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Failures in care
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Tenet's cost cutting, and des killing of nurses resulted in many allegations of poor care. This page examines this issue.
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Every attempt is made to provide accurate and well written material. Your contributions, suggestions, additional information and advice sent to the web address at the foot of the page are welcome. Where possible they will be included in revised pages.
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Oct 2002 Dangerous theatres
In addition, the hospital faces 106 malpractice lawsuits from former patients and families of patients who claim that unsanitary conditions at the hospital caused infections following open-heart surgery.
Twenty of the lawsuits, all of which have been filed since 2000, involve deaths, said West Palm Beach attorney Calvin Warriner, who represents all the patients in litigation.
Gardens hospital could lose Medicare certification Palm Beach Post October 25, 2002
Objective data about poor care comes from oversight by government agencies. As is well illustrated in aged care they are notoriously bad at detecting problems and very lenient. It has required community effort, angry patients or relatives, and whistle blowers to expose the extent of the problems. There are some glaring negative reports published about two Tenet hospitals by government inspectors.
The difficulties are that acute care hospitals treat a vast range of disease processes and easily measurable major adverse events like death are rare so do not show up early. It is difficult to find really comparable hospitals as hospitals often focus on different communities and have different areas of expertise. The data on which more detailed analyses depend is controlled by the hospitals.
The nurses have addressed the problems they are all aware of by comparing available figures for staffing levels and staffing skills with those for other hospitals, and with individual hospitals before they were purchased by Tenet, noting the trends. They compare the clearly demonstrated reduced staffing with the simultaneous increase in complex cases which need more nurses with greater skills. They contrast this with increases in Tenet's prices and executive remuneration.
The massive fraud investigations, the problems at Redding and perhaps the truncation of contracts and arrangements with doctors have changed the landscape in Tenet's empire. Doctors have taken their work elsewhere and Tenet has been forced to sell vast numbers of hospitals to find the funds to pay settlements and to cover huge losses. That it has skimped on money for care seems likely from some of the reports.
It has also been easier for doctors to come forward and speak out about this and about what had happened earlier. They were less likely to be victimised.
This page was written in July 2003. Additional extracts covering subsequent years have now been included.
Government oversight findings
The nursing unions
Doctor's speak out
Patients have problems
Failures in Oversight and Accreditation
Tenet Addresses Standards of Care
Nurses and doctors are prime participants in
the process of caring for patients. Most of what happens to patients
is mediated through them. Many of the positive and negative impacts
on care come through corporate influence on these groups.
Nursing is the largest cost for hospitals. Profits come from underpaying, understaffing, overworking, de-skilling, and using large numbers of agency nurses. All of these compromise care, increasing complications and mortality.
Poorly paid nurses have unsatisfactory working conditions, are unhappy and are most strongly motivated to speak out. Nurses are closer to patients and more aware of treatment failures. Hospital executives have generally targeted individuals who speak out. This has driven the nurses into unions who act for them. It is no coincidence that the first and most of the subsequent complaints have come from the nursing unions. They have carried out studies of care using available data. They have used these to drive industrial action to improve the conditions of their members and the service given to patients.
Companies have responded by attacking the
messenger rather than the message, claiming the complaints are self
serving and obviously this is so. They have seldom challenged the
unions by examining their figures and producing independent figures
of their own. In the majority of instances in the past the unions
have been accurate in their assessment and well motivated in their
actions. They have been particularly scathing about Tenet's
Corporate interest in doctors in contrast is
in inducing them to admit more patients and increase their use of
profitable corporate services in the hospital. It pays them to have
mutually beneficial relationships with doctors and keep their bums in
the butter. We should not be surprised that doctors are less vocal in
To make this more coherent I will deal with the union disputes and the relationship with doctors, which allegedly led to unnecessary surgical procedures, separately on other pages. These pages address the failures in care that are linked specifically to the corporate impact on these professionals. I will only deal with what has been said about levels of staffing and standards of care here.
Government oversight findings are seldom published in the press and then only while reporting major crisis or spectacular legal proceedings. There are a few reports about the more startling findings in a number of Tenet hospitals. What they reveal is disturbing and this is very likely to be the tip of an iceberg.
Cardiac Surgery in Florida
The allegations about Palm Beach Gardens Hospital's cardiac surgery unit in Florida are terrifying. The company has consistently denied the allegations made. A large fine by regulators and a US $31 million settlement with 106 patients who developed serious complications give credence to the findings of authorities. Sixteen of the patients had died. The travesty of Tenet's denials and its lack of frankness were exposed when their own documents confirming the allegations about insects became public.
Among the adverse findings there were major failures in cleanliness probably due to understaffing. There was a plague of insects in the operating theatre over a 5 year period. This is an absolute no no in an operating theatre and should never occur.
A consultant identified the cause of the insect problem in the theatre roof and advised a costly remedy. This would have meant losing money by closing the theatres for major renovation work. Tenet fired the bug exterminators who employed the consultant and appointed another firm. This was another example where financial considerations took precedence over care and the risk to patients. During this period the company was generating huge profits and its share price was spiraling.
This particular scandal gives considerable insight into Tenet's profit before care culture, the failures in the oversight process in the USA (and probably Australia), the dysfunctional nature of the marketplace, and the failure of the medical profession to protect their patients from the company.
I have therefore devoted a separate page to it.
