HospitalInspections.org

Based on review of the surgical schedules, and employee interviews, it has been determined that the hospital failed to have a Governing Body that is effective in carrying out its responsibilities for the conduct of the hospital.

Findings are as follows:

Record review of a community reported complaint, received by the Rhode Island Department of Health on October 24, 2023, alleges that the hospital is not paying their supply venders which is resulting in surgeries and procedures being cancelled.

According to the CMS Regulations and Interpretive Guidelines for Hospitals, under section §482.12 Condition of Participation: Governing Body states in part, "There must be an effective governing body that is legally responsible for the conduct of the hospital...."

Record review of the surgical schedules for October 2023, revealed multiple surgical procedures were cancelled related to the hospitals failure to pay for the medical supplies necessary to complete the procedures.

Surveyor review of the Governing Body minutes dated 2/10/2023, 5/3/2023 and 8/2/2023, failed to reveal that supplies and equipment placed on vendor credit holds were reported to the board. These minutes also failed to provide evidence that the Governing Body was made aware of the hospitals failure to obtain supplies to complete scheduled surgical procedures which resulted in multiple cancellations.

During a surveyor telephone interview on 10/30/2023 at approximately 8:30 AM, with the Chief Executive Officer, he revealed that he was unaware of the cancellation of the surgical procedures. Additionally, he was unable to provide evidence that the Governing Body held meetings to discuss the hospital's inability to obtain the necessary supplies.

During a surveyor interview with the Administrator of Surgical Services, Staff E, on 10/26/2023 at approximately 9:30 AM, she acknowledged that the hospital had cancelled 13 surgical procedures due to the lack of supplies and equipment necessary for the surgeries.

(Refer to A-049 and A-057)

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Based on record review and staff interview it has been determined that the governing body failed to ensure that the medical staff as a group is accountable to the governing body for the quality of care provided to patients relative to the cancellation of 13 scheduled surgical procedures, for Patient ID#s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13.

Findings are as follows:

Record review of a community reported complaint, received by the Rhode Island Department of Health on October 24, 2023, alleges that the hospital is not paying their vendors which is resulting in surgeries and procedures being cancelled.

Record review of the surgical schedules for October 2023, revealed multiple surgical procedures were cancelled related to the hospitals failure to pay for the medical supplies necessary to complete the procedures.

Additional record review revealed that the hospital failed to ensure that it had the necessary equipment to safely perform the following ophthalmology procedures that were scheduled on 10/12/2023, resulting in their cancellation:

1. Patient ID # 1, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
2. Patient ID # 2, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
3. Patient ID # 3, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
4. Patient ID # 4, was scheduled for left eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
5. Patient ID # 5, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
6. Patient ID # 6, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
7. Patient ID #7, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
8. Patient ID # 8, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
9. Patient ID # 9, was scheduled for left eye surgery on 10/12/2023, and was notified that the surgery was cancelled.
10. Patient ID # 10, was scheduled for right eye surgery on 10/12/2023, and was notified that the surgery was cancelled.

During a surveyor interview on 10/26/2023 at 12:30 PM with the Surgeon, Staff A, who was scheduled to perform the above 10 cases, he revealed that his office was notified by the hospital that they needed to cancel the surgical procedures because of a lack of supplies. Additionally, he revealed that the hospital was behind on payments to a supplier (Alcon) resulting in them no longer providing supplies to the hospital. Additionally, he indicated that this was an inconvenience for the patients, and he was concerned because they had already arranged for time off from work, transportation to and from the hospital, and care following the procedure. He further indicated that the patients were upset and that some will go to other facilities for their procedures, and some will seek out other surgeons so that they can have their surgery completed. He also stated that this is the only hospital where he performs procedures, but now may have to investigate other options, such as, surgical centers to perform procedures in the future.

11. Patient ID #11, was scheduled for spinal surgery on 10/20/2023, and was notified that the surgery was cancelled.

During a surveyor interview on 10/30/2023 at 12:25 PM, with Surgeon, Staff B, he revealed that he was unable to perform the surgery as the hospital failed to pay the vendor "Lifespine" and therefore they will not deliver supplies. He stated that "you don't know from day to day" what you will be able to do or what may need to be cancelled. Additionally, he revealed that he had two cases scheduled for 10/20/2023 and that one has not been rescheduled and the other he performed at another facility. He stated that this is the second time his cases were cancelled, indicating the first time was around June/July. He further revealed that it is difficult to move cases to another location and it is very disruptive for the patients to have surgery cancelled at the last minute. Staff B further stated that he has spoken with and emailed the hospital's Chief Executive Officer about this issue.

12. Patient ID # 12, who was scheduled for ENT (Ear, Nose, and Throat) surgery on 10/27/2023 was notified that his/her surgery was cancelled. This patient had the initial procedure on 6/19/2023, " Drug-Induced Sleep Endoscopy" performed under anesthesia to determine eligibility for placement of the "Inspire" implant (a surgically implanted device that treats obstructive sleep apnea).

13. Patient ID # 13, was also had the intial procedure was scheduled for the ENT procedure (Inspire device) on 10/27/2023, and was notified that the surgery was cancelled.

