The Michigan Nurses Association and several Huron Valley-Sinai Hospital nurses filed a lawsuit in Oakland County Circuit Court on Thursday, alleging that the hospital has violated Michigan's public health code by refusing to act on complaints of "unsafe practice or conditions" at the hospital.
The recently formed union at the hospital also released a "short staffing and patient safety" report Thursday that blasted the for-profit owner of the hospital, Dallas-based Tenet Healthcare Corp., for cutting costs and corners in patient care. The union has been in bargaining with the hospital over what would be its first contract.
Two nursing executives at Detroit Medical Center declined to address many of the specifics on the lawsuit and 38-page staffing report issued by the Professional Nurses Association of 158-bed Huron Valley-Sinai Hospital. The association represents 350 registered nurses at the Commerce Township hospital. The union is affiliated with the Michigan Nurses Association.
But Shawn Levitt, DMC's chief nursing officer, and Lori Stallings, Huron Valley CNO, said in an interview with Crain's that patient care and quality are top priorities at Huron Valley.
Levitt said Huron Valley staffs nurses and others based on daily census and industry standards. Stallings cited "A" grades since 2012 that Huron Valley has received from the Leapfrog Group for patient safety.
On the lawsuit and staffing report, Levitt said: "We were surprised to learn the report was filed. There was no mention of it in negotiations, which we have conducted in good faith."
In a telephone news conference with a half-dozen reporters, the Huron Valley nurses described patient falls, late medication deliveries, patients left sitting in their own urine and feces and other unsafe conditions related to low nurse staffing levels at the hospital.
"Huron Valley used to be a nonprofit community hospital, known for the care and concern we showed to our patients," Kathy Lehman, an emergency nurse and president of the PNA-HVSH union, said in a statement. "But after years of corporate penny-pinching, we're now faced with constant short-staffing. It's our patients who are feeling the pain — and we believe it's our professional responsibility to report the unsafe conditions we have witnessed and documented."
Short staffing is defined as not having enough nurses scheduled in each unit for each shift to safely deliver care to patients. The Huron Valley nurses said this is based on the hospital's staffing guidelines and the nurses' own clinical judgment.
In March 2016, Huron Valley nurses voted to create the union. But after 16 months of negotiations, they have not reached a contract deal with DMC.
Levitt declined to address the contract talks. "We don't negotiate contracts in the media," she said. Stallings said hospital management is making good progress in the talks, but she suggested it was up to the nurses when a contract might be signed.
Pat Kampmann-Bush, a recovery nurse who has been with the hospital 13 years and chief steward of the union, said the nurses want to inform the public about their concerns. She said she also wants to pressure DMC and Tenet to hire more nurses, patient care assistants and unit clerks to return the hospital to the staffing levels it had several years ago.
Jeanie Kindermann, a cardiology nurse for 23 years and an union executive board member, said the lawsuit documents multiple public health code complaints. She said the complaints have been submitted to the state for investigation and are contained in the lawsuit against Huron Valley.
"Management has refused to accept the (written complaints)," Kindermann said. "These are the unsafe conditions that put patients at risk. ... I did not become a nurse to file lawsuits. I became a nurse to take care of patients. This is a last resort."
Kindermann said nurses also have used Huron Valley's internal complaint system, called MIDAS, to inform management of potential problems. "We have used it over and over, and there has been no response," she said.
Stallings confirmed that Huron Valley uses MIDAS, which is an internal incident reporting system. "We address every complaint," she said.
Levitt also said that as a magnet hospital certified by the American Nurses Association, Huron Valley has a shared governance model where nursing practice issues are brought forward and worked out.
The nurses created a website on which it has posted the report.
"We know Tenet has a business to run and it needs revenue, but there is a way to incorporate safe staffing into their business model," Lehman said.
Despite the staffing and other concerns at Huron Valley, Kindermann said, the nurses don't want to go on strike.
"This is not what it is all about," she said. "We want to provide quality care. But (turnover and a hiring freeze) have been made and they will trickle down to patients."
Levitt declined to comment on whether there is a hiring freeze at Huron Valley and DMC.