Click Here to go to the Palm Beach gardens web page.
The Queen of Angels Hospital
In California, the Queen of Angels hospital, a not for profit purchased by Tenet in 1998 has repeatedly been in trouble because of inadequate staffing in high acuity units where staffing is critical for patient safely. This is contrasted with the increase in prices during that period.
Nov 25 Hospital deteriorates
Coalition members pointed to the impact of the sale of non-profit Queen of Angels-Hollywood Presbyterian Medical Center to Tenet in 1998 as an example of the consequences for patients and consumers. Since Tenet's acquisition, the hospital has been cited for: -- Violating federal conditions of participation in Medicare/Medicaid programs; and-- Unsafe staffing in oncology, medical-surgical, ICU, labor and delivery, direct observation and telemetry units. In addition:-- Direct patient care staffing hours have been cut 37%;-- Pricing has increased 78%; and-- The value of the charity care commitment that Tenet gave to the Attorney General when it bought Queen of Angels has fallen78%." Coalition for Quality Health Care Calls on California Attorney General to Stop Sale of Norris Hospital to Tenet Healthcare Corporation -- Coalition Says Sale is "Risky Scheme" and a "Sweetheart Deal" That Could Threaten Future Cancer Research and Endanger Patients BUSINESS WIRE November 25, 2002
SouthPointe and Forest Park hospitals
Southpointe in Missouri seems to have been a recurrent offender. Although it claimed to have fixed the earlier problems in 2000, the report suggests it was failing in its duty of care again four years later.
Oct 2002 Hospital sited
Two years ago, Missouri cited Tenet for failing to supervise patients at SouthPointe and Forest Park hospitals in St. Louis. Carey Smith, deputy director of the division of health standards and licensure of the Missouri Department of Health and Senior Services, said Tenet corrected the problems, which did not result in any serious injuries to patients, and was now in compliance.
Concerns about HCA and Tenet focus on questions of patient care, hospital staffing, potentially higher charges and the possibility of hospital closings.
Service Employees International also alleges Tenet spends inadequate amounts on staffing and patient care (denied by Tenet)
Bidding for Kansas City, Mo.-Area Insurer Comes Down to HCA, Tenet Healthcare. The Kansas City Star October 13, 2002
Mar 2004 A large settlement
Southpointe Hospital, St. Louis, will pay the fourth-largest EMTALA settlement to date -- $100,000 -- for four cases in which it allegedly failed to appropriately screen, stabilize or transfer patients whose various complaints included dizziness, depression, lacerated wrists, high blood pressure, rape and a blood-alcohol content five times the legal limit. A spokesman for Tenet Healthcare Corp., which owns the 281-bed hospital, declined to comment. The highest settlement for violations of the 1986 Emergency Medical Treatment and Active Labor Act, better known as EMTALA, was $148,000, paid by the 447-bed University of Kansas Medical Center, Kansas City, in 1999.
Hospital to pay fourth-largest EMTALA fine ever Modern Healthcare's Daily Dose Mar. 10, 2004
Florida Medical Center
Tenet (then called National Medical Enterprises or NME) was involved in a massive scandal in the early 1990s. This involved the unnecessary and deceptive admission of many hundreds of children and many adults to psychiatric hospitals when they did not need psychiatric care. Children were specifically targeted. Some were kidnapped. They were kept for long periods and subjected to vast amounts of unneeded treatment. Many were harmed. Tenet pleaded guilty to criminal conduct and paid out in the region of $1 billion in settlements.
In spite of the new scandal in 2002 the reports indicate that Tenet reverted to past practices. This time it targeted the elderly in nursing homes who because of dementia or infirmity could not give consent and so could be involuntarily admitted to psychiatric facilities.
Feb 2005 Deja vu in Psychiatry
The Florida Department of Children and Families has cracked down on the psychiatric unit of Florida Medical Center, a Tenet-owned facility in Lauderdale Lakes, for improperly admitting patients -- particularly the elderly -- against their will. In a letter sent to the hospital Monday and obtained by TheStreet.com, the agency officially barred the unit from future involuntary admissions. The department said it was investigating the hospital for Medicare and Medicaid fraud, violation of patient rights and "unacceptable clinical practices."
The Tenet Shareholder Committee, a group long critical of company management, expressed a sense of deja vu.
On Jan. 26, the Miami Herald reported that state officials had begun examining allegations that Florida Medical Center had "routinely violated the rights of psychiatric patients -- some of them frail elderly people -- by holding them against their will." The newspaper went on to say that critics had even accused the psychiatric unit of admitting one elderly patient directly from hospice care.
In its letter this week, the Department of Children and Families expressed particular concern about the unit's elderly patients. It noted that the unit's admissions among that age group were roughly twice the state average. And it cited numbers showing that most admissions throughout the unit were conducted on an involuntary basis.
Moreover, the agency raised questions about the involuntary admission of patients who were simply "confused," "paranoid" or "agitated."
Since then, Skolnick has identified the unit as a clear moneymaker. - - - -
"If they were taking somebody from a nursing home knowing that they have no legal justification to do so, and they were doing it to make a profit, that's kidnapping," Howard Finkelstein, a public defender who represents psychiatric patients, told the Sun-Sentinel on Tuesday. "It's that simple."
