After an investigation identified a range of recent troubles at Swedish Health’s Cherry Hill facility, federal officials said the site is at risk of being terminated from the Medicare program.

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Hospital regulators have identified a wide range of recent troubles at Swedish Health’s Cherry Hill facility, including failures of oversight and “numerous” issues related to patient safety, according to records released Thursday.

Federal officials said the Cherry Hill site will be terminated from the Medicare program in 90 days unless Swedish can bring itself into compliance on a couple of key issues.

Investigators began their work after Seattle Times articles in February exposed troubles inside Swedish’s acclaimed neurosurgery institute at Cherry Hill, including staff concerns about the hospital’s culture of intimidation, issues of patient care, and surgeons who were running multiple operating rooms at a time with the help of doctors in training.

A SEATTLE TIMES SPECIAL REPORT

Surgery was supposed to mean a better life for Talia. But something went wrong.

High volume, big dollars, rising tension at Swedish's Cherry Hill hospital

Swedish double-booked its surgeries, and the patients didn’t know

 

Ongoing coverage

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Swedish said in a statement that many of the deficiencies identified in the regulatory investigation have since been addressed. Dr. Guy Hudson, the new CEO who took the job after the Times articles, said Swedish cooperated with investigators and takes their findings seriously.

“These findings, and our action plans to address them, enable Swedish to continue to serve as the highest quality health care organization people love,” Hudson said. “We are committed to continuous improvement, learning from the past and doing what is right for our patients and the community.”

To maintain its status, Swedish must provide a response to federal officials in 10 days describing how it would address the issues raised, and then regulators will conduct another survey to verify compliance. State investigators are also asking Swedish to explain how it will deal with violations of state standards.

Among the findings of the investigative reports, the surveyors said they substantiated “numerous” patient safety concerns, including the failure of the hospital to delineate the roles of some medical fellows, the failure to ensure behavioral issues were addressed, the failure to document the surgical tasks performed by medical fellows, the failure to track when the attending physician was in the operating room, and the failure to heed the concerns of staff.

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“Staff members feared punishment and retaliation for voicing concerns,” the investigators wrote. “Staff members stated they were frequently bullied and intimidated for voicing concerns about the working conditions in the neurosurgical operating area.”

The investigators took particular issue with Swedish’s leaders, saying the organization’s “governing body” hadn’t adequately analyzed adverse patient events or responded to staff concerns.

Three members of Swedish’s Board of Trustees said in a statement Thursday evening that they have been working hard to restore trust. They said that work has involved improving communication, service and support for patients and staff.

“We are sorry for what occurred at Swedish Cherry Hill on our watch,” the board members said. “As volunteers, we continue to be deeply committed to our critical governance role in overseeing patient quality and safety, as well as physician credentialing.”

The investigators also examined the case of Talia Goldenberg, which was the subject of one Times story, and concluded the hospital had failed to identify her death as an adverse event, failed to conduct a complete autopsy and failed to maintain complete information in care records that other providers could have used during her case.

For some issues, investigators did not substantiate allegations. They didn’t find evidence that primary surgeons had been unavailable for “critical” portions of the surgeries — which would be against Medicare rules. They did note that Swedish generally didn’t track the times surgeons were in the operating room, and they cited problems with a 2015 case in which a 32-year-old died after a spine surgery that records show had been largely performed without the attending physician in the room.

Investigators said Swedish’s data on patient outcomes did not show rising complications or deaths at the neuroscience institute. And investigators could not substantiate concerns that nurses faced excessive on-call time but said the facility had reduced the number of operating rooms in the fall of 2016 in order to achieve “safe nurse staffing levels.”

Swedish has already undergone substantial changes since the initial Times stories. Then-CEO Tony Armada resigned less than two weeks after the stories, with Hudson later replacing him. Dr. Johnny Delashaw, a top surgeon featured in the stories, also stepped down. His license has since been suspended by the state.

Hudson has vowed to change what staffers described as a culture of intimidation and retribution, and has held a variety of gatherings with staff to hear their concerns. And earlier this week, Swedish implemented a new policy largely banning the practice of overlapping surgeries.

Investigators said other issues raised in the Times articles were outside the scope and jurisdiction of the investigation, including financial incentives for doctors, whether surgeries were appropriate and the invasiveness of the surgeries.

The investigation, including the portion focused on Medicare rules, was conducted by state Department of Health (DOH) regulators. Records show that an anonymous whistleblower had contacted the state early last year to outline similar concerns. A DOH investigator conducted a two-day investigation at that time and had determined that the allegations were “not substantiated due to lack of evidence.”

Along with the regulatory review, the U.S. Attorney’s Office in Seattle has also been examining issues at Cherry Hill.