Lehman said patients are aware every day of the short staffing of nurses, patient care assistants and clerks.
"Patients complain. Where is my nurse? Where have they been?" Lehman said. "They get angry at us when you tell them they have to wait."
Kampmann-Bush said some patients who have been in the hospital realize they won't be served faster. "Patients no longer ask for anything other than meds or nurses to evaluate them. They are embarrassed to ask for anything like an extra cup of water," she said.
Lehman said the ER used to have four patients to one nurse. Now many times it is seven patients per nurse. "We have one trauma patient come in, and it is a recipe for disaster," she said.
The report said the hospital's staffing policies have led to patient quality problems.
"With an increased focus on generating revenues, many nursing and support staff positions are not posted and go unfilled, creating tremendous pressure on HVSH workers to do more with less," the report said. "Nurses at Huron Valley?Sinai Hospital are in active contract negotiations with management trying to address the working conditions and staffing concerns reflected in this report."
The report also summarized more than 240 "assignment despite objection" forms filled out by union nurses between Jan. 1 and Sept. 1. The complaints documented in a 31-page appendix in the report nearly one unsafe incident every day.
The ADO forms were created to document formal complaints nurses have lodged with their supervisors. Under professional rules set up by the American Nurses Association, the Michigan Nurses Association and nursing unions, nurses must first verbally notify their supervisors of an unsafe patient situation.
If a patient situation isn't resolved, nurses are encouraged to fill out the forms and submit them to management and keep copies for historical proof. ADOs may be used as evidence in court and with regulatory agencies.
The nurses said Tenet and DMC executives at Huron Valley have refused to accept the forms. The union said it will present its report to the Michigan Department Licensing and Regulatory Affairs for investigation.
Stallings declined to address the ADO forms that Huron Valley nurses said they had attempted to file with the hospital.
"Since before the union, we have been required by (the Centers for Medicare and Medicaid Services to have an) appropriate incident reporting system," Stallings said. "It allows us to (accept comments with) complete confidentiality and allows for confidential submissions."
The Huron Valley nurses also reported the following incidents:
- Patient falls in medical/surgical and intensive care units.
- Late-delivered medications.
- Failure to deliver basic hygiene and human care.
- Patients left unattended during critical situations.
- More than 150 instances of nurses going without breaks or lunches during shifts that last as long as 12 hours, despite the impact on patient care.
- Nurses assigned without proper training.
- Management condoning or ignoring unsafe practices
- Equipment failures.
For example, the report said on Feb. 2 an ICU/critical care nurse reported that the census was six patients for two nurses with no assistants. Most patients were unstable, resulting in a patient fall requiring an emergency X?ray. A typical safe ratio would require an additional nurse and at least one patient care assistant.
And on June 26 a medical-surgical nurse reported due to short staffing some "patients had to wait up to one hour for pain meds."
Nurses also reported an inability to "provide safe patient care because of inadequate staff," medications delivered and given late, IVs that ran late or "dry," patients not getting baths for several days, and nurses sent to assist in intensive-care units without ICU training.
Huron Valley?Sinai Hospital was founded as a nonprofit hospital in 1986. In 1997, the hospital was acquired by the DMC and operated as a nonprofit hospital until 2010. DMC was first acquired by for-profit Vanguard Health Systems and later by Tenet.
Over the past two years, 77-hospital Tenet has undergone massive change as it deals with financial losses, Crain's has reported.
In the second quarter that ended June 30, the hospital chain reported a net loss of $56 million, compared with a net loss of $44 million in the same period last year. Its third-quarter report is expected Nov. 6. Tenet reported a net loss to shareholders of $192 million in 2016 after a net loss of $140 million in 2015.
Tenet's longtime CEO, Trevor Fetter, recently resigned and its national operations are going through a corporate reorganization. DMC has laid off more than 320 employees over the last three years and more are expected this year as part of the reorganization and cost-cutting moves.
"Nurses file lawsuit over patient safety problems at DMC Huron Valley-Sinai Hospital" was originally published in Crain's Detroit Business.