Peter Young, a business consultant at HealthCare Strategic Issues, worries that the situation could grow even worse. He believes that other Tenet-owned hospitals may have referred patients to the psychiatric unit in order to maximize company profits. Thus, he sees the possibility of an "intentional organized scheme" that extends far beyond a single facility.
Florida Probes Tenet Hospital The Street.com (Melissa Davis) February 17,2005
Death rates for Cardiac Bypass Surgery
State officials in California examined the death rates following cardiac surgery across the state for 2003. The four worst performers were Tenet hospitals. This is costly surgery and this is what you would expect when a company was either taking too much profit away from care (eg less nurses) or was in financial difficulties and compromised their duty of care in order to survive.
Mar 2006 Too many cardiac surgery deaths
For the first time, state officials on Tuesday released information on death rates for all California hospitals that perform cardiac bypass surgery, a sign of the increasing pressure on medical centers to be accountable to patients.
The data, which cover the 2003 calendar year, show that three of the four hospitals with the worst records are in Southern California.
All four were owned at the time by healthcare giant Tenet Healthcare Corp., although one has since been sold.
Two of the hospitals - Alvarado Hospital Medical Center in San Diego and Desert Regional Medical Center in Palm Springs - have been flagged by the state for poor performance in the past.
The other low-performing hospitals in 2003 were Centinela Hospital Medical Center in Inglewood and Doctors Medical Center of Modesto.
- Alvarado Hospital Medical Center, San Diego; Surgeries (83); Deaths (6) Expected deaths* (2)
- Centinela Hospital Medical Center, Inglewood; Surgeries (105);Deaths (7);Expected deaths* (3)
- Desert Regional Medical Center, Palm Springs;Surgeries (146); Deaths (9) Expected deaths* (4)
- Doctors Medical Center of Modesto;Surgeries (426); Deaths (16) Expected deaths* (9)
State Ranks Hospitals by Cardiac Bypass Death Rates : Three of the four medical centers with the worst records are in Southern California. The study covers 121 facilities. LA Times March 22, 2006
Liver Transplant results
Liver transplants are also cost and staff intensive services. Substandard results were found in a number of units which then closed their transplant units. It is not surprising to find that the university hospital run by Tenet at USC was found to have a very high death rate.
Jul 2006 Deaths after liver transplants
The liver transplant program at USC University Hospital in Los Angeles has one of the highest death rates in the nation, with twice as many patients as expected dying after their surgeries, according to data released this week.
The most recent statistics show that 38 USC patients who received new livers from January 2003 to June 2005 died within a year of surgery - 19 more than expected, according to the Scientific Registry of Transplant Recipients. The agency, which analyzes data on behalf of the federal government, determines the expected rate for each center after adjusting for such factors as patient age and condition and organ quality.
The troubles at USC follow scandals that forced the closure of two other liver transplant programs in Southern California last year: at St. Vincent and UCI medical centers. But USC's reach is far greater: It performed 92 transplants last year, about three times as many as St. Vincent and UCI combined did in any recent year.
A review by The Times shows that the one-year survival rate at USC's liver transplant center, the third-largest in the state, steadily dropped since at least 2002, hitting a low of 75.8% in the new report. That is far below the U.S. average of 86.6%.
USC Center Is Latest With Transplant Woes : University Hospital has among the nation's highest death rates for those receiving new livers, data show. The state plans to investigate. LA Times July 13, 2006
Nov 2002 Union criticises Tenet
In a full-page ad Sept. 23 in The Kansas City Star, the union (Service Employees International Union) alleged that Tenet closes hospitals, drives up prices and "buys and sells hospitals as if they were pork bellies."
Bidding for Kansas City, Mo.-Area Insurer Comes Down to HCA, Tenet Healthcare. The Kansas City Star October 13, 2002
The nursing unions have over the years tried
to negotiate improved staffing, better pay and better care with
corporations and in particular with Tenet. The iron fist behind
Tenet's kindly facade soon appears. Prolonged and bitter
disputes with long strikes have been the inevitable result.
It is likely that Tenet's board and executive had little grasp of the consequence of their cost cutting policies. Corporate boards are made up of financiers, turn around experts, accountants, bankers, successful businessmen from companies like Toys R Us and people who have made their name franchising hotels.
Tenet's board room policies of cutting costs impacts directly on the nurses. Nurses have used their knowledge and concerns about care and staffing as grounds for industrial actions to counter these policies. The nurses attitudes have hardened. It has generated bad publicity. The nurses have make significant gains as Tenet has been forced to give way. The policy may have been very bad business.
I will deal with the actual strikes later and with the way Tenet handled these. This section looks only at the complaints about care
Tarzana, California 1998
The strike was about Tenet's refusal to implement safety procedures for its nurses and its patients. The nurses describe how a nurse was harmed because Tenet saved money by refusing to move at risk patients and staff during hazardous renovation work.
Oct 1998 Disregarding safety
Tenet is refusing to agree to contract language that would require the use of safer medical devices to protect workers from contracting bloodborne diseases, such as HIV and hepatitis. The union is also seeking the right to file grievances when there is short staffing.
The company's disregard for safety came to light on Friday, October 9, when the California Department of Health Services shut down the pediatrics unit to patients and employees because of exposure to toxic fumes during remodeling. A registered nurse suffered serious breathing problems from the exposure. She had to be treated in the emergency room and admitted to the critical care unit.
