A court-appointed inspector to ensure proper patient care at the 131 facilities operated by bankrupt Steward Health Care is giving a mixed review of Steward’s three hospitals in the Valley.

In a report filed in bankruptcy court, Ombudsman Suzzane Koenig spoke with administrators of employees from Trumbull Regional Medical Center in Warren, Hillside Rehabilitation Hospital in Howland, and Sharon Regional Medical Center in Mercer County.

Employees at all three hospitals reported no problems getting supplies and there were no reports of patients getting inadequate care.  However, each of the hospitals had equipment issues in need of repair as well as difficulties in obtaining enough nurses.

The ombudsman also found problems in the kitchens at Trumbull and Hillside.

Hillside Rehabilitation Hospital

The report said that when Hillside was inspected in June, the hospital had recently experienced several nurses and nurse assistants leaving due to the bankruptcy filing and due to competitive wages offered by others in the area.

The staff RN told the Ombudsman and her representative that there was also a shortage of nursing assistants which is believed to be related to low wages for nursing assistants at the Hospital. According to the staff RN, nursing assistants often come and get experience and then leave for other jobs.

Hillside’s kitchen appeared cluttered and unorganized, according to the ombudsman who reported crumbs and signs of dried food on walls and tables.

“Clean pots and pans were stored on shelves containing crumbs. Several bags of food were noted to be unlabeled with expiration dates. There were two bags of noodles that were opened and unlabeled,” according to the report.

The report noted that while the ideal temperature for hot food is 155 degrees or higher, the chicken casserole was 80 degrees. The green beans, pureed pizza, and vegetable soup were also not meeting ideal temperatures with measurements in the low 100s, the report stated.

The kitchen manager told the ombudsman that there would be an in-service for the staff on food temperatures.

The Ombudsman interviewed a patient and the patient’s child who said the food was delicious, the housekeeping staff was wonderful, and the patient was progressing well during their stay

The chief administrative officer said several pieces of equipment were not functioning, requiring the hospital to lease substitute equipment.

There are two non-working elevators.  Steward corporate has been asked for the money to make repairs.

“The staff seemed dedicated, and they believed in getting people healed. The kitchen had a few issues but can be turned around with training and a few equipment purchases,” the ombudsman wrote in her report.

Trumbull Regional Medical Center

 The Ombudsman noted in her report that before Steward’s bankruptcy filing, Trumbull Regional Medical Center usually had between 90 and 110 patients.  On the day of the June 24 inspection, the hospital census was in the low 80s.

The senior leadership team told the Ombudsman that they were having difficulty hiring enough Registered Nurses.

They stated that it could be because of the bankruptcy, but there is a general shortage of RNs in the Valley.

At the time there were several elevators out of order in need of repair or replacement.

The senior leadership team shared that there is a residency program in place for internal medicine, family practice and general surgery and they are concerned about orphaning residents if they had to close.

An administrator in the hospital’s Adult Mental Health Unit told the ombudsman that they have repeatedly asked for the removal of a heavily soiled carpet that smells of urine because shampooing makes odor worse.

The review of Trumbull Memorial Hospital’s kitchen noted that the dishwasher wasn’t able to get hot enough to sanitize properly.

As a result. The hospital’s kitchen uses disposable tableware, which the ombudsman claims results in a huge financial discrepancy, as the cost of washing and sanitizing plates, cups, and silverware inhouse is approximately $200,000 per year compared to $440,000 per year for disposable items.

The general observations of the kitchen included:

  • Dirt and grime in corners, in harder-to-reach areas, and under tables throughout the department.
  •  Food splatters, dirt, and grime on the walls.
  • Debris on the clean pans and on the shelves where the clean pans were stored.
  • Food stains on equipment.
  • Knobs missing on equipment.
  • Overall dirty prep spaces, sinks, etc. throughout the kitchen.

The Kitchen Manager, Director, and Hospital President said that they would deep clean the kitchen immediately. The kitchen team members would now be assigned a section of the kitchen each night. Hospital officials emailed the below “before and after” pictures to confirm the cleaning effort.

 

The leaders in environmental services and food services have also developed a plan for ongoing cleaning that includes clarifying which department is responsible for which areas are to be cleaned and a calendar for cleaning to ensure a thorough cleaning of the entire kitchen regularly. They also say they are focused on properly dating opened food items and doing a regular review of food items for any expired items

On July 8, the hospital updated the ombudsman, saying they were waiting for part for one elevator, and had requested service on two other elevators.

Two other lobby elevators were functioning and there were additional service elevators operational.

However, as of July 8, the ombudsman reported that the following kitchen equipment was still broken.

  • Dishwasher.
  • Two top ovens.
  • One bottom oven.
  • One garbage disposal.
  • Refrigerator door.
  • Condensation drain and one cooler.

Despite the kitchen and elevator issues, the ombudsman found that the hospital’s leadership team is dedicated to providing excellent patient outcomes.

However, the report said that the team is spread thin.

The Chief Nursing Officer is a regional director providing oversight to both Sharon Regional Medical Center and the Trumbull Regional Medical Center. The Associate Chief Nursing Officer is also the director of the ICU/cardiovascular director.

The Chief Financial Officer role is being covered by the Interim Regional Chief Financial Officer and the Financial Director position is vacant.

The Quality Director is regional, covering both Trumbull Regional Medical Center and Sharon Medical Regional Center.

Sharon Regional Medical Center

When the Ombudsman and her representatives inspected Sharon Regional Medical Center on June 25, the hospital’s president reported that the main Hospital chiller unit was 45 years old and not functioning. Two rental units are currently in place. A new chiller will cost about $409,000.

The president said that a grant from the Commonwealth of Pennsylvania has been approved which should cover the total cost of the new chiller.

The ombudsman reported that the hospital’s departments were neat and organized.

The clinical coordinator told the Ombudsman’s representatives that staffing for RNs is “tight” and they often must call around to fill schedule gaps.

The clinical coordinator hoped the situation would improve as several new graduates from the Sharon School of Nursing are undergoing orientation at the hospital.

Unlike the other two hospitals, the ombudsman found the kitchen at Sharon Regional to be clean.

All food was labeled; dry storage, freezers, and refrigerators were neat and orderly and food contents were labeled, according to the report.

Temperature logs were present, up to date, and in range.

“On the day of the visit, the Ombudsman noted that the kitchen staff was well trained, as the tray line was flowing well, and everyone knew their role in the process. The dietary staff functioned like an expert restaurant kitchen staff,” the report stated. “Staff members preparing the trays were on one side of the line and on the other side were cooks who were preparing components of the meal in real-time to ensure the freshest and warmest food possible.”

Ombudsman Keough said the kitchen was one of the cleanest, most organized, and efficient kitchens and staff that she had seen so far.

The hospital’s backup generator failed in December 2021. Since repairing it would cost $690,000, Steward has been leasing a temporary generator for $8,100 per month.

While the hospital works on a timeline to replace a 45-year-old chiller that failed in May, the hospital is renting two chillers to provide air conditioning.

As of last week, the hospital’s Regional Director of Quality told the ombudsman that about 70% of the cooling capability had been restored, with work continuing on the HVAC system to restore 100% of the cooling.

The ombudsman noted that Sharon General is challenged with equipment failures and has been waiting for the funds to replace their backup generator for 32 months. The cost to replace the generator in 2021 was approximately $690,000. Other repairs/replacements needed are an elevator repair and a chiller replacement.