During a surveyor interview on 10/30/2023 at 1:25 PM, with Surgeon, Staff C, he revealed that the above two patients had their procedures cancelled due to the lack of supplies. He stated that "Inspire" has not been paid, and is owed money, therefore they will not supply the devices for implant. Additionally, he revealed that currently this is the only hospital that he has the credentialing to perform this procedure, therefore he cannot reschedule these procedures at other hospitals. He also indicated that it is embarrassing to tell patients that their surgery is being cancelled because the hospital is not paying the supplier. He also stated that one of the cases has multiple health issues and that the patient's Primary Care Physician, Cardiologist, and family are anxious for the patient to have the procedure. He further revealed that he has placed multiple calls to leadership and other agencies to report that the hospital is not paying their bills. Additionally, he revealed that he has spoken with other surgeons who have also been impacted by vendors placing the hospital on credit holds.

During a surveyor interview on 10/26/2023 at 3:15 PM, with Orthopedic Surgeon, Staff D, who performs surgery at both Charter Care hospitals, she revealed that although she has not had any surgeries cancelled at this hospital she has had two of her orthopedic cases scheduled for 10/19/2023, at the Roger Williams Hospital, were cancelled due to lack of equipment, relative to vendors not being paid. Additionally, she stated that one of the cases has yet to be rescheduled and one she performed at another facility.

During a surveyor interview on 10/26/2023 at 9:30 AM, with the Operating Room Director and the Administrator of Surgical Services, Staff E, they indicated that the hospital can obtain some supplies and equipment from their other facilities, and from other hospitals that they have working relationships with. Additionally, she indicated that the hospital is also trying to obtain the necessary equipment from other vendors who have similar products.

During a surveyor interview on 10/26/2023 at 1:45 PM, with the Chief of Surgery, he stated that he "heard something about cases being cancelled". He also revealed that he has spoken with the Surgeons and made it clear that if they are not comfortable with the equipment available then the cases need to be cancelled. He further revealed that the issue of suppliers not being paid has been addressed with the administration.

During a telephone interview with the Chief Executive Officer on 10/30/2023 at 8:30 AM, he revealed that he was unaware that two surgical (ENT) cases were cancelled on 10/27/2023. Additionally, he indicated that he was unaware that these cases were cancelled due to the credit hold from the company (Inspire) that provides the device needed for the procedure. He further revealed that he was unaware that those two patients had to be evaluated under anesthesia to determine their eligibility for placement of the device.

Based on the information obtained during this investigation, it has been determined that the above physicians were aware of the lack of medical supplies/equipment available which resulted in the cancellation of the above-mentioned surgeries/procedures.

Based on record review and staff interview it has been determined that the hospital's corporate parent company failed to provided funding necessary for the Chief Executive Officer who is responsible for managing the hospital, to make sufficient payments to its vendors resulting in several unpaid vendor accounts. This failure to pay these vendor accounts resulted in the cancellation of several scheduled surgeries.

Findings are as follows:

During a surveyor interview with Administrator of Surgical Services, Staff E, on 10/26/2023 at 9:30 AM, she acknowledged that the hospital had cancelled 13 surgical procedures due to the lack of supplies and equipment necessary for the surgeries.

The schedules identified 10 ophthalmology surgeries which were cancelled for 10/12/2023, 1 neurological/spinal surgery was cancelled on 10/20/2023, and the 2 Otolaryngologist (ENT) surgeries were cancelled on 10/27/2023 due to the hospital's failure to pay the vendors who supply the necessary supplies/equipment.

During a surveyor interview on 10/30/2023 at 1:25 PM, with Surgeon, Staff C, he revealed that the above two ENT patients had their procedures cancelled due to the lack of supplies. He stated that "Inspire" has not been paid, and is owed money, therefore they will not supply the devices for implant. Additionally, he revealed that currently this is the only hospital that he has the credentialing to perform this procedure, therefore he cannot reschedule these procedures at other hospitals. He also indicated that it is embarrassing to tell patients that their surgery is being cancelled because the hospital is not paying the supplier. He also stated that one of the cases has multiple health issues and that the patient's Primary Care Physician, Cardiologist, and family are anxious for the patient to have the procedure. He further revealed that he has placed multiple calls to leadership and other agencies to report that the hospital is not paying their bills. Additionally, he revealed that he has spoken with other surgeons who have also been impacted by vendors placing the hospital on credit holds. Lastly, Staff C revealed that he had placed calls to the hospital's corporate parent company in California, who controls the hospital's financing, but has been unable to speak with anyone.

During an interview on 10/30/2023 at approximately 1:15 PM, with the Director of Supplies, Staff F, he revealed that he has been working with the accounts payable department relative to the vendor credit holds. Staff F indicated that there is an ongoing concern and in the past 6 weeks more suppliers have put the hospital on credit holds or in collections. Staff F indicated that some vendors will not accept orders and others will not fill the orders without receiving prepayment. He further revealed that the list of vendors that are on credit holds changes from day to day and vendors will come on and off the list as they receive payments. Additionally, he revealed that the hospital was on hold with approximately 250 vendors including medical equipment and surgical suppliers at this time.

During a phone interview with the Chief Executive Officer on 10/30/2023 at 8:30 AM, he revealed that he was unaware that surgical cases were cancelled due to credit holds. He further revealed that the hospital receives an "allowance" every week and he doesn't know how much money that will be from week to week, and that he can request a certain amount of money, but may only receive half of that amount. He indicated that he does not have enough money in the "allowance" to pay all the vendors that are owed money.