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Lutheran Hospital employees recently made NICHE aware of some serious maintenance concerns. NICHE reports this with reluctance, but with no explanation or clarification forthcoming after visits to Lutheran from local media, we feel compelled ask questions in response to what we feel were accurate reports from employees. Public reporting is, after all, what’s necessary to ensure that consumers, payers, and health care providers have access to information affecting quality of care that might otherwise remain confidential. NICHE’s commitment to ensure quality healthcare for our community demands that we say what must be said.

The questions we shall ask relate less to mishaps that might happen to anyone than to those that may be due to low staff levels, deferred maintenance, needed facility upgrades and whether enough decisions are being made locally, giving proper weight to local concerns.

At a group meeting last week, discussion centered around a live mouse found at Lutheran. NICHE also has received a picture of a dead mouse on an office glue strip. That is but one mouse, but there have been multiple sightings and multiple stories sent to us by employees. NICHE cannot confirm if this was the same mouse, or even the same story slightly altered. It is no surprise that hospital management, referencing a single mouse, prefers to say “no comment.”

Of course, cool nights drive rodents indoors. And frankly, when we first heard this story, we considered not reporting the story. “Oh well,” we thought. “It’s that time of year–one mouse, five mice, seven mice–just call the exterminator.” And an exterminator was called, and we presume all is now OK.

But then we learned that there’s more to the maintenance story. More evidence of poor stewardship, poor custodianship, poor maintenance, and perhaps indifference–call it what you will.

We’ve been told, again by employees and physicians, that sewage backed up into the lower level of Lutheran Hospital, and that water lines were consequently shut down, the cafeteria closed, and patients unable to take baths for a time. We’re told it was blamed on patients, or perhaps employees, flushing “wipes” into toilets. Was it a simple accident, or is it another instance of inattention to aging infrastructure–in this case seemingly not having functioning backflow valves in old sewage lines, and ultimately not assuring that a 25-year-old building is up to date? In our view, even though a structure may be “grandfathered in” from meeting construction and safety codes, prudence demands that upgrades be done whether it involves access, wiring, or sewer lines.

In our view it is a worrisome reminder of the “rats-in-the-ceiling,” and sewage leaks and backups into patient areas reported at a CHS hospital in Venice, Florida, in 2015 (see http://www.heraldtribune.com/…/…/20150722/News/605200985/SH/)

All of this leads to a few questions:

– How much of this is the result of hiring “freezes” or “reductions” of full-time equivalents (FTEs)? Is this the consequence–unintended perhaps but also predictable?

– Will CHS management give assurances that employee levels, (FTEs) are to be increased across the board–that benchmarks guiding “optimization” to “peer levels” are not targeting decrease but instead provide increases in overall employment?

– Were FTE cuts made in maintenance jobs? Do these mishaps reflect an underappreciation for other members of the team who are vital to patient care–maintenance employees who maintain facilities and cleaning crews who clean? When there are too few, trash bins overflow, we are told by employees. Everybody knows what happens when trash accumulates.

– Is this related to the loss of local control? When hospital operations are directed from afar and when infrastructure upgrades are deferred, does cost-cutting cut into quality, allowing vermin to thrive?

The Joint Commission, the hospital accreditation organization, has been reluctant to provide data in any detail. The federal government, through the Centers for Medicare & Medicaid Services (CMS), has believed that the public deserves a better view into the operations of hospitals, but again CMS has delayed a requirement for full disclosure (see references below.) The notion of transparency and openness remains controversial, but when–as we believe–cost cutting may have led to deficiencies, we, at NICHE, come down on the side of full and open reporting.

NICHE recognizes that our questions arise from multiple reports and photos sent to us by service personnel, physicians, and other employees. We are not critical of the proper measures that Lutheran administration has taken in response to these events, which may have been inconveniently random. Employee reports regarding low levels of maintenance, however, raise legitimate questions important to the general public. We ask simply: Were these mishaps–sewer line backup and mouse sightings–related to a need for more staff and a need to upgrade a 24-year-old building?

http://www.healthcaredive.com/…/accreditors-wont-ha…/448633/

http://www.npr.org/…/secret-data-on-hospital-inspections-ma…

http://www.hospitalinspections.org/qa-with-cms/