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Florida HCA patients at risk due to low staffing, union warns

Two patients died after workers at different hospitals failed to monitor vital signs, a report said.
 
HCA Florida Bayonet Point Hospital in Hudson is seen Feb. 7. A study from a union that represents health care workers is accusing HCA of putting patient safety at risk by deliberately understaffing its hospitals to maximize profits.
HCA Florida Bayonet Point Hospital in Hudson is seen Feb. 7. A study from a union that represents health care workers is accusing HCA of putting patient safety at risk by deliberately understaffing its hospitals to maximize profits. [ CHRIS URSO | Times ]
Published April 21, 2023|Updated April 24, 2023

A patient at HCA Florida Blake Hospital in Bradenton had two bowel movements in bed because nurses and other workers were too busy to take him to the bathroom.

At HCA Florida Citrus Hospital in Citrus County, medical technicians failed to monitor the vital signs of a patient admitted in 2019 with an irregular heartbeat. When a nurse finally checked in, the patient was dead.

A similar tragedy was discovered at HCA Florida South Tampa when a 2021 federal review found that a technician remotely monitoring a patient’s vital signs did not alert anyone to a life-threatening heart rhythm change. The patient died.

Related: Find out if Tampa Bay hospitals are hiding costs of medical care

The failures, documented in federal reports, are included in a study from the union representing 10,000 workers at 18 Florida HCA Healthcare hospitals.

Its conclusion? That the company is risking patient safety by deliberately understaffing its hospitals so it can pay billions in dividends to shareholders. The company, the country’s largest health system, in 2021 reported earning $58.7 billion in revenue with profits of about $7 billion.

The Service Employees International Union report found that staffing at HCA’s 180 hospitals across the United States was 30% lower than the national average in 2020.

In Florida, where the company operates nearly 50 hospitals — including 15 in and around the Tampa Bay region — the union reported that staffing levels were 32% below the average of other hospitals across the state.

The hospital disputed the union report’s findings in a statement to the Tampa Bay Times. Officials said the study was being used as a negotiating tactic while bargaining talks are underway in five states, including Florida.

The union “has a history of attacking and bullying community hospitals with cleverly packaged, misleading information and staged events designed to garner media coverage,” the statement said.

It’s not just the union raising the alarm. Congressional lawmakers Sen. Marco Rubio and Rep. Gus Bilirakis last month sent a letter to the chief executive officer of HCA Florida Bayonet Point Hospital in Pasco County, demanding to know what the company was doing to fix problems there. The letter cited an NBC news report that found doctors and other medical staff at the Hudson facility had reported safety concerns to management for more than a year. Those problems included cockroaches in operating rooms, unsanitary surgical instruments, inadequate monitoring of intensive care patients and people waking up during surgery.

Related: Pasco hospital intimidated workers who discussed unionizing, feds say

Officials from the HCA Healthcare West Florida Division said in an email to the Times that the allegations made in the NBC report are “misleading and inaccurate.” Subsequent reviews of their Florida hospitals by accrediting agencies led to no adverse findings, although one of them requested to see the plan to improve staffing at Bayonet Point.

In June, nurses protested outside HCA Florida Oak Hill Hospital in Brooksville, saying those who worked in medical wards were assigned as many as seven patients, well above recommended nurse-patient ratios. The protest was organized by the National Nurses Organizing Committee, which represents about 450 nurses at the hospital.

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Nurses rally outside HCA Florida Oak Hill Hospital in June to call for more nurses to be hired. A shortage of nurses in the hospital is threatening patient safety, they warned.
Nurses rally outside HCA Florida Oak Hill Hospital in June to call for more nurses to be hired. A shortage of nurses in the hospital is threatening patient safety, they warned. [ Courtesy of National Nurses United ]

The Florida chapter of the Service Employees International Union, which represents 35,000 caregivers and other essential health care workers in hospitals, nursing homes and other facilities across Florida, has also organized protests outside HCA hospitals.

“For years, our members have been talking about short staffing and how it’s putting their patients and licenses at risk,” said union Vice President Robert Gibson. “This is not a small community hospital; this is a giant corporation.”

