Kaweah Health targets Aug. 18 Emergency Department opening

Visalia-Based Kaweah Health hopeful for Aug. 18 Emergency Department opening after staffing, “diversion event” setbacks

VISALIA – Kaweah Health is targeting Aug. 18 to open the expanded Visalia Emergency Department, four months and a few setbacks after the Visalia-based healthcare group announced its intent to open the expanded ED in April.

The $28 million expansion was initially advertised to bring the ED bed count up to 73, but the California Department of Public Health’s concern over Kaweah Health’s ability to staff the expanded facility has caused a change of plans. After having two staffing plans turned down by the state, Kaweah Health now plans to open Zone 5—the new 24-bed unit and waiting room—and close down zones 6 and 3, reducing the number of beds in the old ED to provide and staff 57 beds in total, with the long term goal of eventually opening and staffing all 73 beds available through the expansion.

Staffing is only part of Kaweah Health’s woes. Prior to the April unveiling, Kaweah Health had two separate “diversion events,” of healthcare workers stealing prescription medication. In a July interview with the Sun-Gazette, Kaweah Health CEO Gary Herbst said there appears to be “a direct correlation” between the two diversion events and the delay in CDPH’s greenlighting of the expanded emergency department.

Herbst said one instance resulted in the death of a scribe, a contracted position which inputs physician notes dictated during rounds at the hospital. In December 2020, at the height of the pandemic when Kaweah Health had 170 COVID patients in acute care was nearing 100% capacity at the hospital, the scribe snuck into the emergency department around midnight. He found an empty room where an IV of a common sedative known as Propofol was still hanging for a patient who had died a few hours earlier. Herbst said the scribe found a syringe in the room, extracted some of the sedative and then went to an employee bathroom where he was found unresponsive next to the syringe and later pronounced dead shortly after.

A second instance of a health care worker stealing prescription medication for personal use was reported in January 2021. Herbst said the physician had shown signs of possible impairment but there were never any witnesses or unreconciled medication use. A group of certified registered nurse anaesthetists, who had just returned from a drug diversion prevention webinar, filed some concerns with the chief medical officer and confronted the physician. After a week, the doctor admitted to having a substance abuse problem and confessed he had been taking drugs since May 2020. Herbst said the doctor would order three micrograms of Fentanyl, a synthetic opioid, administer only two micrograms and keep one for himself. Empty syringes had been found in the trash cans of employee bathrooms during that time.

Kaweah Health’s self-reporting of the incidents triggered an unannounced complaint validation survey by the Centers for Medicare and Medicaid Services (CMS) in March. CMS detailed its findings, observations and deficiencies identified during their survey in a statement of deficiencies report in May. The report said Kaweah Health did not consistently follow its own established practices and policies. Herbst called the report “deeply disappointing” because the activities and behaviors did not meet the hospital’s standards and expectations for patient safety.

Herbst said Kaweah Health’s plan of correction for the diversion events was accepted by the state and federal government July 9. Kaweah Health says it was unaware of the connection between the diversion events and their potential impact on the ED’s opening when it unveiled its expanded Emergency Department in April. Herbst claims it was a phone conversation with CDPH in June when he first connected the two, despite both diversion events having occurred well before April—though not public knowledge until July—and the CMS investigation having begun in March.

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