New complaints highlight alarming increase in patients experiencing preventable hospital-acquired pressure ulcers (bed sores) due to lack of staff to monitor and reposition patients, the assignment of managerial staff unqualified to fill those roles, and a listing of patient reviews showing most patients are dissatisfied with care
Conditions are so bad, the nurses appeal to DPH for the assignment of investigators at the hospital on a daily basis to ensure the safety of patients
WORCESTER, MA – As patient care conditions continue to deteriorate at St. Vincent Hospital, the registered nurses and the Massachusetts Nurses Association (MNA) have filed yet another round of complaints to state and federal agencies seeking immediate intervention to protect patients and staff, a situation so dire the complaints include a direct appeal to the Department of Public Health to assign onsite inspectors on a daily basis to ensure hospital administration is providing the resources needed to ensure the safety of all concerned.
In fact, the nurses report that DPH has recently been at the hospital investigating yet another serious patient safety incident.
In December, January, March, April and last week, the SVH nurses and MNA filed a number of official complaints with the Department of Public Health Division of Healthcare Quality, Joint Commission (which accredits acute care hospitals), the Center for Medicare and Medicaid Services and the Mass. Board of Registration in Nursing in response to a growing and dire crisis in the safety of care for patients admitted to the Worcester-based facility.
Among the issues raised in this, the fifth round of complaints, is an alarming increase in patients experiencing preventable, hospital-acquired pressure ulcers (debilitating bed sores), which studies show and SVH nurses attribute to unsafe staffing conditions at the hospital. Below is a statement from the complaint detailing the issue:
The lack of staff, both licensed and unlicensed has allowed too many patients to go unmonitored and left unattended without the ability of staff to reposition patients as required under accepted patient care standards, which has resulted in an alarming number of patients suffering from documented hospital acquired pressure ulcers, including 25 in April alone. As you are aware, pressure ulcers are mandated by the Joint Commission and the DPH as serious reportable events that signal problems in care management that need to be addressed. Instead of addressing the systemic issue that prohibits the nurses from repositioning at-risk patients and minimizing the risk for soft tissue injury, nurses have been told that nursing leadership has threatened to fire every nurse who has cared for a particular patient whose ulcer advanced to a Stage IV wound while admitted to the hospital.
“In my over three decades working at St. Vincent Hospital, I can’t remember a time when dozens of patients were afflicted with pressure ulcers in a single month,” explained Marlena Pellegrino, RN, a long time nurses at the hospital and co-chair of the MNA local bargaining unit at the hospital. “As a nurse, like all the nurses at St. Vincent Hospital, I take pride in providing the best care possible, but I am sad to report that under these current staffing conditions, conditions we have been duty bound to report to appropriate authorities, we are unable to fulfill our professional responsibilities. If anyone is to be disciplined or terminated for this situation, it is not the dedicated RNs and nurses aides at the hospital, it is our senior hospital and nursing administrators who are professionally and morally accountable for the unnecessary pain and preventable suffering their decisions have caused for our patients.”
According to a 2020 report on a number of studies regarding hospital-acquired bedsores, “pressure ulcers are the third most costly disease after cancers and cardiovascular diseases. The mortality rates from this disease are 2 to 6 times as much as from other diseases, with 60,000 deaths annually due to this complication. In the USA, about $11 billion is spent annually by the healthcare system for the prevention and treatment of pressure ulcers. Another study makes clear that “The prevention of pressure injury is of great importance in providing quality care to patients, as it has been reported that approximately 95% of all pressure injury are preventable. Nurses working in clinical settings play a key role in identifying patients at risk and administering preventative care.”
The MNA complaints detail staffing cuts to nearly every floor and unit in the hospital over the last several months that have resulted in more than 900 official reports of patient care conditions that jeopardized the safety of their patients. Many of those complaints cite patients being left unattended and unmonitored for several hours, due to the lack of RN and support staff. Dozens of those report detail instances where patients were left for hours lying in their own urine and feces – these are just the conditions that serve as a breeding ground for the pressure ulcers the nurses are now documenting for state and federal officials.
The nurses are not alone in raising the alarm about unsafe conditions at the hospital. Nurses aides, technicians and other valuable support staff who are represented by UFCW 1445 had been conducting informational picketing outside the hospital in an effort to win provisions in their contract to ensure they can provide appropriate patient care. Like the nurses, they have seen their staffing levels cut by Tenet, which forced them to care for too many patients, limits their ability to help reposition patients or help to ensure a clean patient care environment, which contribute to the increase in bedsores. One aide reported being responsible for more than 20 patients on a single shift.
“In years past, we had a robust program to prevent pressure ulcers, including wound care swat teams, with specialized training for staff on how to prevent them,” Pellegrino explained. “But all that has been dismantled under our current administration, and instead of supporting us in preventing these outcomes, they are threatening to punish us for the result of their mismanagement.”
