Hospital execs respond to critics’ claims they put profit over patients

Hospital execs respond to critics’ claims they put profit over patients
Published: Sep. 22, 2022 at 10:08 AM EDT
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WILMINGTON, N.C. (WECT) - It’s been a rough year at Novant Health New Hanover Regional Medical Center (NHRMC). After months of complaints about long wait times in the Emergency Room, and patients having to wait days for a hospital bed if they needed to be admitted, some people’s worst fears were realized. A 77-year-old woman coded in the ER lobby, after waiting more than five hours to be seen. She died about two hours later.

While hospital officials initially downplayed the significance of that event, her death appears to have been the trigger for an inspection by state health regulators, who also investigated other complaints about the hospital during a week-long visit at the end of June. Inspectors found the conditions at NHRMC - specifically a severe nursing shortage - put patient safety at risk. Federal health officials informed hospital leaders they had been placed in Immediate Jeopardy status, and would lose their Medicare contract on August 11 if the issues were not rectified.

The hospital has since hired hundreds of nurses and made other improvements to rectify the issues discovered by investigators, and their contract with Medicare remains in tact. But the inspectors’ findings underscore that there have been very real problems at the main hospital and only trauma center available for hundreds of thousands of patients across southeastern North Carolina.

For the first time since the issues began, executives from Novant granted WECT a sit-down, in-person interview to discuss a wide range of concerns and what’s being done to address them. These are highlights from that discussion:

WECT’s Ann McAdams: The perception from the community is that we were lied to. And the perception from the community is that we were told the patient did not die in the ER lobby. And when the report came out from the federal government saying what happened, it was pretty close to what we had initially been told. She coded, and it looks like from the report that she didn’t have a pulse for 20 minutes. Then they were able to reestablish a pulse and she died at a later time, not in the lobby. But for people who wonder if we were misled by the hospital saying that she didn’t die in the lobby, even if that’s technically true, if the general gist of the story was fair, how would you respond to people who feel like we were lied to?

NHRMC President Shelbourn Stevens: “I don’t feel like we lied to anyone. I think we gave you the facts that we had at the time. And actually, since that time, the [patient’s] family has asked us not to talk about the case at all.”

McAdams: We asked and I guess, probably, we just asked too early. We asked [on June 15], ‘Have any state investigators been here’ [looking into this patient’s death], and at the time we asked, they hadn’t. [But] they came the next week and they stayed for a week, and it turned out to be a pretty big deal. How can you let the public know that you can be trusted?

Stevens: “We provide great service. And we’ve had some back steps this summer, we know with staffing and we’re going to do everything and we’re committed to getting that care right and serving this community going forward. I think all of us would sit here and agree that us and our teams are very committed to provide top quality care for this region.”

NHMRC Chief Nurse Executive Amy Akers, RN: “We come to work to take care of the community and the patients that come to see us. I mean, that’s where our heart is and that’s where our team’s heart is. And so we have no intention and do not want to lie. You know, we talk about how we receive feedback, that’s how we get better. I mean, we want to address anything that comes up that we need to improve upon.”

McAdams: Some people were like, ‘Well, why didn’t they tell you that the state did come to investigate? Why did nobody mention that we are in jeopardy of losing our Medicare contract?”

Stevens: “That’s just not our normal process. I mean, the state has been at New Hanover before. Even since I’ve been there, prior to this, on complaint investigations. And we’ve just never notified anyone. We get focused on their survey, and any findings that they make, and on the improvements that we need to make when they come.”

McAdams: When push came to shove, when you all got threatened with having your Medicare contract cancelled, a lot of nurses got hired quickly. Tell me about how that was made possible. Did dollars just become available because they had to become available for you all to continue to function, or what changed that there was able to be this hiring surge?

Akers: “We made some decisions in May based off of the knowledge that we had, and quickly learned that we did not retain some of the travel[ing nurses] that we were counting on retaining. And we did not convert all of the hires that we had planned on hiring.... This happened very quickly, because you can’t get travelers in very quickly either. But we got them in quickly because we were already in that process of bringing on additional travelers. Now we did know in conjunction in July and August, we did bring on a third agency actually called Fast Staff, that does bring in [nurses] a little bit faster. But we were already in that that process of bringing them on.”

McAdams: Is there a time that New Hanover [Regional Medical Center] has ever been in Immediate Jeopardy status before?

Hospital executives seemed to recall there had been one other Immediate Jeopardy designation several years before when the county still owned the hospital. They followed up after our interview to confirm that inspectors surveyed NHRMC September 29-30, 2015 before notifying them they were in Immediate Jeopardy status due to issues with Patients Rights, Nursing Services, Emergency Services, and Governing Body. The hospital was resurveyed the week of October 26, 2015 and apparently returned to good standing.

McAdams: A lot of people have pointed the finger at Novant and said [recent issues happened] because of the new ownership. Tell me about your take on that. **Editor’s note: Novant Health purchased NHRMC from New Hanover County in 2021**

Stevens: “This was not a Novant thing. There was a staffing shortage prior to COVID and it got worse with COVID. I felt it even down in Brunswick, in my time there, it was hard. Nurses retired. And then replacing them it was hard and people were burned out. And it’s not just nurses, it’s respiratory therapists, it’s food and nutrition, and EDS. So we’re hearing nationwide a lot of hospitals really struggling. We’re very fortunate here that we’re able to keep all of our services going. We’ve had to slow down with some staffing issues, but those services are back up and running. But we haven’t stopped any services, like I have read around some hospitals.”