Is staffing at HCA Florida hospitals adequate?

The union’s study, released earlier this year, compared HCA hospital staffing levels with the number of occupied beds. It used 2020 data supplied by hospitals to the Centers for Medicare & Medicaid Services.

HCA officials, in the statement to the Times, said their staffing was appropriate and in line with other community hospitals and regulations. That’s despite a national nursing shortage, exacerbated by the pandemic and continuing surges in the number of patients.

The company also touted its hospital safety rankings from Leapfrog, an independent nonprofit that ranks hospitals based on 22 measures, including the number of patients who get blood or urinary tract infections and complications after surgery, falls and bedsores.

In rankings released in November, 17 HCA Florida hospitals earned an A, and 14 a B.

A number of HCA’s Florida hospitals, however, earned mediocre scores from the Centers for Medicare & Medicaid Services, which issues a star rating system between 1 and 5 based on hospital safety; patient experiences; the delivery of timely and effective care; the number of patient deaths; and the number of patients who need to be readmitted.

No HCA Florida hospital was given five stars. Eight HCA hospitals, including Bayonet Point, were given the lowest score, with another 23 facilities getting two stars.

Nurses and other hospital workers from HCA Healthcare hospitals in California, Florida, Texas, and Kansas rallied at the company’s headquarters in Nashville Wednesday, calling on the company to improve staffing levels, quality of care and worker retention rates.
Nurses and other hospital workers from HCA Healthcare hospitals in California, Florida, Texas, and Kansas rallied at the company’s headquarters in Nashville Wednesday, calling on the company to improve staffing levels, quality of care and worker retention rates. [ Service Employees International Union ]

What other problems have been reported at HCA hospitals?

Multiple examples where staffing shortages or a lack of training compromised patient safety are documented in lawsuits and in Centers for Medicare & Medicaid Services surveys conducted at hospitals that receive Medicare payments.

Julie Griffin, a former intensive care nurse at HCA Florida Westside Hospital in Plantation, sued the company in 2018. She claimed she was fired after raising concerns that she was assigned three or more patients even though the unit’s monitoring equipment could only track two patients simultaneously. HCA agreed to a confidential settlement with the veteran nurse in February, about a week before the case was to be heard by a jury, court records show.

The federal government found HCA Blake Hospital in Manatee County violated staffing and level of care standards in 2017. A review of the hospital included an interview with the patient who defecated in bed and found one ward had only seven nurses and two technicians for 37 patients. There was not enough staff to turn, reposition and feed everyone, the review found, and patients were getting medications late.

A Centers for Medicare & Medicaid Services review of HCA Florida Citrus following the death of the unmonitored patient put the hospital in “immediate jeopardy” status. That sanction can strip a hospital of its Medicare accreditation. Hospital officials acknowledged in a correction plan that too many patients were being monitored by too few technicians.

Rublas Ruiz, an intensive care unit nurse at HCA’s Kendall Hospital in Florida, said the hospital frequently has a shortage of nurses and other staff, a situation that predates the COVID-19 pandemic.
Rublas Ruiz, an intensive care unit nurse at HCA’s Kendall Hospital in Florida, said the hospital frequently has a shortage of nurses and other staff, a situation that predates the COVID-19 pandemic. [ 1199SEIU ]

Rublas Ruiz has worked as an intensive care unit nurse at HCA’s Kendall Hospital in South Florida for about 10 years. The hospital frequently has a shortage of nurses and other staff, a situation that predates the pandemic, he told the Times.

The ratio of patients to nurses in the Intermediate Care Unit, where he’s assigned, should not exceed 4 to 1, but Ruiz said he is frequently given five patients. That often delays critical care and increases the risk to patients, he said. Nurses often miss taking breaks because they are overworked.

There have also been times when no one was available to take an intensive care patient for a CT scan, Ruiz said, so nurses had no choice but to take them and leave their other patients unattended.

He fears that patients will die because there aren’t enough nurses, he said, but when he and others raise the issue with supervisors, they are told to make do.

“We get poor response from management,” he said. “They know exactly what is going on.”