An HCA Healthcare hospital in California is under fire for a slew of patient safety and staffing failures, and its status as a Medicare provider could be in jeopardy.
According to CMS, Good Samaritan Hospital in San Jose compromised patient safety by failing to adhere to the state's nurse staffing ratio law, left some patients unattended, committed medication errors and didn't inform its internal governing body about these negative outcomes. The hospital also neglected to notify its boards about safety and quality assessment contracts HCA made with vendors, the agency says.
"These cumulative failures resulted in the hospital's inability to endure patient safety and quality of care," the CMS letter says. "The governing body failed to fully address serious, systemic and recurring issues, placing 13 of 37 sampled patients at risk for adverse events."
The California Department of Public Health inspected the hospital on June 14 and CMS sent a letter instructing the hospital to correct its shortcomings on July 12. KNTV-TV in San Jose first reported the story after obtaining the letter from a source at the hospital.
Good Samaritan staff didn't give doctor-ordered medications to patients in at least four instances and missed 11 patient assessments because nurses said they were so busy, CMS details in the letter.
In one case, a patient on a Fentanyl IV drip should have been checked on regularly to measure the patient's pain and determine whether to reduce or halt the dosing. That didn't happen, and the patient received Fentanyl for five days. Good Samaritan's chief nursing officer subsequently carried out audits to ensure nurses are monitoring and adjusting pain medication doses based on how the patients feel, the hospital said.
Good Samaritan also failed to recognize the potential for staffing shortages to lead to negative patient outcomes and didn't track those that took place. And when adverse events occurred, the hospital didn't report them to its Board of Trustees or quality and safety committees, the letter says.
California is one of two states with mandated nurse-staffing ratios. Until late 2020, hospitals were required to have at least one nurse on duty per four patients. Gov. Gavin Newsom (D) relaxed that standard to six-to-one because of the COVID-19 pandemic. Lower nurse to patient ratios are associated with higher quality and safer medical care, studies have shown.
"The leadership of Good Samaritan hospital take quality and patient safety very seriously as a governing body," hospital officials said in response in the report. "On identification of compliance issues, Good Samaritan hospital leadership immediately convened to identify contributing factors, including oversight of identified issues."
Nurses have protested about staffing shortages around the country since the pandemic began. HCA has pledged to create 43 new nursing jobs at Good Samaritan and another local HCA hospital. In the meantime, Good Samaritan will reschedule elective procedures and defer ICU admissions when there aren't enough nurses available to meet staffing requirements.
In addition to these workforce and safety issues, CMS also dings Good Samaritan for failing to notify its oversight bodies about two contracts. HCA made those deals at the parent company level, but individual hospitals are nevertheless required to inform their governing boards about them. This rule applies to all contracts, including for basic needs like medical gas or elevator service. The hospital has corrected the error.