Akers: “You know, the nursing shortage, and as we talk about that, in my 27 years of being a nurse, we’ve always had a nursing shortage. With what we’ve been through the last couple years, it’s amplified it and we knew when we got to 2020, 2030, it was going to increase. It just made it come faster.... Here’s our opportunity to look at what do care models look like moving forward? What changes do we need to make? Because we’re gonna have to, to come out of this. This isn’t as simple as we’ve got to graduate more nurses. We’ve got to really look at the way we’re delivering care on a day to day basis in order to meet the needs that we want to in our communities.”

Novant Health Coastal Region Chief Clinical Officer Dr. West Paul: “This is probably the most unique time certainly I’ve ever seen in medicine. I’ve practiced medicine for 30 years, I don’t know if we’ll see this again. It wasn’t Novant that caused these issues. I would concur that Novant has brought resources to us I can say from the quality and safety arena...that we could have never had here. It just was financially impossible. So we were quite happy with that. And I think whatever issues we have faced, have been made actually better by that partnership.”

McAdams: Nurses have been scared to talk, they feel like they’ll lose their jobs. In fairness, they felt like that before the hospital was owned by Novant. It’s the largest employer in town. It’s the only hospital in town. So it’s not like there’s 100 places you can go to work if you lose your job. Are people allowed to talk to media? Is there a policy that they’re not allowed to talk to the media? And why?

Stevens: “It saddens me to hear that staff feel that way.... I haven’t had any staff asking to talk to media. Typically, just like if I were to get a call from media, I would contact our media relations and make them aware that they want to be involved with that. But we do want an open environment.”

Akers: “It kind of goes back to HIPPA and making sure that we are also looking out for them and what they’re saying in the public. And so it’s not to say they can’t [talk], or that they shouldn’t, but just done in the right way in order to protect everybody’s privacy.”

McAdams: Dale Folwell, the state treasurer, has been an open critic of not just Novant, but large hospital systems. And he is probably the most outspoken, highest profile critic... He has called these hospital groups “cartels.” He says it’s a joke that they consider themselves to be nonprofits and that they are putting profits over patient care, and the executives are laughing all the way to the bank. How would [you] respond to the state treasurer making comments like that?

Stevens: “Well, I think a lot of those stories make a good headline, but it’s not all accurate. We have one of the most robust charity care policies and it actually improved for New Hanover when we took over in February of 2021. And we made sure any families that meet that policy have that charity care, as a matter of fact, that a lot of the other programs that we do out in the community, screenings and stuff, that we’re getting back to now post COVID. We’re going to be doing more of that. I think we were a little over a billion dollars in charity care and community benefit for 2021 of all of them. So it saddens me that somebody wants to say those comments around healthcare systems that are already damaged.”

McAdams: Nonprofit [status] is a big deal. They save a ton of money on taxes being a nonprofit. And some states require that you provide a certain amount of charity care to justify that nonprofit status. North Carolina doesn’t have qualify. And [Treasurer Dale Folwell] would like to see that happen. Where there’s a more clear standard for what you have to do to qualify to be a nonprofit, how do you feel about that?

Stevens: “Well, most hospitals that I’ve worked with or talked to have always kind of used the 200% of the federal poverty level, I’m sure there’s different ranges. But Novant Health has, for the last many years, been 300% of the federal poverty level, which is much higher than most healthcare systems. And as I said, we were able to bring that with this partnership here to Wilmington.

Paul: “There are other benefits. It’s not only charity care, but what other benefits it provides, in free screenings, free clinics, there’s a lot of care that’s provided that is not necessarily ever reimbursed. So a lot of care is provided that is under-reimbursed, but we continue to do that because it’s for the good of the community.

McAdams: 32% turnover. That’s the number that I was given [that the hospital has] experienced in the last year.... That’s tough to deal with. And, from what I understand... a lot of the people who left were some of your most long-serving employees.

Paul: “All the nurses that have retired are really the nurses with the most knowledge, the most... knowing how to do things. So we’ve been trying to hire nurses. A lot of them are newer. It’s nice to have those experienced nurses and we lost a lot, and a lot of them chose to retire. That is a big drain. A brain drain is what it is.”

**Editor’s note - the turnover rate at NHRMC had decreased by the end of the summer. The hospital provided the following statistics after our interview**

At the end of August 2022, Novant Health New Hanover Regional Medical Center’s turnover rate was 27%, which is in line with the national average of 26% in 2021. New Hanover Regional Medical Center’s turnover rate in August 2020 was 17%.

McAdams: On the burnout topic.... [nurses tell us], ‘We know how much we get paid and we know how much the executives get paid. And the discrepancy is so large that it’s demoralizing to us.... We’re not being adequately compensated for the amount of effort and drudgery sometimes, especially under the current conditions.’ How would you address that, where people just feel like the executive pay versus the nurse pay is really out of line?

Stevens:Well, our HR team really monitors that. And they have metrics just like we do for any physician, whether it’s a physician, nurse, or an executive. There are goals out there....and we rely on them to make sure we’re in line with those benchmarks. [Novant has spent] a little over $60 million, just at New Hanover and Pender increasing salaries to get them at that market range since 2021. So there’s been some significant increases, and we’re not done. We still have some work to do. The minimum wage did go up to the $15 an hour, we call it a living wage. But then we also went back and looked. Nurses were leaving New Hanover, they could go to Brunswick for a little more, and we realized we were not paying at the same rate. So we did have to do what we called some parity work across the board.”

While this story focuses on the hospital’s response to recent problems, there have also been some noteworthy improvements since the hospital sale thanks to the resources of Novant. This report about the first year under Novant’s ownership highlights some of those accomplishments.