Patient care is improving at the Juan F. Luis Hospital, the board of directors heard Tuesday night, and the balance sheet is slowly showing improvement, but for one visitor to the Tuesday night board meeting, the picture is anything but rosy.
Sen. Alicia "Chucky" Hansen sounded a dire note during a three-hour meeting that otherwise was cautiously upbeat.
The hospital has been the focus of legislative concern ever since Feb. 28, when it dismissed 85 licensed practical nurses and certified nursing assistants, shifting direct patient care to the registered nurses on staff.
With only a one-day cash flow on hand, an accounts payable that now tops $30 million, and a cut in the funds appropriated to the hospital by the government, the hospital’s fiscal health had become so critical that only a complete change in direction was feasible, the board and management had decided. But lawmakers, mindful of the laid off workers, have expressed discontent. Tuesday Hansen upped the ante to "outrage."
Early in the meeting, assistant chief nursing officer Jacintha Stevens presented statistics showing that patient care is improving. According to Stevens, statistics of almost every type of patient safety index were better in March than in February.
Patient falls decreased from 10 in February to three so far in March; medication errors fell from 16 to 14; there was a slight increase in some skin care issues, caused by a patient staying in one position too long, but a decrease in others, especially the most severe. Also, Code Blues, called when a patient goes into cardiac arrest, fell from 17 to 10, and Code Greens, called when a patient is deemed to be nearing cardiac arrest, fell from 11 to one.
Stevens did not have the numbers for the same months in 2011 to compare these to, but promised to get them to board members.
Terry Lynch, interim nursing supervisor, said the nursing staff meets three times daily to make sure staffing ratios are kept up throughout the hospital, with RNs shifting from area to area as patient loads shift. There were initial concerns, she said, but the kinks in the process are getting worked out.
"I’m pleased to say that as the weeks have gone on they’ve become a real team, a real source of strength for each other," she said.
Board member Deepak Bonsal called these numbers "deeply refreshing."
But Hansen told the board that hospital Chief Executive Officer Jeff Nelson has threatened to fire anyone who says there are problems at the hospital, and that she has heard a very different story.
Hospital Board Chairwoman Kye Walker, who in private life is a plaintiff’s attorney, reminded Hansen that whistle-blower laws protect people who raise such concerns, adding that if she believed Nelson was threatening to fire people for speaking, "It’s called retaliation and I sue people who do that."
Hansen said nurses who have contacted her told alarming stories of lax patient care. In a letter presented to the board and read by Walker, the senator expressed outrage over the conditions.
"You have patients on the floor in ER," Hansen wrote.
After the meeting, nursing supervisor Lynch said her first reaction to Hansen’s comment about patients on the floor was, "Oh no. Oh, come on."
Then, she said, she felt insulted.
"This is an American healthcare system," Lynch said. "We have standards. We have rules we operate by. We can’t have patients laying on the floor in emergency." Asked if that happened, she replied flatly, "No."
For the record, a reporter who visited the Emergency Room lobby after Tuesday night’s meeting found a dozen people all seated quietly in chairs, and through the windows everything appeared calm. What could be seen of the floor was unoccupied by patients.
Hansen also said Nelson had lied to the Senate by saying he would reduce the hiring of traveling nurses, but has recently hired four from the Philippines. In his March 9 testimony to the Senate, Nelson specifically said the hospital has always used traveling nurses and would probably have to continue the practice a while longer, but he hoped to increase the number of locally hired registered nurses by negotiating salary increases, thereby building up local staff and dispensing with the travelers.
The board’s goal, which was stated at the Feb. 28 press conference announcing the dismissals, is to cut the number of traveling nurses in half by the end of September and by 90 percent by the end of the year.
Lynch added that traveling nurses, by their nature, travel and thus need to be replaced periodically, which the recent hiring of the four from the Philippines was for. In his Senate testimony, Nelson had also addressed those four, and said the hospital had actually saved money over previous traveling nurse hires.
In a financial report, Aishe Nilbert, director of financial services, said gross revenues increased from $6.7 million in February 2011 to $9.1 million this February. Operating expenses increased from $5.3 million to $6.3 million over the same time period. But when all the numbers were factored in, the hospital actually had a net income of $1.2 million this February, compared to a loss of $1.6 million in the same month last year.
The amount the hospital owes its vendors has risen to $31.7 million.
The gross accounts receivable – money owed to the hospital – is $44.1 million. But technically, that is "owned" by the government, so the hospital can’t use it as collateral to borrow against to alleviate its cash flow problems. The board voted unanimously to request the Senate to address the issue.
The board also voted to ask the Office of Management and Budget to increase its budget appropriation for the coming fiscal year by $5 million to $10 million. This year’s government outlay to the hospital is $18.2 million.
The hospital is required by law to provide medical service to all, and in the last three years has paid out $75 million for "uncompensated care," medical services it provided for which it was never paid. The estimate for the 2013 budget year’s uncompensated care is about $28 million, Walker said, and the additional $10 million added to the current outlay of $18.1 million would just cover that.
