sutter Health hospital system several years ago, is battling nearby Santa Rosa Memorial Hospital for designation as Sonoma County's first and sole trauma center.
That designation is expected to be awarded by next spring.
The unfavorable HCFA report "certainly is one of the things we will look at" in making that determination, said Kent Coxon, coordinator of emergency services for Sonoma, Mendocino and Napa counties.
In the meantime, hospital officials are scrambling to respond to HCFA and state complaints. Investigators said Sutter Santa Rosa "failed to ensure adequate numbers of licensed nurses to provide nursing care to all patients as needed," failed to provide sufficient supervision by registered nurses and failed to implement a plan that explained patterns of authority and delineated specific responsibilities for patient care.
HCFA was especially concerned about the hospital's failure to ensure that registered nurses adhere to the facility's policies and procedures.
Sutter Santa Rosa denied that staffing was inadequate but submitted a correction plan to HCFA that called for hiring 17 part-time employees, including seven registered nurses and five licensed vocational nurses.
The HCFA report also criticized Sutter Santa Rosa for disorganized record-keeping. In the motorcyclist's case, doctors' notes were commingled with other reports, anesthesia records were out of order and night-shift nurses' notes were missing, the report stated.
Hospital officials say the paperwork became disorganized only after multiple internal reviews of the case, but they have agreed to put procedures in place to avoid a recurrence of the problem.