Union Representative Bob McCloskey said, "This lack of concern for patients and employees shows that Tenet's bottom line is profits. They could have easily taken the necessary precautions to prevent this unfortunate incident but didn't want to spend the money to move the patients out while using toxic substances.'' Nurses Vote to Strike Again at Tarzana PR Newswire October 15, 1998
Nov 1998 Call to put some profits back into care
Registered Nurses and other professionals from Tarzana Medical Center will call for the removal of the Tenet Healthcare Corporation [NYSE:THC - news] Board of Directors at a protest at Tenet headquarters in Santa Barbara on November 9, 1998
We work very hard to give quality patient care and often have too many patients to take care of,'' said Union President Anne Clarke. "This board needs to put some of Tenet's $500 million in profits for this year back into patient care and the employees that make our hospital work. When Tenet took over our hospital, we took 6% pay cuts - - . Tarzana Nurses Target C.E.O. Press Release: Local 535 SEIU November 6, 1998
Worcester, Massachusetts 2000
The nurses had been negotiating for 2 years and had hit a brick wall. Tenet insisted on an unrestricted right to force nurses to work mandatory overtime of up to two shifts (16 hours) continuously without any say in this. The nurses thought this was a threat to patients and intolerably unfair, particularly to nurses who had families and children. The nurses believed that this was simply a ploy so that Tenet could under-staff the hospital. Over the years the nurses had made large numbers of formal complaints about inadequate staffing.
Mar 2000 Dangerous conditions
The nurses have been negotiating two years for an initial contract with Tenet. The strike has pivoted around issues of working conditions that the nurses contend are dangerous to patients, such as mandatory overtime.
Tenet wants the right to require nurses to work double shifts, but the nurses argue that tired, overworked nurses could slip up on the job and that Tenet should hire more nurses to handle the workload.
St. Vincent Hospital will remain open during strike :: Nurses torn over care for patients, principles Worcester Telegram & Gazette March 31, 2000
Apr 2002 Consequences for staff of becoming for-profit with Tenet.
Nurses who began their careers decades ago working for a nonprofit institution, St. Vincent Hospital, now find their fates tied to an out-of-state company.
And although the role of nursing has not changed, the work environment has changed, both nurses and administrators acknowledge.
Charles J. Idelson, a spokesman for the California Nurses Association, that state's largest nurses association, said, "Tenet is emblematic in what is going on with health care today. You have a huge corporation whose primary interest is not the health care of patients, but the profit they can generate for Wall Street investors."
As the nurses union negotiated with the hospital for a contract the past two years, the hospital has been deluged with staffing complaints from nurses.
The MNA reports the hospital is the subject of more formal complaints filed by nurses about "unsafe staffing" than any other hospital in the state where it represents nurses, Ms. Craven said.
"There is a trend to replace nurses at the bedside," Ms. Cardoza asserts.
Patient care assistants, or PCAs, who once were called orderlies, do more bedside care in today's health care world, both sides said. These unlicensed, lower paid employees have been given expanded duties.
Mandatory overtime, 'flex' hours top nurses' issues :: Heath care trends trouble nurses in for-profit hospital businesses Worcester Telegram & Gazette April 3, 2000
Apr 2000 Public's sympathy
Talking with people about this strike and perusing readers' comments on the issue, one senses a level of sympathy for the nurses that goes beyond the presupposed labor union support, beyond even the goodwill one expects the public to feel toward nurses.
It may be simplistic, but in this anonymous age of HMO "gatekeepers," when the doctor is a "provider," the patient a "consumer" and health care something that is "delivered," nurses represent for many of us the human face of medicine.
St. Vincent move reflects critical shift :: The face of health care growing more impersonal Worcester Telegram & Gazette April 5, 2000
Apr 2000 Impact on care
Sandra A. Ellis, a leader of the striking St. Vincent nurses, told the Legislature's joint Committee on Health Care that Tenet's for-profit approach is lowering patient care standards and putting nurses' safety at risk. Yesterday was the 19th day of the nurses' strike against Tenet.
An "alarming factor in Tenet's pursuit of profits at the expense of patient care is the diminished availability and cheapening of basic patient care and medical supplies," Ms. Ellis said. "Its emphasis is on satisfying its stockholders, rather than providing the highest quality of patient care."
"St. Vincent Hospital is gone. Tenet has destroyed the institution that was once renowned for its close ties to the community and its service to the people of Worcester, from cradle to grave," Ms. Ellis said.
"Our community hospital was once focused on providing excellent patient care. It is now known as a money 'saving' and 'making' machine," she said. Striking nurses blast hospitals :: For-profit health care is scorned Worcester Telegram & Gazette April 19, 2000
San Roman hospital California 2001
Oct 2004 Massive care violations 3 years ago
But three years ago, nurses there complained about understaffing and sought to unionize. Diane Ganzell, CEO of the hospital, failed to calm the storm and departed after less than two years on the job. Just weeks later, a powerful nurses union alleged "massive care violations" at the facility. The California Nurses Association claimed that health officials had cited San Ramon for, among other things, failure to both adequately staff operating rooms and dispose of outdated or mislabeled drugs.
