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State investigators probe complaints by hospital patients

STORY BY MEG LAUGHLIN (Week of July 10, 2014)
Photo: Sandra Griffin and her husband Norman.

Investigators from Florida’s Agency for Health Care Administration recently paid an unannounced visit to Indian River Medical Center to investigate a complaint filed by Sandra Griffin about how the hospital treated her 80-year-old handicapped husband, Norman.

The state health care agency, which is based in Tallahassee and has statutory authority for licensing all hospitals in Florida and policing the quality of patient care, found “serious violations” with the Griffin case and several other cases it looked into while investigators were at the Vero hospital.

The AHCA investigation revealed that IRMC violated patient care and patient rights rules and statutes in the Griffin case. Furthermore, a random selection of five other complaints, dated between January and late March 2014, revealed that in four out of six cases studied – including the Griffins’ – the hospital ignored its own complaint policy.

The on-site investigation, wrote an AHCA administrator, consisted of interviewing patients and staff at IRMC as well as reviewing completed medical charts.

“We consider our findings quite serious. Indian River Medical Center was found not in compliance with state and federal law,“ said AHCA press secretary Shelisha Coleman.

On Monday, hospital CEO Jeff Susi said: “We take every patient and patient family grievance very seriously and make every effort to reach out to them to identify and find the root of their concern.

“As is consistent with our policy review efforts, we evaluate policies from time to time and make minor revisions when needed in an effort to continually improve,” he added.

Over the next six months AHCA investigators say they will make more unannounced visits to Indian River Medical Center to see if there has been an improvement in how complaints are handled.

“We will definitely be keeping an eye on this,” said AHCA’s Coleman.

Sandra Griffin, who lives in Fort Pierce with her husband, said she filed the grievance with AHCA launching the investigation “because I don’t want what happened to Norman to happen to another person.”

Sandra Griffin took her husband to the local hospital emergency room after severe pain in his thigh and down his leg had kept him up for three nights, and she feared complications from his recent bladder cancer operation.

After an 11-hour wait in the Emergency Department on March 2, where he was diagnosed with pneumonia, Norman Griffin was moved to a patient room on the third floor.

His wife left to get a few hours of sleep. But shortly after she left, after he was given laxatives, her husband was put in total body restraints for seven hours. Griffin was unable to walk without braces, and he and his wife both said he was no threat to anyone. But hospital staff described him as “belligerent.”

“I had terrible pain in my leg – like lightning bolts – and I was on my side and restless. Maybe they misinterpreted my movement as violence,” said Norman Griffin.

When his wife returned, he was tied to the bed.  He had been left unattended – not cleaned despite defecation and urine in the bed and not offered water or anything else  – which violated patient rights and patient care statutes and rules. Also, respiratory therapy orders, given in the Emergency Department because he was wheezing, were lost and had not been followed, which further endangered his well-being.

The Griffin case, as well as the three other complaints cited around the same time, were initially logged in by the hospital, meaning they were noted in writing. But, wrote AHCA administrators, these grievances were not entered into the hospital’s electronic system, as policy mandated. Nor was there contact with the family or patient, according to procedure, about resolving the complaints.

Instead, the complaints remained in limbo and were not officially addressed.  

From a Medicare report on Indian River Medical Center generated after the AHCA report: “It was learned that once the Administration Assistant logs in a complaint and the complaint is delivered to the appropriate Director, follow-up was not done to ensure the resolution ... There is no evidence of administrative review per the policy standards.”

On April 3, after a brief look at the initial notation of dozens of complaints over six months at Indian River Medical Center, AHCA investigators asked if the information in the complaints was complete. The hospital’s Quality Manager admitted that “several complaints had not been logged into the system to date.”

That troubling information led AHCA investigators to take a detailed look at five recent complaints – plus the Griffins’ – where they learned that four of the six had not been entered into the system until after they showed up at the hospital.

From the AHCA report: “The Quality Manager ... stated ... she realizes the hospital has an issue. In addition to the delay of the complaints being logged into the data system, there had been no follow-up nor resolution for the complaints.”

In late March, Sandra Griffin wrote Hospital District trustee Burton Lee about her husband’s treatment and also wrote a letter, which appeared in the local daily newspaper. After that, hospital CEO Susi invited her to come to the hospital for a discussion and apology. Then, he followed up the meeting with an apologetic letter to her husband and gave his cell phone number to the family.

“We will be taking steps to address staff attitudes, our restraint policy and communications with patients and family,” wrote Susi.

But, when Susi wrote the letter on April 1, the Griffin complaint had still not been logged into the hospital’s tracking system. In fact, it was not until AHCA investigators arrived at the hospital two days later that the complaint – and three others from earlier dates – were entered into the tracking system, according to AHCA.

Susi said he could not comment on the Griffin case for privacy reasons. When told that Mrs. Griffin had waived her rights to privacy in the case, Susi said that such a waiver does not free the hospital to reveal any details about the case and declined comment again.

In early May, Indian River Medical Center approved a new complaint policy that says all complaints must be entered into the hospital’s electronic system within two days and an automatic email will go to the Quality Management staff to begin tracking the complaint. Also, complainants will be called “to make sure they are aware the hospital received the complaint and it is being addressed.”

“The complaint should be resolved and closed within 30 days,” according to the new policy.

Three of the four complaints that made the hospital noncompliant this year originated in the Emergency Room, which has been the subject of frequent patient criticism.

While ER wait times are improving, in June, the average wait-time in the Indian River Medical Center ER before being admitted was over five hours, an hour more than the national average. 

Miami healthcare attorney Monica Rodriguez, immediate past chairman of the Florida bar’s healthcare law section, called the AHCA findings on IRMC “very serious.”

“Reviewing complaints is a good way to find out what’s going on at the hospital and improve things. Seldom are positive changes made without follow-through. The hospital doesn’t look too good in the handling of this,” said Rodriguez.

Tallahassee healthcare attorney Bill Dillon, who just became president of the Florida bar’s healthcare section and who is a licensed healthcare risk manager, in general agreed.

While Dillon did not want to speak specifically about IRMC, he did talk about the handling of complaints at hospitals: “You need to know what went wrong and fix it instead of ignoring problems and circling the wagons. It’s a big deal not to follow through on patient complaints. If you’re a public-relations-sensitive hospital, keep in mind that not following up on complaints can lead to state and federal investigations and lawsuits, which get in the newspaper. Transparency from the start is the best way to go.”