New complaint highlights inadequate staffing in the critical care units that has resulted in two patient deaths, CEO-mandated restrictions on nurses' access to IV fluids that is jeopardizing the safety of patients, including birthing mothers and patients recovering from surgery, the continued increase in patients experiencing hospital-acquired pressure ulcers and pharmacy practices that increase the risk for preventable medication errors.

As conditions continue to deteriorate the nurses once again appeal to DPH for the assignment of investigators at the hospital on a daily basis to ensure the safety of patients, and call for meeting with DPH Commissioner to hear their concerns

WORCESTER, Mass., Dec. 31, 2024 /PRNewswire/ -- As patient care conditions continue to deteriorate at Tenet-owned St. Vincent Hospital, the registered nurses and the Massachusetts Nurses Association (MNA) have filed the sixth in a series of complaints this year 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.  For a copy of the complaint, contact David Schildmeier at dschildmeier@mnarn.org.

"We need those responsible for ensuring the safety of our hospitals to step in and prevent this hospital from what Tenet is doing to undermine the care our patients receive," said Carla LeBlanc, RN, a frontline nurse at St. Vincent and member of the Massachusetts Nurses Association Board of Directors.   "We have made repeated appeals to our management to address our concerns, filed more than 1,000 official reports to them of conditions that jeopardize the safety of our patients, and we have now filed six complaints to all the agencies responsible for the safety of hospital patients yet still patients are falling, patients are suffering preventable complications and yes, patients are dying as a result of Tenet's practices and the lack of oversight from state and federal regulators.  Nurses are once again pushing the call button and its time for someone to respond to protect our community."  

In December 2023, January, March, April, May and this 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. In September, the nurses also filed a complaint against Tenet-owned Framingham Union Hospital citing similar deficiencies in care.  Reporters and editors can access all the complaints filed, including additional information related to the patient safety crisis at the St. Vincent Hospital and Framingham Union Hospital by following this link.

The new complaint, follows a recent report in the Worcester Business Journal that the DPH has launched an onsite investigation into each of Tenet's facilities in the state, including "onsite investigations into Leonard Morse Hospital in Natick following a hospital related incident on Aug. 23, launched its investigation into Saint Vincent Hospital in Worcester on Sept. 12, and most recently, DPH began its investigation into Framingham Union Hospital on Sept. 23."  The complaint also comes as the National Labor Relations Board is conducting a trial next week against Tenet for numerous violations of the St. Vincent nurses' rights, including unlawful efforts to stymie the nurses' ability to file grievances, including those dealing with the unsafe patient care conditions. It also comes as the nurses have a case pending in Worcester Superior Court for the illegal firing of eight nurses who participated in the first round of complaints

Key Patient Safety Issues Cited in Current Complaint

Understaffing in ICU Compromises Patient Safety, Including Two Deaths

Staffing for RNs throughout St. Vincent Hospital has been and continues to be dangerously low on all floors and units in direct violation of the contractually guaranteed levels Tenet negotiated with the nurses to end the nurses historic 10-month strike over that very issue.  This includes staffing for the intensive care unit, which is not only regularly in violation of the nurses contract but is also in violation of Massachusetts state law that requires strict limits on the number of patients assigned to nurses in critical care units to one to two patients, with the number of patients assigned to a nurse to be adjusted based on the acuity level of those patients.   

On September 29 – 30, nurses in the hospital's ICU faxed reports directly to the DPH regarding incidents where the lack of staffing and resources to ensure timely dialysis and other aspects of care were delayed resulting in the death of two of those patients. 

Chronic understaffing in all other units is also contributing to a number of patient safety concerns, including an increase in patients falls, delayed or missed medication administration, unmonitored patients eloping from units, and in the ED, as result of excessive wait times due to understaffing, patients are leaving without being seen. 

CEO-Mandated Restrictions on IV Fluids Delay and Compromises Care and Patient Safety

While the MNA acknowledges there is a national shortage of IV fluids, at St. Vincent Hospital, Tenet CEO Carolyn Jackson has implemented irresponsible and dangerous restrictions on nurses' access to IV fluids and medications, restrictions that are threatening the safety of patients, which the MNA is not seeing at other facilities.  In fact, the nurses report that Ms. Jackson herself, someone with no clinical background, has been witnessed on the floors policing the stock of IV fluids.

In one case cited in the complaint, a birthing mother, depleted of fluids and blood products to keep her and her fetus safe, was denied needed fluids for an extended and dangerous period of time, necessitating more than 20 frantic calls to the pharmacy to release the needed fluids for the patient.  Even when an order was approved, it was subsequently denied, necessitating another call, all the while exposing the mother to potentially serious complications from the lack of needed fluids. 

The provision of IV fluids and other products for patients undergoing and recovering from surgery have also been placed at serious risk due to the hospital's draconian IV fluid restrictions.  The nurses in the Post Anesthesia Care Unit, where patients go to recover immediately following surgery report multiple incidents where patients suffered unwarranted complications from the lack of fluids to replace those lost during surgery.  In two cases cited in the complaint, patients experienced dangerously low blood pressure due to the lack of access to appropriate fluid which contributed to their being admitted to the hospital's intensive care unit to be stabilized.  Another patient who was septic, and lacked needed fluid intake due to these policies also ended up in the ICU for care. 

"It is absolutely unacceptable for the hospital to place these patients in such unnecessary jeopardy," explained Mary Sue Howlett, PhD, FNP-BC the MNA's Associate Director of Nursing at the MNA who worked with the nurses on the complaint. "They are making decisions on patients access to life saving and life preserving fluids not based on the actual needs of patients, but on arbitrary restrictions based on what they believe a specific condition would require.  In the cases cited in our complaint, the lack of those fluids easily could have resulted in major organ failure.  This cannot be allowed to continue."

