At St. Michael’s Medical Center in suburban Seattle earlier this month a charge nurse working in the hospital’s problem-plagued ER was forced to call 911 and ask the fire department for backup support. There were reportedly five nurses on duty and 45 patients in the waiting room.
At Ascension Saint Joseph’s Medical Center of Joliet in suburban Chicago three nurses last week were suspended and escorted from the hospital after voicing concerns about ER staffing. According to the Illinois Nurses Association, there were only four nurses available to treat 46 patients. The ER’s staffing requirement was 14 nurses.
In Dallas, a maternity ward nurse and a case worker at Methodist Dallas Medical Center were shot and killed this past weekend when a gunman on parole and wearing an ankle bracelet opened fire. The gunman reportedly hit his girlfriend while she was in labor and then opened fire on the hospital staff.
Although the alarming three incidents in different regions of the country seem unrelated, what binds them are the inept managements overseeing U.S. hospitals.
The 911 call
St. Michael’s Medical Center (SMMC) is part of CommonSpirit Health, which was formed in 2019 when Dignity Health and Catholic Health Initiatives merged to form the second largest health system in the nation, with over 700 care sites and 142 hospitals across 21 states. Statements from both systems emphasized that “the potential of the combined ministry to achieve scale and impact for Catholic health care is compelling.”
That hasn’t proven to be the case for St Michael’s, based in Kitsap County where a pediatrician named Niran Al-Agba lives. Al-Agba is co-author of “Patients At Risk,” a book that serves as a wake-up call about how the U.S. healthcare industry is looking to displace doctors with lesser trained nurse practitioners and physician assistants. The book had a major influence on me, which I wrote about in this column.
Al-Agba is the rare physician willing to publicly criticize the medical establishment. She writes a regular column for the local Kitsap Sun, a small daily publication covering western Puget Sound that isn’t afraid to publish damning articles about area hospitals. Al-Agba has been quite vocal in her criticisms of SMMC, and her prescience has proven spot on.
In this column published just weeks before the 911 ER incident, Al-Agba warned, “believe it or not, things might be about to get worse.” Al-Agba took aim at SMMC president Chad Melton laying off employees in “non-patient facing roles” given that the hospital had just received a preliminary denial by a national healthcare standards group because of conditions that posed “a threat to patients or other individuals served.”
“At a time when ambulances are stacking up outside, local fire chiefs are sounding the alarm about a looming emergency crisis and a patient-safety organization is raising red flags, does it make any sense to reduce the number of staff at the lone hospital in Kitsap County?” posited Al-Agba.
Al-Agba also doubted that Melton’s claims in a September 14 memo that less than 20 employees were fired.
“I’m skeptical that number cited September 14 is still valid,” Al-Agba said. “I have heard from several employees who were terminated prior to or after that date. While the majority were indeed “non-patient facing,” not one had been working for the organization less than a decade. And not one of those who spoke with me ever had a negative performance review.
“Furthermore, some terminated employees were near retirement. Some were in managerial positions. Make no mistake, (Virginia Mason Franciscan Health Network) is first and foremost, a business. And it appears to be in trouble.”
SMMC is part of Virginia Mason.
What triggered the SMMC 911 call was the chaos resulting from a hack of CommonSpirit’s IT system, one of the most massive in terms of healthcare disruption. In addition to forcing ambulance diversions across the country, CommonSpirit’s hospital workers couldn’t access medical records. SMMC’s ER was overwhelmed before the hack, but the IT breach pushed the department over the edge.
“I think about the courage of that nurse to reach out and call for help,” Central Kitsap Fire and Rescue Chief Jay Christian told the Kitsap Sun.
Christian said two firefighters worked in the emergency room for about an hour and a half, cleaning rooms, and beds, moving patients and taking vital signs. He said the firefighters remained until a hospital manager said the situation was under control.
“Short-term, the fire departments are going to do whatever we can to help support, if there’s a public health issue going on, a public safety issue, we’re going to do whatever it takes,” Jim Gillard, who chairs of the Kitsap County Fire Chiefs Association, told the Sun. He said that after two meetings with hospital leadership about the staffing issues and some “small gains,” conditions deteriorated. With the IT breach, “the wheels just came off.”
St. Joe’s suspended nurses
According to media reports, a recently signed union agreement with Ascension Saint Joseph’s Medical Center provided guaranteed nursing staff levels. Julia Bartmes, executive director of the Illinois Nurses Association, told a Chicago TV station that the hospital’s ER was supposed to be staffed with 14 nurses, but only four were scheduled to work, including a charge nurse who wasn’t supposed to have patient assignments. According to union leaders, the nurses asked management for additional support but didn’t get it.
“The hospital escorted the nurses out with security and locked them out for the remainder of their shift,” Bartmes said. A nursing website reported that the three nurses were replaced with nurses from other cities who received triple pay.
Consider the intellect of the management running Ascension St. Joe’s. Nurses are among the most trusted professionals in America, and they are in very short supply. Trust in hospitals is fast dwindling and suspending three nurses at a union hospital for expressing concerns about patient safety is a very bad public image. Replacing the suspended nurses with nurses earning triple time is lunacy.
Imagine if you were one of the staff nurses working alongside the replacements earning triple time. I’m guessing the replacements were employed by so-called travel nurse agencies – little wonder why staff nurses are increasingly quitting their jobs to become travel nurses.
And U.S. hospitals complain that travel nurse agencies are exploitive!
Dallas Hospital Shootings
Nestor Hernandez, who allegedly killed two Dallas hospital nurses, is a parolee who was released from jail last October after having served jail time for aggravated robbery. He was wearing an ankle monitor when he entered Methodist Dallas Medical Center. Hernandez’s criminal history spans aggravated assault of a public servant, burglary, aggravated robbery, and several parole violations.
Police said it wasn’t clear what prompted Hernandez to shoot two hospital workers. Fortunately, there was a police officer in a nearby room investigating a stolen property call and he shot Hernandez in the leg after hearing shots and called for backup.
Police Chief Eddie Garcia called the hospital murders “a failure of the criminal justice system.”
“A violent individual such as this should not have been on an ankle monitor and should have remained in custody,” Garcia said.
The American Hospital Association (AHA) says that healthcare workers suffer more workplace injuries because of violence than any other profession. The industry group also says that 44% of nurses reported an increase in physical violence since the pandemic and 68% reported an increase in verbal abuse.
The AHA, which represents the interests of hospital managements, in March wrote a letter to Atty Gen. Merrick Garland asking for prioritized prosecutions of individuals who harm hospital workers, but the AHA appears short on practical ideas on how to prevent the incidents.
Here’s the best Robyn Begley, the AHA’s chief nursing officer, could muster.
Seems to me that metal detectors are urgently needed at U.S. hospitals, and there are some knowledgeable healthcare security executives who agree with me.