Tulare Regional Medical Center reacted Friday to a state investigation that found the hospital had inadequate staffing of its operating room at night that contributed to the deaths of two surgery patients last year.
The November 2016 report said the district hospital had only one operating room team to cover elective and all emergency surgeries, including emergency Caesarean-section deliveries, between 5 p.m. and 7 a.m.
The staffing shortage led to long delays, between two and eight hours, for operations for high-risk patients, investigators said. And in at least one case, they said doctors stopped a surgery and a patient was removed from the operating room so an emergency surgery could be performed on another patient.
Investigators said the delays put patients at risk for complications and contributed to the “deterioration and/or changes in the surgical plan” for two patients who died and a third who had a surgical instrument left in her body that required a second surgery to remove. “Lengthy, high-risk, urgent and emergent surgeries were routinely performed during periods when the limited operating room resources (a single on-call surgical team) were needed to care for multiple surgeries at the same time,” according to the report by investigators at the California Department of Public Health.
Hospital officials said the the investigation, which was first reported by the Visalia Times-Delta, is the latest negative report to roil the hospital in the past 18 months. “It turns out that these were due to repeated frivolous complaints filed by the very same disgruntled ‘opposition” group,” it said.
Lengthy, high-risk, urgent and emergent surgeries were routinely performed during periods when the limited operating room resources (a single on-call surgical team) were needed to care for multiple surgeries at the same time.
California Department of Public Health
Tulare Regional and its district board of directors have come under fire from a group called Citizens for Hospital Accountability, which support a recall of Dr. Parmod Kumar in an upcoming special election on July 11.
Findings from the latest survey of the hospital led state investigators to declare an “immediate jeopardy” about surgical services on Nov. 9. An immediate jeopardy is called when the health and safety of patients is found to be at risk. The report said the state accepted a plan of correction from the hospital on Nov. 14, and the immediate jeopardy was abated.
Tulare Regional and its operator, Healthcare Conglomerate Associates (HCCA), said in written statements that it does not agree with the seven-month-old state report. But it said it offered a plan of correction, which is not an admission of wrongdoing. The district hospital board brought in HCCA about three years ago to manage the taxpayer-supported hospital.
According to the hospital’s plan of correction, no elective surgeries will be scheduled after hours or on weekends unless adequate backup resources are available; a surgical physician assistant was recruited to assist surgeons with high-risk surgeries, and additional surgeons were recruited and added to the on-call schedule, among other actions.
In the written statement, hospital officials said they would not comment further on the report because of the likelihood of litigation. “Any speculation by anyone as to the responsibility of any doctors or the hospital for the unfortunate events that led to deaths in the hospital are nothing but that – speculation,” they said.
The state investigators said one of the deaths was a 68-year-old woman, identified as patient A, who was admitted to the hospital on Aug. 8 with bleeding of the rectum. She agreed to have surgery at 8:45 a.m. on Aug. 22, 2016 but it did not occur until 8 p.m., the report said. Investigators said the operation was interrupted when the surgeon was needed to perform an emergency C-section. Patient A was taken out of the operating room unconscious and with a breathing tube, the report said.
Any speculation by anyone as to the responsibility of any doctors or the hospital for the unfortunate events that led to deaths in the hospital are nothing but that – speculation.
Tulare Regional Medical Center/Healthcare Conglomerate Associates
Investigators said the second death was a 67-year-old woman who came to the emergency department at 10:50 a.m. on Sept. 16. She had severe abdominal pain. An imaging X-ray showed a possible strangulated bowel, a surgical emergency. But investigators said the woman remained in the emergency department and surgery did not begin until 11 p.m. An assessment noted that she was at high-risk for surgery. She died at 12:25 a.m.
The third patient was a 62-year-old woman who was admitted on Sept. 22. Bowel surgery was planned for Sept. 29. The surgery lasted more than five hours, but operating room staff were called away before the end, which the state investigators said caused a distraction of the instrument count and contributed to a surgical device being left in the patient.
The three surgeries were all done by a doctor who investigators identified only as MD 6. The investigation found that the doctor, who covered for emergencies after hours and on weekends, had patients who experienced frequent surgery delays of two to four hours. The doctor also held the role of chief of surgery and was a member of the hospital’s medical executive committee.
According to the hospital’s correction plan, the doctor took a voluntary leave of absence. The hospital’s correction plan said the doctor would be proctored (or monitored) for 25 cases, and would not be on-call until the completion of proctoring. The hospital also said the doctor had been replaced as chief of surgery and was no longer on the medical executive committee. It’s not known if the doctor has returned to work. Hospital officials did not respond Friday to questions about the doctor’s status.