Investigator releases report on local Steward Health hospitals

(WKBN) — An inspector paid a visit to Steward Health Care System’s three Valley locations last month as part of ongoing court proceedings regarding the company’s Chapter 11 bankruptcy filing and recently released the report of her findings.

The report was conducted by patient care ombudsman Suzanne Koenig and filed Tuesday morning in the U.S. Bankruptcy Court for the Southern District of Texas — where Steward Health is based.

Local Steward Health locations include Trumbull Regional Medical Center in Warren, Hillside Rehabilitation Hospital in Howland and Sharon Regional Medical Center.

Hillside Rehabilitation Hospital

The hospital is accredited through the Commission on Accreditation of Rehabilitation Facilities (CARF), whose main purpose is to evaluate a rehab facility’s ability to meet certain standards that factor into higher success rates for patients — the report notes these standards are very strict.

The hospital is comprised of one inpatient unit, three gym areas (two inpatient, one
outpatient), and two outpatient rehab facilities in Austintown and Cortland. It has a dietary department, a pharmacy, a case management department, central supply and laundry. It also has a special unit that is designated to care for forensic patients currently incarcerated at a local jail. Trumbull Regional Medical Center also rents a space in the hospital and operates a sleep lab.

Koenig visited Hillside Rehabilitation Hospital on June 24 and returned the following observations.

Hillside recently experienced several nurses and nurse assistants leaving due to the
bankruptcy filing and due to competitive wages offered by others in the area, the report states.

The staff RN told the ombudsman and her representative that there is a shortage of nursing assistants which is believed to be related to low wages for nursing assistants at the hospital. According to the staff RN, nursing assistants often come and get experience and then leave for other jobs.

The staff RN said that there were no issues with supplies and equipment. However, according to the chief administrative officer, several pieces of equipment are not functioning, and as a result, some equipment is being leased. In addition, there are two nonfunctioning elevators. Capital requests have been submitted to Steward Corporate and are awaiting approval.

The ombudsman visited central supply and reported the space appeared clean and organized. She also toured the kitchen, storage areas, coolers, freezers and the equipment used for preparing meals and storing food and described the kitchen as a “cluttered and unorganized space.”

During the kitchen tour, she noted issues such as crumbs, dried food on walls and bags of food without expiration dates. One of the kitchen’s freezers was inoperable on the day of the visit, replaced with a rental freezer that she noted posed a tripping hazard. Koenig also noted the kitchen tray line was 20 minutes late and a disorganized process.

The temperatures of the food about to be plated was surprisingly low, the ombudsman noted. Almost everything had to be reheated. Ideal temperatures for hot food is 155 degrees or higher. On this day, the chicken casserole was 80 degrees.

Visit summary

In an impressions summary, Koenig said the staff seemed dedicated and they believe in getting people healed. She reiterated the kitchen issues but said they could be turned around with training and a few equipment purchases.

Trumbull Regional Medical Center

The hospital’s departments consist of an ED, two ICUs, two med-surg departments, two
adult behavioral health departments, an operating room, a pre-op/post-op unit, a gastro-intestinal lab, a cath lab and various offsite ambulatory departments (such as medical offices, urgent care, wound center and a sleep center).

Koenig visited Trumbull Regional Medical Center on June 24.

She noted the hospital’s census was in the low 80s, which is higher than the typical low 70s
census. Prior to the bankruptcy filing, the hospital’s census ranged from 90 to 110 patients.

Areas of need were reviewed with the senior leadership team, who told the Ombudsman and her representative that they are having difficulty hiring enough RNs. They stated that it could be because of the bankruptcy, but there is a general shortage of RNs in the local area.

Regarding equipment issues, they have multiple elevators that are out of order and
need to be repaired or replaced. They also have carpet in one of the mental health units that is
soiled and needs to be removed.

The senior leadership team shared that there is a residency program in place for internal medicine, family practice and general surgery, and they are concerned about orphaning residents if they had to close.

Like in Hillside Rehabilitation Hospital, Koenig reported numerous pieces of kitchen equipment that were not functioning and observed food splatters, debris on clean pans, food stains on equipment, and overall dirty prep spaces. However, after her visit, an update was provided stating the kitchen team had completed a deep clean and implemented an ongoing cleaning plan. Some items were repaired, but others remained not functioning at the time of the report.

Visit summary

The ombudsman reported the hospital has an engaged leadership team dedicated to providing excellent patient outcomes but says the team is spread thin.

The CNO is a regional director providing oversight to both Sharon Regional Medical Center and Trumbull Regional Medical Center. The Quality Director is also regional, covering both Trumbull and Sharon Medical Regional Center.

Sharon Regional Medical Center

The hospital’s departments consist of an ED, an ICU, a cardiac intensive care unit, two med-surg departments, an adult and a pediatric behavioral health department, an OR, a pre-op/PACU, a gastrointestinal lab and a cath lab.

Before the ombudsman visited the hospital on June 25, a March inspection by the Pennsylvania Department of Health showed that Sharon Regional Medical System (SRMC) was not in compliance with several safety requirements. At the time, Steward said it was working to correct the issues and expected to address them all by June 4.

Koenig noted the following during her recent visit.

The hospital chiller unit is 45 years old and non-functioning. Two rental units are currently in place. A grant from the Commonwealth of Pennsylvania has been approved which should cover the total cost of the new chiller.

During a safety meeting, the following statistics were mentioned, among others:

• It has been 47 days since the last fall without injury
• It has been 95 days since the last fall with injury
• It has been one day since the last mislabeled specimen

It was also reported during the meeting that there were currently no safety concerns or concerns related to supply/equipment issues.

During her visit to the OR, the ombudsman noted the staff was unavailable for interviews because there was a delay issue going on related to an add-on surgery case. The surgeon was noticeably upset and was communicating with a raised voice that the hospital was going to lose $10,000 in equipment costs if they did not get his case to the OR and ready for surgery within the next hour, according to the report.

Trips to the central supply department and pharmacy were reported as neat and organized.

The ombudsman’s representative asked how the nurses in the emergency room stay up-to-date and competent to care for patients. The nurses replied that they attend competencies and Steward U online courses. According to a staff member, nurse orientation lasts for about 12 weeks in this unit, and you may not be in charge of triage until working in the department for more than one year.

When asked about quality measures, the staff stated they are working on eliminating mislabeled specimens, early sepsis recognition, and reducing patients leaving without being seen.

The kitchen was reported to be clean with all food labeled and heated to the appropriate temperatures.

One area of issue noted is non-functioning equipment, notably the hospital’s backup generator, which failed in December of 2021. Other equipment issues noted include a chiller and an elevator.

Visit summary

The Ombudsman notes the hospital is challenged with equipment failures and has been waiting for the funds to replace their backup generator for 32 months.

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