Inoperable Equipment, Other Problems Found at Local Steward Hospitals

YOUNGSTOWN, Ohio – While an ombudsman found that Steward Health Care System is demonstrating a strong commitment to patient care, she also reported problems, including inoperable elevators and other nonmedical equipment at three local hospitals.

The U.S. Bankruptcy Court in Houston appointed Suzanne Koenig patient care ombudsman for Steward Health hospitals, including Sharon Regional Medical Center in Sharon, Pa., Trumbull Regional Medical Center in Warren and Hillside Rehabilitation Hospital in Howland.

“A patient care ombudsman is concerned only with the current and prospective care of patients during a Chapter 11 case,” the Monday evening court filing says. “Accordingly, this report does not review past actions or inactions by the debtors with respect to patient care. Instead, the report focuses on the care being provided to the patients by the debtors during these bankruptcy cases.”

Koenig visited each site with a nurse employed by SAK Management Services, a medical operations adviser. 

During each visit, Koenig “met with the relevant hospital’s leadership team, conducted a walk-through tour of each hospital and its buildings, and interviewed key professional staff and patients where possible,” the filing says.

The filing says Koenig found equipment in need of repair and dirty or cluttered kitchens at some of the Steward facilities. While staffing has proved challenging, she “did not observe any issues that made her believe patients were in immediate danger or otherwise receiving unsafe care due to staffing issues. The debtors are actively recruiting and filling vacant shifts with overtime, in-house travelers, and bonuses.”

Koenig visited the facilities in the Mahoning and Shenango valleys June 24 and 25.

Trumbull Regional

Koenig met with nurses in the emergency department who reported no issues with obtaining adequate supplies and equipment to do their jobs. The nurses said they assess their patients at least hourly – more, if necessary, according to patient status.

Senior leadership informed Koenig they were having difficulty hiring registered nurses, pointing to a shortage in the area.

“Regarding equipment issues, they have multiple elevators that are out of order and need to be repaired or replaced,” according to the filing. “They also have carpet in one of the mental health units that is soiled and needs to be removed. Ideally, an easy to clean surface should be installed.”

The carpet smells of urine.

Koenig reported several pieces of equipment not working in the kitchen department. That includes the dishwasher, two top ovens, one bottom oven, a garbage disposal, a refrigerator door, a cooler and a condensation drain.

The dishwasher doesn’t heat hot enough to sanitize properly, so it’s used only for kitchen trays. The kitchen uses disposable tableware – at a high cost.

“The use of disposable tableware is causing a huge financial discrepancy, as the cost for washing and sanitizing plates, cups, and silverware in-house is approximately $200,000 per year compared to $440,000 per year for disposable items,” the filing says. 

Also in the kitchen area, Koenig observed dirt and grime in the corners, food splatters and dirt and grime on the walls, debris on clean plates and on the shelf where clean plates are stored, food stains on equipment, missing knobs on equipment and overall dirty prep spaces and sinks throughout the kitchen.

After the areas were pointed out to leadership, those areas were deep cleaned, with photographs sent to Koenig. Kitchen staff were assigned areas of the kitchen to clean each night and directed to send photographs to leadership of what they had accomplished.

The ombudsman reported Trumbull Regional has, overall, “an engaged leadership team dedicated to providing excellent patient outcomes.” But the team is spread thin, she determined.

The chief nursing officer provides oversight to both Sharon Regional and Trumbull Regional. “The associate CNO is also the director of the ICU/cardiovascular director, the chief financial officer role is being covered by the interim regional chief financial officer, the financial director position is vacant. The quality director is regional, covering both the hospital and Sharon Medical Regional Center,” the filing says.

Sharon Regional

The president of Sharon Regional told Koenig that the main chiller unit is 45 years old and stopped functioning in May. The hospital has two rental units in place. The cost of a new chiller is about $409,000, and a state grant has been approved, which should cover the cost.

Staff members reported no issues with getting supplies or needed medications. But staffing for RNs is tight.

Koenig noted the kitchen space was clean.

“​​On the day of the visit, the ombudsman noted that the kitchen staff was well trained, as the tray line was flowing well, and everyone knew their role in the process,” the court filing says. “The dietary staff functioned like an expert restaurant kitchen staff.”

But she found nonfunctioning equipment at the hospital.

Its backup generator failed in December 2021. A bid to remove it and have it repaired totaled $690,000. “Steward determined it was cheaper to lease a temporary generator from Penn Power at a cost of $8,100 per month,” the filing says.

One elevator isn’t operating and can’t be repaired. It requires a complete rebuild. The hospital is waiting for a bid, but the contractor has “been slow to engage based on payment issues arising prior to and during the bankruptcy cases.”

Hillside Rehabilitation

The hospital is seeing an increase in referrals from the Cleveland Clinic even though that facility is an hour away as “rehab beds can be challenging to find and patients often choose to drive long distances to receive inpatient rehab care,” the filing says. “The hospital attributes this increase in referrals from the Cleveland Clinic to the work of their three liaisons [two staff and one manager].”

Hillside recently saw several nurses and nurse assistants leave due to the bankruptcy and to competitive wages offered elsewhere.

Regarding equipment, Hillside, like Sharon, has been using rental units. That includes two generators, one for about two years and one for about four months. Other rental equipment includes an air handler, a chiller, air conditioner compressor, freezer and a steamer.

Regarding staffing, a staff member told the ombudsman that Hillside is experiencing a nursing assistants shortage and that it’s believed to be related to low wages at the hospital.

“The staff RN told the ombudsman and her representative that they love the job and cannot imagine working elsewhere,” the filing said. The staff RN also reported no supply or equipment issues.

In the kitchen space, Koenig found “crumbs and different areas had signs of dried food on walls and tables.” Clean pots and pans were stored on shelves with crumbs.

One of the kitchen’s freezers was inoperable the day of the visit, and a rental unit was being used on-site, outside the building.

“It is a bit difficult to access this freezer and is a trip hazard for the staff,” the court filing says. “This issue causes a longer work process when the staff needs to quickly access the freezer for meal preparation items. This should be considered a temporary fix, and not the new normal for cold storage at the Hospital.”

The ombudsman found the tray line disorganized. She asked that the temperature of food be taken before it was served and found it “surprisingly low.” Most had to be reheated. The steam table wasn’t functioning properly.

“Ideal temperatures for hot food is 155 degrees or higher,” Koenig’s filing says. “On this day, the chicken casserole was 80 degrees. The green beans, pureed pizza and vegetable soup were also not meeting ideal temperature with measurements in the low 100s. The kitchen manager plans to provide an in service for the staff on food temperature issues.”

When interviewed by Koenig, a patient and that patient’s child were complimentary to Hillside staff and therapy department.

“The patient reported that the food was delicious, the housekeeping staff was wonderful, and the patient is progressing well during their stay,” Koenig’s filing says. 

Like in the other two Valley hospitals, equipment at Hillside isn’t functioning, so replacements are being leased. That includes generators, a kitchen freezer and air conditioner compressors. 

Two elevators, a chiller, air handler and steamer also aren’t functioning.

Overall, the ombudsman reported: “The staff seemed dedicated and they believe in getting people healed. The kitchen had a few issues but can be turned around with training and a few equipment purchases.” 

On July 20, Steward reported in a filing to the court that it received no qualified bids for the three local hospitals. Steward said it’s evaluating alternatives and would make an announcement at a later date. Steward operates 31 hospitals in eight states.

Copyright 2024 The Business Journal, Youngstown, Ohio.