Pointing to an investigation by the state health department that found staffing levels contributed to the "woefully inadequate" post-operative care of a liver donor who died at Mount Sinai Medical Center, New York, union officials said last week that layoffs finally have caught up with the beleaguered hospital.
"This unfortunately is the most recent problem we've had here, but short staffing has gotten to a critical mass," said Angela Doyle, who advocates for 7,000 Mount Sinai employees as vice president of Local 1199 of the Service Employees International Union-New York's Health and Human Service Union. "There have been many, many layoffs in the last five years, and it's filtered into the direct patient-care area."
The reaction from union officials highlights the key seat that hospital staffing levels have taken at bargaining tables throughout the country.
The New York State Department of Health last week slapped 1,008-bed Mount Sinai with a $48,000 fine-the maximum amount-for 18 deficiencies in the care of Michael Hurewitz, 57, a reporter for the Times Union of Albany, N.Y. Hurewitz died Jan. 13, three days after surgery as a living liver donor for his brother, Adam Hurewitz, M.D., 54, a pulmonary specialist in Stony Brook, N.Y. Mount Sinai discharged Adam Hurewitz, who reportedly is recovering well.
State health officials blamed the death on post-operative care that was "fragmented at best and entrusted to individuals who although qualified were unable to provide the level of attention necessary for his total post-operative care." Of 18 violations found by state health investigators, three $6,000 fines were related directly to the staffing and supervision of residents, and another three $2,000 fines were related directly to the staffing and supervision of nurses. Among other violations, a first-year surgical resident was left alone for three hours Jan. 13 to care for 34 patients, investigators said. In addition, they said the hospital's transplantation institute was inadequately staffed the weekend after the surgery, and the hospital did not adequately staff nurses to care for all the patients in the unit.
Mount Sinai officials vowed that correcting the problems was top priority before resuming the liver-transplant program, which has been put on a minimum six-month hold by state health officials. But they categorically denied that layoffs had anything to do with Hurewitz's death.
"Our recent layoffs in all areas of the hospital minimally affect bedside care and have nothing to do with this high-profile case," said Joan Lebow, a hospital spokeswoman. "Our ratios remain constant."
Earlier this month, the hospital announced it would slash 450 jobs on the recommendation of the Hunter Group, a turnaround firm.
Union officials representing 1,821 registered nurses at Mount Sinai who have been working without a contract since January said staffing is a crucial issue in ongoing contract negotiations. "We're seeking improvement in the staffing levels in the hospital. It's disturbing; they don't consider it a subject of mandatory bargaining, yet we already have an incident in this hospital," said Mark Genovese, a spokesman for the New York State Nurses Association in Albany.
Staffing levels increasingly are at the top of nurses' demands nationwide, said Christy Hawkins, spokeswoman for SEIU Nurse Alliance, Washington, which represents 110,000 nurses.
Since 1988, Mount Sinai physicians have performed more than 2,100 liver transplants; 178 of the surgeries involved living donors, officials said. Hurewitz's death is the first of a living donor at Mount Sinai.