St. Agnes Medical Center in Fresno, Calif., is under fire from state regulators and the CMS for patient care and governance problems that have led to the abrupt departure of its chief executive officer and suspension of its cardiovascular surgery unit, one of the largest in the Central Valley region.
The turmoil stems from a complaint survey investigation conducted by California regulators in late May. Inspectors found seven leg-wound infections among open-heart surgery patients, and closed the cardiovascular surgery program for six days after declaring patients were in “immediate jeopardy.” No patient deaths resulted in the infections, according to state officials. In addition, on March 11 the Joint Commission made an unannounced site visit in response to a complaint related to medication management. The results are still under review, and the Joint Commission may have further information by late July, a commission spokesman said.
The 426-bed hospital voluntarily suspended its cardiovascular surgery department indefinitely on June 19, after the state survey report became public. The hospital performed 427 open-heart surgeries last year.
The next day, Kaiser Permanente, which operates a medical center in Fresno, announced it had stopped referring cardiac surgery patients to St. Agnes. “We don’t know when or even if we will start referring there again,” Kaiser Fresno spokesman Rob Veneski said.
In May, state licensing surveyors found deficiencies in five areas required for CMS participation: governance, infection control, medical staff, surgical services and quality assurance. Besides the seven leg infections, surveyors reported a lack of surgeon supervision during at least three surgeries where physician assistants removed the veins of a patient’s leg without proper training and without a surgeon present. Veins from the legs are often used to replace damaged coronary arteries.
In addition, several surgeons violated federal privacy rules by peeking at 37 medical charts or more, and medical staff showed poor infection control by walking in and out of restricted areas without changing their scrubs, including to and from the parking lot, according to the 54-page report.
The report harshly criticizes the hospital’s board of trustees and chief executive officer for inadequate supervision of the surgical staff—which had episodes of “infighting”—and for being slow to respond to problems in the cardiovascular surgical department. The hospital had no system for pinpointing and tracking infections, according to the report.
“We certainly take the state’s concerns seriously, and we expect to have our plan of correction to them next week,” said Jamie Huss, spokeswoman for St. Agnes.
Novi, Mich.-based Trinity Health, which owns St. Agnes, announced on June 17 that St. Agnes’ President and CEO Matthew Abraham would resign immediately. Thomas Anderson, chief operating officer at St. Agnes, was named interim president and CEO. Two top Trinity officials, Terry O’Rourke, chief medical officer, and Michael Slubowski, president of Trinity’s hospital and health networks, have been on-site at St. Agnes for the past two weeks, Huss said.
Patient-care problems at St. Agnes came to light last year, when at least 12 open-heart-surgery patients developed infections and three patients died. The Centers for Disease Control and Prevention visited the hospital last October to investigate the source of the infections.
“The CDC actually praised our infection policies and procedures and found no central cause of infection,” Huss said.
Patrick Marabella, CMO for St. Agnes, said the infections spanned several months, and the three who died were “very, very sick patients.”
Other problems were identified. An intensive-care-unit nurse administered a potentially lethal dose of pain medication last May to a patient on a respirator after being ordered to give just a bolus of the drug. The state fined St. Agnes $25,000 for the incident.
State surveyors have revisited the hospital since their inspection in May and plan more site visits, said Ken August, spokesman for the California Public Health Department. The hospital has 90 days to submit a plan of correction, and the CMS is “monitoring the situation,” August said. “Other disciplinary actions could occur,” he added.
Marabella said one of the issues is “ensuring the board is fulfilling its corporate oversight” of the hospital. In the wake of the report, the board has formed a medical affairs committee that will review physician credentialing, performance and violations of rules and bylaws. Some physicians, including Marabella, will serve on the committee.
The hospital stopped performing open-heart surgeries indefinitely.
