Published February 2003

Providence left reeling
from health inspection
Plan now in place to address 22 deficiencies

By Todd C. Frankel
Herald Writer

It wasn’t a surprise inspection.

Providence Everett Medical Center had two weeks’ warning that the state health department would descend on the hospital for four days in December to conduct its annual health and safety survey.

But what the inspection found was a surprise, sending a devastating shock wave first through the hospital’s nurse stations and doctor offices and, after the report was made public on Dec. 30, through the community served by the second-busiest hospital in the state.

Health inspectors spotted an unusually high number of deficiencies in meeting minimum standards of care. These ranged from small items, including the wrong electrical outlets in waiting rooms, to larger issues of operating-room airflow and the handling of blood and intravenous fluids. Most worrying to the health department were several problems still not fixed after being cited the previous year.

It has been an abrupt turnabout for an institution that until recently was riding a wave of good news. In May 2002, it opened its $56 million Pavilion for Women and Children. In September, its Comprehensive Breast Center was accredited for mammography exams. A month later, a study named its cardiac and vascular care unit as one of the country’s best and tops in the Puget Sound region.

Now Providence is left insisting what many took for granted: that the hospital is safe.

The state inspection report has turned Providence upside down, said hospital CEO Gail Larson.

“I think, unfortunately, it has proven to make patients nervous, make physicians very angry and make our staff very upset,” Larson said.

One of those doctors is Dr. Harold Dash, a Harvard-trained cardiologist and hospital board member in Everett. He pointed to the heart program’s awards as evidence of the hospital’s overall excellence because “these awards do not occur in a vacuum.”

A hospital with health and safety problems “would never receive these awards because it would not achieve the excellent outcomes, low mortality and low complication that (Providence) has regularly achieved,” Dash wrote in an e-mail. “I feel fortunate to work at a hospital with such a high standard of excellence.”

From Dec. 2-6, a team of seven health surveyors examined the workings at Providence’s two Everett campuses and a smaller Mill Creek facility.

By the time they wrapped up their investigation, hospital officials knew the news was bad. Some managers gathered their staffs to warn them. On Dec. 23, the state delivered its final report to Providence. It ran 45 pages and included 22 deficiencies — an uncommonly high number of both total infractions and recurrent ones, according to state officials.

The report noted, “The cumulative effect of these systemic problems resulted in the hospital’s inability to ensure the provision of quality health care in a safe environment.”

The state health department decided it needed to closely monitor the hospital as it addressed the problems, rather than allowing it to submit unsupervised progress reports, as it had in the past. The health department also wanted a face-to-face meeting with hospital officials.

A week later, on Dec. 30, the report was released following a public records request by The Herald, a sister publication of the Snohomish County Business Journal.

Many of the deficiencies related to documentation, such as no proof that workers in the surgical unit were immunized for hepatitis B or that a plan of care had been developed for certain patients, including two suicidal patients.

Investigators also found instances of inappropriate abbreviations for drug instructions in medical records. One example they included was of a patient admitted for a colonoscopy. His doctor noted the patient was to be given “F100” and “V4.” A nurse interpreted that as 4mg of Versed and 100mg of Fentanyl. That was correct, but health officials said these vague terms place the patients at risk of getting the wrong medication.

Another problem was the airflow in several operating rooms, two nuclear medicine areas and the surgical unit’s soiled utility room, placing patients at risk for possible exposure to dangerous infections, the state said.

This has since been fixed, the hospital said.

No patients were harmed as a result of any of the cited problems, said both hospital and state officials.

But the point of following guidelines — no matter how seemingly minor — is to avoid what they call “bad outcomes,” said Byron Plan, head of the state Office of Health Care Survey, which oversaw the inspection.

“Do I think they were small, picayune things?” Plan asked. “No.”

The hospital and state officials met in early January to hammer out a plan for addressing the problems. Many have already been fixed, others will be soon, said Larson, the hospital CEO.

Larson also has said the hospital is working on a new internal monitoring process to ensure the problems are fixed and future deficiencies are avoided.

She stressed that the hospital has many checks and balances to prevent missteps from affecting patient care. Prescriptions and other orders are checked and re-checked, she said.

Related: Providence to lay off 350

Related Health-care Briefs

Back to the top/February 2003 Main Menu