Tenet Doctor Probe Widens The Street.com (Melissa Davis) October 13, 2004
Californian Nurses 2002
The nursing unions had been in ongoing
disputes and negotiation with Tenet about staffing levels,
de-skilling, patient care, agency staff, and pay over the years. They
were in conflict again in 2002. The nurses seized the opportunity
presented by the many reviews of Tenet's practices to give evidence
and expose the extent of Tenet's failures in staffing and care. They
presented papers to a government review investigating whether Tenet
had exploited Workers Compensation, and to a similar investigation by
a Californian Retirement Fund Health Benefits organisation.
This was a company which had deliberately marketed itself as providing more major and complex therapies to more sicker and older people. One would have expected them to increase both the number and the quality of trained staff. They would reduce the number of agency staff who would not be familiar with the protocols and nuances required for the more complex technology and protocols.
The unions knew this was not so. They commissioned an inquiry based on government figures to look at what Tenet had done with staffing. They took these disturbing figures to government inquiries and to the public in a report. Tenet denied their findings.
The nurses pointed to the cries for economic review and oversight and stressed the need for attention to standards of care as well. They organised for out of state experts to conduct a review of staffing practices at Tenet hospitals using publicly available data. Tenet energetically denied its validity but did not attempt to dispute the staffing issues with verifiable data.
Dec 2000 Impact on care
Tenets aggressive profit-making strategies have also hurt:
- Consumers who are paying inflated prices for hospital care;
- Taxpayers who bear the burden of extraordinary Medicare reimbursements;
- Communities at large who are seeing hospitals close; and
- Patients whose care is compromised.
Tenet Healthcare Corporation: The Untold Story SEIU web site Dec 2002
Dec 2002 Understaffing causing more deaths in Tenet hospitals
Tenet Healthcare Corp. (THC), already facing federal inquiries into its Medicare billing practices, is the subject of a study by a major health-care labor union that condemns the company's nurse-staffing practices.
Nurses, patient advocates and health-care union leaders with the Service Employees International Union, or SEIU, held a press conference in downtown Los Angeles on Thursday to release the study, called "Tenet Hospitals: Corporate Conduct Puts Patients at Risk."
The study points out how cost-cutting practices by Tenet have been so aggressive that mortality rates have risen slightly in comparison to hospitals not run by Tent. The SEIU study says the root of the problem is a disproportionately lower number of nurses, compared with non-Tenet hospitals, and an increase in temporary nurses who are unfamiliar with a hospital's culture.
There is additional risk of two patient deaths per 1,000 admissions to medical-surgical units due solely to the staffing level, the study says.
"This is an organization that is apparently robbing the public purse on the public side, and at the same time is providing very poor patient care," said Howard S. Berliner, a professor of health-care management and policy at the New School University of New York who acted as a consultant on the study.
In an interview with Dow Jones Newswires prior to the press conference, Berliner said the study also is critical of California's Department of Health Services, which lacks enforcement powers, staff to investigate cases, and the power to impose penalties and fines when problems are uncovered.
Union Says Tenet's Low Staffing Puts Patients At Risk excerpts from the Wall Street Journal, 12/12/02 From the SEIU web site Tenet Monitor Accessed Dec 2002
Dec 2002 Tenet Hospitals: Corporate Conduct Puts Patients At Risk (Note that these are hospitals which are specifically targeting older and sicker patients and complex high risk procedures.)
Nursing staffing levels matter to patient outcomes. Current medical research documents that there is a strong correlation between inadequate nurse-to-patient staffing levels and patient deaths, hospital-acquired infections, falls, and medication errors.
In Los Angeles, Tenet hospitals provide 20% fewer hours of direct patient care per adjusted patient day than non-Tenet hospitals, - - - In California, Tenet hospitals patient care hours fall 14% short of non-Tenet hospitals:- - - -
- - - Thus Tenet hospitals spend 30% less than non-Tenet hospitals in Los Angeles on labor costs, and 26% less than non-Tenet hospitals statewide.
Patient care hours before and after Tenet ownership Tenet bought ten hospitals in Los Angeles County between 1995 and 1998. The mean change in patient care hours for all ten hospitals was a decrease of more than 15%.
The hospitals patient care staffing system violated California law - - - - DHS found that patient care staffing levels at Tenets Queen of Angels failed to meet the standards for patient care set in California law and regulation.
DHS found, - - - - that the hospital repeatedly failed to provide adequate nursing care even when measured against Tenets own staffing policies. Indeed, on the Oncology and AIDS units, for example, patient care staffing levels were below those set as the minimum levels by Tenet on more than half the shifts surveyed.
As a result, DHS concluded its second investigation with this sharply worded critique: "The facility failed to address the current severe, ongoing staffing shortage in a meaningful way to provide safe/adequate nursing care to its patients. Facility management staff denied that the facility had a serious staffing problem
According to a retired Tenet hospital executive, - - - - the number of allowable "hours per patient day" per unit was also dictated from the corporate level.
The Chicago Tribune reports that in Illinois, state disciplinary records show that temporary nurses have increasingly been the focus of medical error investigations which turn out to be related to a lack of knowledge of hospital procedure or unfamiliarity with patient ailments."
Up to now, public attention has focused largely on Tenets pricing scandals. Now it is time to devote equal scrutiny to the patient care side of the picture.
Tenet Hospitals: Corporate Conduct Puts Patients At Risk SEIU report December 1, 2002
Dec 2002 Tenet attacks the union report
Tenet Healthcare Corp., Santa Barbara, Calif., dismissed as a union-organizing ploy a 30-page report, issued last week by the Service Employees International Union, that criticized the quality of care at Tenet hospitals.