As a result of hospital managements’ mistreatment of staff and their failure to provide staff with the resources they need to deliver safe care, hundreds of experienced nurses have left the hospital for facilities that offer better conditions. On one unit, a medical surgical floor that was once predominantly staffed with seasoned nurses, is now being run almost exclusively by newly graduated nurses, representing a loss of experience, particularly on aspects of nursing care dealing with wound care and pressure ulcer prevention.
Nurse Cite Hiring of Manager Unqualified for Their Role in Care Delivery.
The new complaint also calls attention to Tenet Healthcare’s hiring of managerial staff into roles for which they are not qualified. For example, the complaint states, “The role of the Bed Manager who is “responsible for the coordination and management of personnel and assumes responsibility for hospital administration” for the off shifts, requires a registered nurse with “3-5 years of demonstrated leadership ability in an acute care setting” by the hospital’s own job description. The hospital has violated its own policy and hired a Bed Manager who graduated from community college and has an LPN license that was issued on 9/29/2023, just months prior to being hired in the role. The relief Bed Manager is not clinically trained, but rather the Director of Transportation. Neither of these employees meet the basic requirements of the hospital’s own identified qualifications for skills and education to manage the flow of patients through the hospital and onto appropriate units, which has resulted in patients receiving inadequate care.
Patient Reviews Indicate Dissatisfaction with Care While Agencies Cite Tenet for Deficiencies
The new complaint includes a document sharing recently published patients reviews that reveal widespread dissatisfaction with care provided at the hospital. As stated in the complaint, “Of the 73 reviews posted in the first quarter of the year, more than half (53%) are negative; 12% are neutral and 10% are mixed. Less than one quarter of the posted reviews indicate a positive experience at the hospital. This provides some indication of the patient experience under the current care conditions.”
Two agencies have already validated the concerns raised by nurses following submission of previous complaints. In March, the Joint Commission, which conducted an investigation into the nurses complaints found the hospital to be “non-compliant with applicable Centers for Medicaid and Medicare Services (CMS) Conditions”.
And in April, as reported by MassLive, in response to reports by the nurses, the Department of Public Health conducted an investigation and interviewed several nurses, ultimately citing the hospital for its failure to provide appropriate telemetry boxes, essential devices that are used to monitor patients who have been admitted for serious cardiac conditions.
According to the DPH findings, “Based on interviews and medical record review, the hospital failed to provide care in a safe setting. This nurse stated that the situation comes up often where a patient arrives to the telemetry unit with telemetry orders and the nurse has to either wait for an available tele-box or go hunting for a tele-box.” When patients go without appropriate monitoring their lives are placed at risk, as an ensuing cardiac arrest could go undetected until too late. “The patient has the right to receive care in a safe setting,” the report reads. “This standard is not met as evidenced by interviews and medical records.”
Despite Previous Investigations by State and Federal Agencies, More Needs to be Done
While the nurses appreciate efforts by some agencies to investigate Tenet in response to their complaints, they believe much more needs to be done to protect the patients under their care.
“As we have stated in previous complaints, every patient and every nurse on every shift is subjected to abnormally dangerous conditions, with both patients and nurses at risk for imminent harm at the hands of an administration that fails to meet the most basic standards of patient care delivery. We have already reported to your agency and all other applicable agencies specific deficiencies in staffing, hospital policies, allocation of technology, and a deliberately punitive management culture that is resulting in dangerous delays in the administration of needed medications and treatments, preventable patient falls and other complications, including preventable sentinel events. Despite onsite investigation and monitoring by state and national agencies, the conditions have not improved and have in fact, gotten worse,” the complaint states.
In fact, conditions are so bad, the nurses’ complaint includes a direct appeal to DPH for the assignment of investigators at the hospital on a daily basis to ensure the safety of patients in keeping with a similar approach taken by DPH in the wake of the Steward crisis. The complaint concludes:
As an organization, the MNA represents nurses and health care professionals working in 70 percent of the state’s acute care hospitals, including the hospitals currently owned by Steward Healthcare, and we can state without equivocation or hyperbole that the conditions at St. Vincent Hospital are the worst among all those providers – by far. As such, we believe the DPH, as they have done in the case of the Steward facilities, should immediately assign DPH inspectors on site on a daily basis to ensure that this administration fulfills its responsibility to provide the care these patients and this community deserves. As an agency responsible for holding providers accountable for the care they provide, we reiterate our call for your immediate intervention, as without proper oversight, we fully expect many more patients to be harmed, and tragically, a number of our patients will die.
For media who wish to view all the complaints, along with other information about these issues, which contain numerous examples of unsafe patient care conditions, visit this page or contact David Schildmeier at dschildmeier@mnarn.org.
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