2013 News

Quincy Medical Center Nurses’ Briefing Paper on the Patient Safety Crisis Caused by Cerberus-Steward Health Care

03.31.2013

About this Document

Among the contributors to this paper are RNs who themselves were born at Quincy Medical Center (QMC), whose children were born at QMC, whose families have been cared for at QMC, and who have provided care at QMC for 20 and up to 35 years. We and our Union, the Massa-chusetts Nurses Association-NNU, are deeply committed to the mission of this institution that we have helped to build and which we urgently want to see succeed. This document presents a dis-turbing portrait of the effects of recent decisions of the hospital’s owners. We present this out of a sense of duty to defend our patients and this institution. This is our hospital, and speaking out for the quality of patient care and defending the hospital from harm so that it can thrive for dec-ades into the future are, in our view, one in the same.

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Summary

Throughout 2012 and early 2013 Steward-Quincy Medical Center Registered Nurses have been presenting urgent pleas to Cerberus/Steward-Quincy Medical Center management both in meet-ings and through written documents stating that they considered the declining nurse and other patient care staff to patient levels to be increasingly unsafe.

Since February 17of this year the situation worsened dramatically when management shut down a 40 bed nursing unit. Since that time, RNs have been reporting severely unsafe staffing condi-tions to be so unsafe as to cause them to warn management, government agencies and the public that serious negative patient outcomes may immanently result.

On March 19, the QMC RN members of the Massachusetts Nurses Association/National Nurses United voted to authorize their elected committee to call a strike in protest of these conditions and management’s refusal to negotiate with them over staffing and related issues. The vote numbers tell their own story of how urgent RNs consider the situation has become: 94% voted to authorize the strike. More remarkable is that 90% of the MNA members at QMC participated in the one day secret ballot vote.

The Hospital’s parent corporation, Steward Health Care, is 100% owned by the private equity giant Cerberus Capital Management, LLP.ii Cerberus recently came under criticism for its own-ership of Freedom Group, the largest conglomerate of gun manufacturers in the U.S, when it was reported in the Wall Street Journal, the Boston Globe and elsewhere that they manufactured the Bushmaster AR15-style assault rifle used in the Newtown, CT massacre.iii Cerberus responded to the published reports and threats of divestiture from the giant California State Teachers Re-tirement Systemiv by announcing their intention to sell the Freedom Group.

As of this writing, three months later, Cerberus remains the sole owner of the Freedom Group.


Details

Complaints of deficient staffing levels / conditions prior to February 17:

  • Since January 2012, RNs at QMC have submitted to Steward management more than 150 written reports documenting what they consider to be unsafe patient care situations at the hospital.
  • In 2012, Steward reduced the total number of RNs at the hospital by 30. (There were 57 resignations. Management backfilled them by hiring only 27 RNs, and then, for many more months continuing through this writing, failed or refused to hire any additional RNs). MNA also has been attempting to engage management on needed non-RN health care workers with little success. Other health care classifications also have been reduced.
  • Management has explicitly refused MNA’s repeated requests to hire additional staff. The 30 position decrease was not the result of lack of applicants: For an approximate three-week period in late January/early February, when management briefly posted eight full time positions, they received more than 200 resumes and hired no one. They subsequent-ly rescinded the postings and announced the closure of the A3 unit.

Acutely Worsened Situation Since the February 17 Closure of the A3 Unit:

  • There is no evidence that Steward management created a new staffing model to care ap-propriately for patients prior to the closure of the unit. In fact, hospital managers have told MNA representatives that this process began only weeks later.
  • Steward management has refused to negotiate with nurses representing MNA over a staffing plan to safely care for patients or to discuss the decision to close the unit.
  • Since the A3 unit closed, RNs have reported that frequently there have been six (6) to a high of thirteen (13) patients who have been admitted to the hospital by physicians and “boarded” in the Emergency Department (ED) at a given time, sometimes for as long as 24 hours (with the longest time so far being 30 hours), waiting for an appropriate inpa-tient bed like those provided on the unit that was just closed.
  • ED nurses report being put in the position of providing types of care for which they are not equipped to patients who have been “admitted” to the hospital as ICU, Medical Sur-gical or Telemetry patients, but who, in reality, are physically being housed in the ED.
  • MNA members report that, not only are they caring for admitted patients who should not be housed in the ED, but that they are doing so without adding to the number of ED staff. Indeed, on several days the MNA RNs have reported that the ED has been dramati-cally short staffed relative to a normal day in which no patients would be boarding: There have been several episodes in the past month in which there have only been two nurses on the schedule in the Emergency Department on a given shift, instead of the five nurses that are supposed to be on duty to care for patients under normal circumstances. MNA RN members confronted management and asked how they expected the nurses to care for patients in the event of a “code” -- a critical case such as cardiac arrest -- which demands at least two RNs, leaving no one else to care for other crises. Management has been non-responsive, saying they aren’t obligated to have that conversation. One manag-er said let’s knock on wood that that doesn’t happen.
  • Emergency Department wait times, according to ED RNs, have skyrocketed on many days since the closure. On Thursday, March 21, RNs reported ED wait times of five (5) hours.
  • “The public needs to know how worried we are, that we’ve been telling management we don’t consider this situation to be safe, and they have been refusing to discuss the issue with us for a month,” said Stacey McEachern, RN, a nurse in the emergency department. “The patients who are being boarded in our ED have been admitted to the hospital, but are not receiving an appropriate level of care because they are being placed on stretchers in an already full emergency room, waiting for a bed on a medical floor that no longer is available to them. The bottom line is patients are being deprived of the services they need. The only explanation that Steward management has given us is that the hospital is trying to cut costs, and that their parent company Cerberus won’t invest more money.”

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