The nurses also report that patients undergoing surgery, who used to receive IV fluids to bolster them for their surgery during pre op care, are no longer provided those fluids, further adding to the depletion of those vital fluids.  And while other hospitals have postponed or delayed elective procedures to account for the shortage, St. Vincent continues to book all types of surgeries including pure elective (but profitable) cosmetic procedures. 

As part of the complaint, the MNA calls on DPH and other agencies to intervene immediately "to remove these dangerous restrictions."

Nurses Provide Hospital Documentation of Alarming Number of Hospital-Acquired Pressure Ulcers

The latest complaint includes official hospital documentation of 96 hospital-acquired pressure ulcers (debilitating bedsores), which studies show and SVH nurses attribute to unsafe staffing conditions at the hospital. 

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."

Of the 96 pressure ulcers documented in the complaint, 30 of them are at stages that require reporting by the hospital to the DPH, and the complaint specifically requests the agency to provide the MNA with information as to the hospital's reporting of these serious complications. 

In addition to the document detailing the number of pressure ulcers, the complaint also references and includes a copy of a written directive from the hospital acknowledging that there is a problem with an increase in pressure ulcers, and details their punitive and ineffective response to the issue.  Specifically the complaint states:

The hospital itself admits to "a great increase" in pressure ulcers but has failed to implement measures, such as adequate staffing, to mitigate the risk to vulnerable patients. 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.

While Tenet threatens to fire nurses as a result of their failure to address the root cause of the problem, the six MNA complaints detail staffing cuts and unsafe patient assignments for nearly every floor and unit in the hospital over the last several months, with many specifically citing patients being left unattended and unmonitored for several hours, due to the lack of RN and support staff.  Dozens of those reports detailed 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 complaint concludes this section with a pointed call to action for the DPH and other agencies, stating "To allow this to happen occasionally is unacceptable.  To have it happen as a matter of course is a travesty, and the fact that we have documented and reported so many of these incidents and our regulators allow it to continue unaddressed for months on end represents a failure of our entire system of patient protection." 

Unsafe Pharmacy and Instrument Cleaning Practices Increase Risk of Medication Errors and Infections

In addition to the restrictions on IV fluids describe above, the complaint also highlights other issues nurses are experiencing with the pharmacy service, including the unsafe labeling of IV products that have led to inappropriate mixing of medication doses for patients and the potential for other serious medication errors. Here is a key section from the complaint:

We have been notified of at least 3 times when the pharmacy has interfered with safe medication administration.  Diltiazem intravenous infusion is typically administered via bolus with a continuous infusion to follow and used to treat uncontrolled atrial heart rates.  The manufacturer produces the medication as a powder in a vial connected to a 100cc bag of normal saline.  The cap to the vial must be removed in order to reconstitute the medication to the appropriate concentration. On at least 3 occasions, the pharmacy has covered the red lettered notice to the provider to remove the vial top to enable adequate mixing of the medication powder with the saline diluent.   Therefore, on those 3 occasions, the medication was not mixed and the patient received an infusion of normal saline only, thus depriving the patient of the medication needed to manage their heart rate.  On one instance, a seasoned RN identified the issue immediately and promptly mixed the medication appropriately.  On at least one occasion, more than 70cc of the saline was infused when the error was identified.  When questioned by the staff nurse who followed the chain of command, the supervisor suggested that the nurse mix the powder in the remaining 30cc instead of the intended 100cc of saline, a more than three times concentration of the medication as recommended by the manufacturer.  That dose is potentially lethal. (see page __ of the complaint)

The problems associated with these pharmacy practices, as well as other issues identified by the complaint is compounded by the fact that on many floors, most if not all the nurses on some floors are newly graduated, less experienced nurses, who lack the experience and knowledge to spot issues that could lead to serious harm to patients. 

Finally, the complaint also details and provides photos of surgical instruments used by the labor and delivery service where the instruments were not properly cleaned and showed visible residue and other features that could lead to an infection of a patient undergoing surgery or other treatments. 

"What these complaints demonstrate is the complete breakdown and failure of this hospital system to ensure the conditions required to take care of acutely ill patients," Howlett explained.  On every level, in every aspect of patient care delivery, Tenet is failing these nurses and their patients."

Despite Previous Investigations by State and Federal Agencies, More Needs to be Done

Two agencies have already validated the concerns raised by nurses following submissions 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.  The nurses continue to report serious problems with the hospital's outdated telemetry and other cardiac monitoring equipment that are impacting the care of cardiac patients. 

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.  Despite multiple cries for help, the conditions at that facility have deteriorated even more.

In fact, the nurses' complaint once again 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, and renews its call for a meeting with the DPH Commissioner. 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 previously 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 deserve. Also, we once again request the opportunity to meet with DPH Commissioner Goldstein, so that nurses impacted by these conditions, can present to him their first-hand accounts of the deplorable care their patients are experiencing at the hands of this callous administration.  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. 

Finally, while Tenet has cut staffing levels, and implemented policies to undermine care for patients at their Massachusetts-based facilities, the for-profit corporation has done so while posting enormous profits for its shareholders.  At the end of October the company announced third quarter profits in excess of $470 million on revenue in excess of $5 billion.  During a year when nurses have documented more than 1,000 instances where patients' safety has been compromised, Tenet projects year-end revenue of more than $20 billion and $4 billion in total profit. 

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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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

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