The report, Tenet Hospitals: Corporate Conduct Puts Patients At Risk, was authored by Howard Berliner, a professor of health services management and policy at the New School University in New York.
"Our analysis shows that with increased nurse-patient ratios, fewer nurses caring for more patients, we can likely see an increased number of deaths at those hospitals that are inadequately staffed," Berliner said.
SEIU alleges Tenet staffing levels may put patients at risk Modern Healthcare December 16, 2002
Dec 2002 Tenet claims to support more nurses
"At the same time, we are committed to maintaining the important educational mission of the School of Nursing," added Wolfman (for Tenet). "At a time when hospitals across the country are impacted by a severe shortage of nurses, Tenet has made a commitment to make its hospitals the preferred places to work for nurses. Tenet strongly supports efforts to increase the number of new nursing graduates entering the profession."
Tenet Completes Acquisition of Roxborough Memorial Hospital BUSINESS WIRE December 18, 2002.
Jan 2003 Testimony presented to the Senate Industrial Relations Committee
I was asked by the Service Employees International Union (SEIU), - - - - - to conduct an analysis of the impact of Tenet Healthcare Corporations practices on the California Workers Compensation Insurance system and the CalPERS Health Benefits program.
My testimony will focus on Tenet Hospitals and utilization manipulation. This is one of the three principal strategies Tenet Healthcare Corporation has employed to maximize profit by increasing revenues while cutting costs to the bone.
Second, and worse, it (utilization manipulation) puts patients at risk of unnecessary procedures and tests so that providers can make more money. Some patients may simply experience unnecessary anxiety and discomfort as they undergo the unnecessary medical procedures. For others, however, the consequences will be much worse. Admission to a hospital for a surgical procedure exposes otherwise healthy individuals to potentially deadly infections. The Centers for Disease Control have estimated that patients suffer nearly two million hospital acquired infections annually. Experts warn that increasing reports of unsafe staffing levels and "downsizing of infection control departments" contribute to the threat facing hospital patients.
Tenet Hospitals and Workers Compensation in California: Utilization Manipulation: Testimony presented to the Senate Industrial Relations Committee January 15, 2003 Tom Moore, Jr., Consultant on Health Policy and Programs Service Employees International Union
Jan 2003 Tenet denies
The idea that Tenet gets double the rate of worker compensation payments than that received by other hospitals in the state, as suggested by the testimony of others that appeared before this committee, is far-fetched. :
Tenet Offers Testimony at California Senate Committee Hearing Company Seeks Regulatory Change to Reduce Influence of Gross Charges From Tenet Healthcare web site January 15, 2003
As Tenet's profitability, its credibility and its hold on doctors were eroded some doctors started to speak out about some of the practices at Tenet hospitals and also about standards. Two doctors claimed that their hospitals were allowed to deteriorate.
North Ridge Medical Center in Florida
Jan 2005 Tenet has lost its clout
Dr. Ali R. Ghahramani, a Fort Lauderdale cardiologist and outspoken Tenet critic, said not enough is being done to ensure quality at a Tenet-owned hospital where he has practiced. North Ridge Medical Center once regularly drew patients from across the state and overseas, he said.
Since Tenet took over North Ridge 10 years ago, the center has lost its clout and credibility, and Mr. Fetter has not done enough to restore it, Dr. Ghahramani said.
"All they want to do is make money. The quality went down. It's so sad to see the place fall apart," he said.
Tenet officials disagree.
"Dr. Ghahramani's opinion does not represent the thinking of the vast majority of affiliated physicians at North Ridge. The commitment to quality has, and is, making a measurable, demonstrable difference in the quality and efficiency of care at North Ridge and our other hospitals," the company said.
Tenet faces tough road to recovery. CEO knows his hands are full as hospital chain moves to Dallas The Dallas Morning News January 1, 2005
Houston Northwest Medical Center
Aug 2005 A hospital going nowhere
But these days, the busy surgeon (Phillip Sutton) thinks twice. He looks around Houston Northwest Medical Center -- a hospital prized by its previous owners -- and feels ashamed.
"It's old," Sutton says. "It's worn-out. Tenet really needs to invest about $100 million more just to update it.".
Problems at Northwest highlight the issues Tenet must address as it tries to steer its way through a lengthy turnaround.
Some doctors say Tenet has never spent enough on hospital maintenance, and that the company has alienated physicians who can choose to send their patients to more updated facilities operated by competitors. T
Back in the late 1980s, The New York Times portrayed Houston Northwest as "an institution much admired in the industry for its superb staff and profitability." It went on to describe Houston Northwest as a "crown jewel" that, by itself, produced 25% of the earnings for a hospital chain that operated 56 facilities at that time.
That hospital chain, which would change its name to OrNda before going on to merge with Tenet, found itself celebrating when it regained full control of the facility -- after buying out its own employees -- in 1995.
By early 1997, however, OrNda -- along with its star hospital -- had been acquired by Tenet. And Sutton began to feel the hospital's purse strings tighten just a few years later.
At one point, he says, physicians there actually threatened to tell the Joint Commission on Accreditation of Healthcare Organizations -- the agency that inspects hospitals -- in order to convince Tenet to spend some of the hospital's generous cash flow on long-promised improvements.
