State investigation also finds lapses in patient safety, quality of care and infection control.
Upstate University Hospital, in Syracuse, was cited by the state Health Department for not protecting the health, safety and rights of the patients. Upstate said it has submitted a correction plan to the state and that many of the problems have been fixed.Syracuse, N.Y. -- A state investigation has turned up violations of state regulations at Upstate University Hospital, including the case of a student doctor performing a complex operation on a patient’s spine while a supervising doctor not qualified to do the operation oversaw it.
The state Health Department found shortcomings involving doctor performance, patient safety, quality of care and infection control practices at the Syracuse teaching hospital. Upstate’s neurosurgery department was a major focus of the investigation. The report also criticized Upstate’s administration.
“... the hospital CEOs have not effectively managed the operational affairs of the hospital,” the report said.
In a 68-page report summarizing the findings of its investigation, which began last year, the Health Department said Upstate did not provide surgical services in a way “that assures protection of the health, safety and rights of the patients ...”
The Health Department provided a copy of the report to The Post-Standard in response to a request under the Freedom of Information law. The department blacked out extensive sections of the document containing details about specific cases and information that could lead to the identification of doctors and patients.
The department launched the investigation in spring 2009 in response to a complaint, said Jeffrey Hammond, who speaks for the state Health Department. The department might fine or take other enforcement action against the hospital, he said.
Most of the details about the spine surgery conducted by the resident, or student doctor, were redacted from the report by the Health Department.
But a neurosurgeon, who spoke on the condition of anonymity, said the Upstate resident performed the operation because the doctor scheduled to do it was in a nearby operating room performing another surgery that took longer than expected. The surgeon supervising the resident did not have the experience to do the operation, he said. The Health Department report also indicated the supervising surgeon was not qualified to do the procedure.
“Residents are strictly forbidden to perform the major portion of operations without direct attending supervision by an individual qualified to do the operation themselves,” the neurosurgeon said. “Residents are student doctors and do not have the qualifications or credentials to do any of these procedures without proper supervision — ever.”
The hospital did not tell the patient after the operation which doctor performed the surgery, Hammond said. The patient was not harmed during the operation, he said.
The report said investigators could not find documentation in another surgical case to show doctors, nurses and others involved in the operation conducted a “time out” before beginning surgery.
During a time out, members of the operating team have to stop, verify they have the right patient in the operating room and are preparing to operate on the right body part. This process is designed to prevent wrong-side or wrong-site surgery errors.
The Health Department report said the hospital’s inability to document that a time out occurred was unacceptable because the hospital’s surgeons have been cited twice before in recent years for cutting two patients in the wrong places.
In 2006, a surgeon at Upstate operated on the wrong side of a patient having a tumor removed from an adrenal gland. That mistake happened because the doctor did not double-check radiology pictures before making the incision.
In 2004, an Upstate surgeon planning to remove a blood clot from an infant’s brain made the initial incision on the wrong side of the baby’s head.
The investigation also found evidence some patients did not get a complete history and physical work-up before surgery, as required by state regulations.
Upstate refused to comment on any of the specific details of the report.
Dr. John McCabe, who took over a year ago as the hospital’s chief executive officer, said he agreed with many, but not all, of the Health Department’s findings. He said many of the problems identified have been fixed. Upstate has submitted a correction plan to the Health Department, he said.
“Every time we get a statement of deficiencies, it concerns me,” McCabe said. “But is this a damning indictment of the quality of care at University Hospital? Far from it.”
McCabe said the deficiencies cited by the state resulted in “no substantive harm” to patients.
Art Levin — of the Center for Medical Consumers, a consumer advocacy group based in New York City — called the violations found by the state troubling.
“When you put this all together, it’s a sloppy picture,” Levin said. “They are not doing some very basic things that are designed to protect patients from harm.”
He said doctors supervising residents performing surgery must know how to do the operations themselves.
“That’s how residents learn to do what they will be doing later on,” Levin said. “What is the resident going to do when something goes wrong?”
Some other problems identified in the report include:
• Lax infection control. Records from 2007 and 2008 showed the hospital’s infection control committee did not adequately analyze data it had collected to identify increased rates of infections in various hospital departments.
Records did not show if infection rates increased or decreased compared to the year before. Different departments monitored their own infection rates but did not always share that data with the infection control committee.
Also, the hospital did not require different surgical departments to report infections in “clean surgical cases” — scheduled, non-emergency operations.
“The ICC (infection control committee) ... did not provide adequate oversight when these departments identified problems with infections, and did not assure appropriate follow-up of problems identified.”
McCabe said Upstate has made significant progress over the past year decreasing the rate of bloodstream infections and urinary catheter infections.
• Failure to report to the state misconduct by doctors. Hospitals are required by state law to report to the state Office of Professional Medical Conduct all instances of potential misconduct by doctors or restrictions imposed on doctors. But the hospital’s internal written rules erroneously said a temporary suspension of a doctor’s clinical privileges did not have to be reported to the state until the hospital completed its own review.
The report said the hospital failed to report restrictions imposed on a doctor, even after problems with the care the doctor provided to patients clearly had been established.
• Failure to obtain permission from patients to have vendors in the operating room during surgery. Vendors who represent companies that make medical devices are often present in operating rooms to advise doctors about how their products work.
Kenneth Powers — who speaks for the Joint Commission, an agency that accredits U.S. hospitals — said patients should be told if vendors will be in the operating room and told the reason for their presence. He said patients should also have the right to refuse to have a vendor in the operating room.