Kaweah Health emergency department delayed by staffing, ‘diversion’ events

Expanded ED still not open after multiple instances of healthcare workers stealing prescription medication resulting in one death, state repeatedly denies staffing plans

VISALIA – In April, Kaweah Health unveiled the brand new expanded emergency department, touted to bring their ED bed count up to 73 with state-of-the-art medical care and an expanded waiting room, said to be ready to start seeing patients the next week pending state review. Come mid-July, the doors to the new facility have yet to open.

Kaweah Health CEO Gary Herbst said there now appears to be “a direct correlation” between two recent diversion events—instances of healthcare workers stealing prescription medication—at Kaweah Health and the delay in the California Department of Public Health’s (CDPH) 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. Herbst said the doctor has been placed on leave and Kaweah Health is currently reviewing his case to see whether or not he will be allowed to return to the hospital at any point.

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, and that there would be a validation team on site through the next week to ensure Kaweah Health was doing everything promised in the plan of correction. As of press time, there was no update as to the result of the validation survey.

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 Julyand the CMS investigation having begun in March.

To muddy the waters further from the initial information given in April about the expanded ED—presented to bring the total number of beds to 73—the plan has now changed to open and operate only 57 beds. Kaweah Health’s staffing plans were turned down by CDPH twice, and the health care group is currently waiting to hear back on their third submittal. Herbst said the hospital is short staffed with dozens of travel nurses hired, and the hospital runs short in the emergency department in particular.

“What we had told the state is we said, ‘We understand your concern. We’re not asking that you give us approval to open all 73 emergency department beds,’” Herbst said. “What we’ve told them is we have enough staff consistently to open and staff 57 beds…They’re having a hard time understanding that.”

Herbst said the plan would be to open Zone 5—the new 24-bed unit and waiting room—and close down zone 6 and zone 3, reducing the number of beds in the old ED to provide and staff 57 beds in total.

“We have not been deliberately trying to misinform the public,” Herbst said.

-This article was updated at 12:05 p.m. PST on July 23, 2021.

Note: After reading this article, Kaweah Health officials called to offer some clarifications. One has already been updated in the story, the other note has been made here. While Kaweah Health is currently proposing a plan to open and staff 57 beds, their long-term goal is to open and staff all 73 beds available through the expansion.

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