Tenet's Fraying Ties to Doctors The Street.com (Melissa Davis) August 23, 2005
Gardens Grove Hospital in California
The chief of surgery at this hospital resigned and spoke out when he found that staff had been prohibited from telling him that the sterilizers were malfunctioning in case he cancelled surgery.
This is on a separate web page.
Click Here to explore what happened.
It has frequently required concerted action by individual patients, their families or activist groups to expose and initiate action. In some of the matters described above (eg Palm Beach Gardens) actions by patients have driving forces in exposure, Redding Hospital is the most spectacular example.
The Redding Hospital Scandal
A US $500 million settlement involving over 700 patients at the Redding hospital was exposed by a patient who became a whistleblower. These patients produced evidence to show that they had been subjected to risky coronary artery bypass surgery when it was not required. This provides a fascinating insight into the way Tenet's policies and practices impacted adversely on care.
Click Here to explore what happened in Redding
One or two law suits against a hospital says little. I picked one up because the allegations relate to Tenet's cost cutting and if the allegation is valid then the delay was unacceptable. There may of course have been other factors not disclosed. The other relates to a suicide by a determined patient but it should not have happened.
May 2005 Obstetric death
Today, attorney Rhonda Wilson argued Rosalyn (32 year old obstetric patient) waited more than an hour for a transfusion. In the meantime, her brain had been severely damaged.
Wilson alleged what occurred was not an accident, but the result of cost-cutting measures by Hahnemann's owner, Tenet Healthcare that allowed unqualified and unsupervised personel into the operating room.
Today's trial stopped abruptly Tuesday afternoon as Hahnemann moved to settle the malpractice case behind closed doors.
Medical Malpractice Case Against Hahnemann Hospital Settled 6abc Action News - Local News 6abc.com May 2, 2006
Feb 2007 A suicide case
The Circuit Court jury decided the hospital, owned by Dallas-based Tenet Healthcare Corp., was responsible for the death of Vaughn Hollon, who was 53 in October 2003 when he was admitted as a suicide risk. Brookwood spokeswoman Debbie Hollenstein said the hospital did nothing wrong and intends to appeal the verdict.
Hollon died after he scaled a fence in an outdoor area of a psychiatric ward at the city's second-largest hospital. He broke both legs after the initial fall onto a parking deck. He was killed by a second jump that sent him plunging 80 feet to the ground after escaping the grip of a nurse who tried to restrain him.
The $12 million in punitive damages is the largest civil judgment in Alabama so far this year
Hollon had been in Brookwood's care for about 48 hours when he climbed the fence, court documents said.
The attorneys presented evidence and testimony during the two-week trial that attempted to show Brookwood breached the accepted standard of care for worker training, staffing levels and security procedures. They also argued the wrought-iron fence with metal bars that Hollon climbed was not within the accepted standards for a mental-health center.
She (Hollenstein) also said the hospital workers "acted heroically" to save Hollon's life, which included putting their own lives in danger to keep him from killing himself.
Brookwood loses suit in patient's suicide The Birmingham News February 16, 2007
By 2006 Tenet had had plenty of time to sort out its hospitals and ensure that proper processes were in place. Disturbing if conflicting allegations about the judgments made and the procedures followed in the harvesting of a donors organs in a Texas hospital. At the least it seems that processes were not followed.
The mother of a San Luis Obispo man who died after an attempted organ donation at Sierra Vista Regional Medical Center last year claims she never gave hospital officials consent to take her son off life-support and was misinformed when agreeing to the organ harvest, according to a wrongful death lawsuit.
Ruben Navarro was brought into the operating room at 11 p.m. Feb. 3, 2006, and his breathing tube was removed. But he did not die within 30 minutes - the window during which organs could be harvested. He died nine hours later, according to the lawsuit.
An operating-room nurse reported that standard medical procedures weren't followed when Navarro was taken off life support.
Suit claims no consent to end of life The Tribune News Jul. 4, 2007 http://www.sanluisobispo.com/news/local/story/84132.html
Dr Pearce and his group of shareholders had tried to unseat Barbakow and do something about its problems and their impact on care. He made the point forcefully again in 2002. Newspapers interviewed people and looked themselves.
Dec 2002 Wall Street Medicine and care
Because of Tenet's reliance, in part, upon the alleged over utilization of cardiac surgical procedures and its focus on the bottom line, too many Tenet patients are dying, or experiencing unnecessary morbidity;
How many of the 167 deaths of Medicare patients at Redding under the care of Drs. Moon and Realyvasquez were avoidable? The allegations, respecting the Redding Medical Center and the infection problem at Palm Beach Gardens clearly demonstrate, if true, systematic failure of quality controls at some of Tenet's hospitals. How many more Tenet hospitals are putting their patients at risk? How many people must die before the Board puts an end to the current culture of profits over quality patient care? I have been a licensed physician for over 47 years, and I'm appalled at the apparent systemic disregard for public safety.
How much longer will you embrace Wall Street Medicine and its spurious earnings to the detriment of quality care?
Two years ago, we asked to meet with the Board to discuss very serious governance and quality of care issues.
