1. Health

State orders Town and Country Hospital to stop taking new surgical patients

TAMPA — State officials investigating the deaths of three patients last month at Town & Country Hospital have issued a temporary order barring the hospital from admitting new patients to its surgical units.

The emergency moratorium from the Agency for Health Care Administration says Town & Country failed to staff the two-wing surgical unit with enough registered nurses to meet patient needs. Instead, the hospital left too many duties to licensed practical nurses, who lack the training and skills of registered nurses.

The temporary moratorium does not affect other areas of the hospital, including the emergency room, behavioral health unit and intensive care unit.

Though the report does not say proper staffing could have prevented the three deaths, it says the hospital's overall failure with nursing assignments in the surgical units puts prospective patients at immediate risk.

"The facts are clear that (Town and Country's) nursing services in its medical surgical units are not meeting patient needs to the level required by law," the report says. "These events are not isolated and have continued over a period of time."

According to the state report, hospital nurses acknowledged problems.

"Nursing staff stated that the patient load exceeds time and service capabilities of staff," the order says.

The 201-bed hospital's surgical units provide services to patients transferred from the emergency room or from surgery and require a close level of nursing care.

Each registered nurse is assigned 6 or 7 patients, according to the AHCA report, and is also required to supervised a licensed practical nurse, who gets a separate set of patients.

When the state signed off on the moratorium on Oct. 31, there were 53 patients already in the surgical units who were allowed to remain. The state says in its report it will monitor conditions at the hospital and reserves the right to take stronger actions.

An agency spokeswoman did not return a phone call seeking additional comment.

The state's report elaborates on problems associated with the care of several patients, including three who died last month. Those three patients included:

• A stroke patient with a feeding tube whose charts lack documentation that a registered nurse was monitoring the patient's vital signs.

• A patient with chest pains whose move to intensive care came 20 minutes after a physician had ordered it to be done immediately.

• A patient complaining of fecal impaction (a consequence of long-term constipation) whose charts lacked documentation explaining why prescribed intravenous fluids were not being administered, or why low levels of oxygen in the blood were not addressed.

In other cases in which patients survived, records lacked documentation showing registered nurses monitored their initial assessments or their treatment.

The report does not name any of the patients, or indicate where they were from.

This isn't the first time in recent years that Town & Country's nursing staff has captured the attention of regulators.

In February 2011, a state review found significant time gaps — as many as five hours in one case — before emergency room nurses assessed patients after initial triage. The hospital was fined $1,000.

Town & Country Hospital is owned by Iasis Healthcare, a privately held chain based in Tennessee that also owns Memorial Hospital of Tampa and Palms of Pasadena hospital in Pinellas.

In a written statement, Town & Country CEO Dale Johns said the staff is "responding seriously and expeditiously" to the items raised by the state. He said Town & Country has submitted a corrective plan and is waiting for the state's approval and lifting of the moratorium.

"Town and Country Hospital has provided high quality patient care in Tampa for more than 30 years, so this situation is concerning to us and our many experienced care givers," the statement reads. "We are working cooperatively with the Agency and bringing all necessary resources to fully respond to its requirements. … We hope to be admitting patients to our medical/surgical unit very soon."

Jodie Tillman can be reached at