Report details hospital defects
St. Joseph cited for problems with hygiene, patient rights
Sloppy documentation in the dialysis unit, nurses reusing contaminated gloves and psychiatric patients escorted over fecal-stained carpet were among the findings of the federal government’s most recent inspection of St. Joseph Medical Center, a new report shows.
The report was released a day after the Centers for Medicare & Medicaid Services announced it would terminate its agreement with the hospital Dec. 3, a potentially fatal blow to Houston’s oldest hospital.
The report shows that St. Joseph has made dozens of changes in response to the latest findings. But the problems still were too much for federal regulators, who have noted that St. Joseph has been out of compliance for nearly six months. The center has drawn intense scrutiny for its handling of the Aug. 27 shooting of a combative, unarmed patient, although the episode is not specifically mentioned in the report.
During observations at
the hospital from Oct. 12 through Oct. 15, government officials documented incidents that put the hospital out of compliance for infection control, nursing services and patient rights.
Joanie Brady, a spokeswoman for IASIS Healthcare, St. Joseph’s parent company, declined comment on the latest report and referred a reporter to a statement released Monday. In that statement, Brady said hospital officials are working with CMS on “options moving forward and are hopeful we (can) come to a resolution that preserves our ability to provide care to our community.”
According to the inspection report, the hospital’s governing body “failed to ensure that dialysis services provided under contract utilized safe procedures,” placing patients “at a potential for harm.”
The hospital has since assigned a registered nurse to oversee dialysis treatments around the clock, and to ensure patients’ weights and physician orders are tracked.
The report also documented problems in the behavioral health unit, including failure to properly address suicide risks.
According to the report, a 61-year-old woman was admitted to the center Oct. 1 after she was found “with bra wrapped around her neck in the bathroom and a bottle of pills by her hand. She was unconscious.”
Yet the review found suicide risk was not part of her treatment plan, though her reason for admission “indicated a suicide risk.” Another suicidal patient
In a separate incident cited in the report, an inspector noted that a 63-year-old woman was admitted on Oct. 10 after she was found to be delusional. The report said she had threatened to kill her brother and herself with a knife and “apparently, she was running down the street naked.”
Again, the investigators found, no suicide precaution was noted in her treatment plan, despite her threat prior to admission to kill herself.
The hospital has since instituted a policy that requires a selfharm risk assessment during admission, the report shows, and has increased oversight of suicide treatment plans.
The hospital also failed to “proactively maintain a strong infection control program,” the report states. It notes that staff members failed to remove gloves and wash or sanitize their hands after direct contact with contaminated items and patients in nine random observations — including in the intensive care and hemodialysis units and the newborn nursery.
On Oct. 13, a registered nurse moved a patient into a bed in the dialysis unit wearing gloves, and later wore the same “contaminated” gloves to administer IV medication, the inspection found. When the surveyor notified the nurse later that day, the nurse responded: “Shucks, just now I thought about it.”
On Oct. 14, a registered nurse put on a pair of gloves and disconnected a patient’s central venous catheter. She then removed her contaminated gloves and took a new pair from a box — without washing her hands. The surveyor immediately told the nurse, and documented her response: “Oh!”
The hospital has launched a hand hygiene awareness campaign, according to the report.
The inspection also noted that the floor in psychiatric ward intake was “smeared with copious amounts of what appeared to be brown fecal matter.” An employee was cleaning it up, but “the fecal matter was observed to trail out of the room into the carpeted entry.” A white towel was placed over one large brown spot.
Eventually, the white towel was removed before the carpet was cleaned. Two patients wearing only socks were escorted by staff “through the fecal covered carpet,” according to the report.
A nurse also was seen dumping a bag of fecal-soiled clothes in an open laundry hamper. The center’s infection control director said he would ensure the carpet was cleaned immediately, and would re-educate the staff. Previous problems
The notice of termination followed four extensions to correct deficiencies outlined in an earlier report. That inspection was made shortly after patient Alan Pean, 26, was shot in the chest during an altercation with two security officers, both off-duty Houston police officers, who had been unable to subdue him with a stun device. The report criticized the hospital’s failure to train the officers to respond to crises involving confused or aggressive patients.
CMS will no longer pay for patients admitted on or after Dec. 3 through Medicare. It may continue to reimburse for care for patients admitted before Dec. 3 for up to 30 days after the termination date.
In an email to employees Monday, St. Joseph CEO Mark Bernard wrote that the hospital’s leadership is “working with CMS and the Texas Department of State Health Services to demonstrate our commitment to quality and safety and to excellent patient care.” He wrote that he remains “hopeful of finding a solution where our hospital remains in these governmental programs and able to continue to provide care to our Medicare and Medicaid beneficiaries.”
U.S. Rep. Sheila Jackson Lee, D-Houston, and state Rep. Garnet Coleman, D-Houston, said they are assisting in the effort to negotiate a solution to save St. Joseph.