Letter to Tenet's board by Dr Pearce December 2002
Jan 2003 Threatens to cut costs further
Barbakow admits Tenet will have to cut costs. That infuriates many employees, who say Tenet is already too tight-fisted. For example, to save money, it has been slashing hospital cleaning staffs and outsourcing much of the janitorial work. Cleanliness has declined as a result, critics say. "Our operating rooms weren't scrubbed down or sanitized often enough," says one former Tenet administrator, who asked not to be named. Responds Tenet's Anderson: "We flatly and vehemently deny it. We meet all the federal and state guidelines for cleanliness and infection control."
Tenet's Prognosis: Lots of Complications BusinessWeek magazine NEWS ANALYSIS JANUARY 13, 2003
The Tenet debacle is an excellent example of the way oversight and accreditation has failed over and over again. This material has now been incorporated in a new page.
Click Here to look at how the JCAHO failed to address the problems in Tenet hospitals.
In the midst of the outcry about what was happening in its hospitals Tenet once again went through the ritual of claims and processes about its "quality of care". The ritual of industry (rather than medical) assessments, senior appointments, compliance processes, ethical commitments and government oversight are similar to those made following the 1990s scandal. Given the outcome following similar processes and the elaborate claims made in the 1990s we should not expect a change in behaviour after this new round. There is no evidence that Tenet's culture and profit focus has changed in any way. If they did then Tenet would have little chance of survival in this ruthless marketplace. It is trying hard to claim that its hospitals provide good care.
Jul 2003 Quality Initiatives
Tenet Healthcare Corp., Santa Barbara, Calif., said it will participate in two voluntary quality initiatives, including a program pushed by the hospital industry to head off a proposed Medicare rule requiring publication of patient survey results. Tenet said 111 of its 114 hospitals -- three aren't eligible -- will collect and make public performance data related to three medical conditions as part of the hospital industry-backed effort. Tenet also will take part in the 2003 survey being conducted by the Leapfrog Group, a business-supported organization devoted to improving healthcare quality. Tenet said all but 14 hospitals, which the company has slated for sale or closure, will participate.
Tenet commits its hospitals to quality efforts Modern Healthcare's Daily Dose July 21, 2003
Jul 2003 Fetter's commitment. Is it real?
Trevor Fetter, president and acting CEO of Tenet, said the company is "committed to taking a leadership position in our industry" on the issue of quality of care.
Tenet To Take Part in Second Leapfrog Group Quality of Care Study Taken from www somewhere July 2003
July 2003 Appointment in clinical quality
"In my mind, there is only one sustainable strategy for health care providers, and that is a relentless emphasis on quality," Trevor Fetter, the acting chief executive, told shareholders.
Nurses from the union picketed outside the meeting and nearly monopolized the question-and-answer session inside, saying quality would not improve until the company hired more nurses and paid them better.
Calling Tenet's new quality initiatives "lip service to sound good to the shareholders," Sherri Stoddard, a nurse at Sierra Vista Regional Medical Center in San Luis Obispo, Calif., said: "The place to start is at the bedside. We have been so unable to provide quality of care because we are told `We have budget constraints, we have budget constraints.' "
Tenet said its new senior vice president for clinical quality is Dr. Jennifer Daley, who had senior positions in quality-related functions at Beth Israel Deaconess Medical Center and Massachusetts General Hospital. Lauren Arnold, from the University of Pennsylvania Health System, was named vice president for nursing.
Tenet Vows Improvements in Patient Care New York Times July 24, 2003
Jun 2005 Joining a quality campaign
Tenet Healthcare Corporation (NYSE:THC) announced today that it has joined the Institute for Healthcare Improvement's "100,000 Lives Campaign" as part of the company's overall ongoing Commitment to Quality initiative. The 100,000 Lives program is an unprecedented effort to implement health care techniques proven to prevent avoidable deaths and save lives. All 69 hospitals owned or operated by Tenet subsidiaries are participating.
"Quality is the centerpiece of our business and health care strategy, and we have already been making great strides in the majority of IHI's recommended implementation strategies," said Jennifer Daley, M.D., Tenet's chief medical officer and senior vice president of clinical quality. "This is a worthy and noble endeavor, and we are pleased to participate. We will continue to support this life-saving work."
Tenet Joins Campaign to Save 100,000 Lives Businesswire June 07, 2005
Dec 2005 Achievement awards
Tenet Healthcare Corporation (NYSE:THC) announced that 12 of its facilities have received one or more Get With The Guidelines(SM) (GWTG) Performance Achievement Awards from the American Heart Association.
GWTG is designed to ensure that patients with cardiovascular disease are consistently treated and discharged with appropriate medications and instructions to help reduce the patient's risk of a second heart attack or stroke.
Jennifer Daley, M.D., Tenet's senior vice president for clinical quality and chief medical officer, said: "Evidence-based practice of medicine is a key component of Tenet's Commitment to Quality initiative. The American Heart Association's GWTG program is aligned with our own goals. Having 12 Tenet hospitals recognized as Performance Achievement Hospitals, with two of those hospitals achieving this level of recognition for both coronary artery disease and heart failure, is a wonderful example of how hard our facilities are working to ensure quality care for our patients."
12 Tenet Hospitals Receive Get With The Guidelines(SM) Performance Achievement Awards Dallas - Dallas Business news December 29, 2005
In June 2007 Tenet boasted about awards for excellence in care from Blue Cross insurers and from a quality improvement group in Texas. These and other claims to corporate reform and credibility are described at the bottom of the second page telling the story of Tenet's second scandal.