‘Full operations’ resume at HCA’s North Florida Hospital (2024)

HCA Florida North Florida Hospital reports it has returned to normal operations, even as reports of inadequately cleaned instruments persist.

The hospital’s surgical instrument crisis forced it to abruptly cancel all elective surgeries nearly two months ago, leaving one of the region’s largest hospitals to only perform emergency surgeries for about three weeks, beginning Jan. 17.

The unprecedented event saw an untold number of operations scratched and spawned re-scheduling “chaos” for surgeons and patients.

The shutdown came after surgeons had complained “for at least a year” about instruments routinely delivered to operating rooms with “blood and tissue” from previous surgeries still on them.

Two sources in a position to know told Mainstreet the persistent problem of “leftovers”—or “bioburden”—remaining on ostensibly cleaned and sterilized instruments has been dramatically reduced, but not fully resolved.They said that, as recently as Monday, at least a half-dozen trays of surgical instruments were found with bioburden.

Last week, a patient whose surgery had been delayed for weeks by the dysfunction was left waiting again on the day of his surgery.According to family, the man waited in pre-op for eight hours past his scheduled surgery time due to what his surgeon called an “equipment problem.”

The hospital reported surgery schedules were back to normal Wednesday. In an 8:39 p.m. email to Mainstreet, corporate spokesperson John “Trip” Farmer said, “HCA Florida North Florida Hospital has resumed full operations.”

The message marked a significant milestone in a monthslong saga:

• On Jan. 10, with doctors “up in arms” and clamoring for help, hospital leadership convened a 6:30 a.m. meeting with more than 50 surgeons who expressed “disgust” over the “festering” problems.
• On Jan. 12, the administration laid out an “action plan” but told surgeons in an email that the “best course of action” was to “stay open to surgery.”
• On Jan. 14, Chief Medical Officer Dr. Sherrie Somers wrote to surgeons that the action plan had revealed “additional layers of vulnerability,” including, “Rusted instruments were more severe than anticipated.”
• On Jan. 17, the hospital abruptly reversed course, ordering an immediate halt to all elective surgeries. It also informed first responders to take patients needing emergency surgery elsewhere—then rescinded that directive the next day.

• On Feb. 5, operating rooms re-opened to some elective surgeries, but only to “high acuity” patients—those in immediate, critical need.Even those surgeries were subject to rejection by a “physician review panel,” according to a Somers email.
• On Feb. 12, doctors were permitted to schedule half their usual operating room time.
• On Feb 20, hospital CEO Eric Lawson announced surgeries had resumed at 75%.
• On March 13, the hospital said it had restored 100% of surgical operations.

HCA and HCA Florida North Florida Hospital have repeatedly declined to say how many surgeries were canceled.The hospital said its “proactive” decision to still surgeons’ scalpels was caused by unspecified “operational,” mostly “equipment related” issues.

Whether contaminated or defective instruments caused complications or infections among patients is not known.HCA has not said.

The Agency for Health Care Administration (AHCA), the state agency that inspects hospitals for the federal government, conducted an unannounced inspection Feb. 6.In a “status” report, AHCA found “no deficiencies,” but offered no further detail.

AHCA, and its federal overseer, the Centers for Medicare and Medicaid Services, have not replied to Mainstreet’s repeated requests for more information about any potential ongoing investigation. Both agencies are constrained by statutes and rules as to what they can say publicly.

A hospital source told Mainstreet that AHCA saw no evidence of violations during the February inspection, which took less than a day.The person, in a position to know, said investigators “were satisfied with the actions already in place” and the hospital’s plans for future compliance.

Mainstreet’s reporting has relied on information received from doctors, nurses, patients, medical practice staff and others—most of whom spoke on condition of anonymity, for fear of reprisal. Mainstreet has also obtained internal hospital documents that confirm and expand on many of the details provided by confidential sources.

January messages obtained by Mainstreet reveal that administrators, including Lawson and Somers, were aware of unfulfilled promises to correct the problems surgeons identified over a period of “6-12 months.”

Internal documents reveal the hospital, by its own admission, employed technicians in its sterile processing department who were not properly trained.A surgeon said skilled technicians had been whittled out in favor of less expensive, less-experienced ones who “didn’t know what they were doing.”

The hospital brought in Steris Corporation, a company approved for federal disaster response, to help ensure local staff used “correct processes” in the sterile processing department, where instruments are supposed to be rendered germ free and squeaky clean.A convoy of Steris trucks assembled in the back parking lot as technicians began the job of cleaning and repairing “a lot, probably thousands” of surgical instruments and tools.

Steris “educators” and “supervisors” also oversaw training of “existing” hospital staff and ongoing recovery efforts.

On Feb. 20, Lawson wrote a message to staff, saying efforts were well underway, including “installation of additional pre-surgical processing units, the procurement of new instruments, and the expansion of our surgical services staff.”

As recently as Wednesday, however, technicians were still at work in a Steris Corporation “mobile” instrument sterilization facility parked behind the emergency room. The operation, a partly open-air setup that somewhat resembles an oversized food truck, is the length of a tractor trailer that expands to three times its highway width.

Some surgeons said they believe North Florida Hospital operates under a “corporate culture” the puts “profit over patients.”Two told Mainstreet the debacle of tainted and damaged instruments can be directly attributed to cost-cutting aimed at increasing profit margins.

“My reputation has been damaged, and these people (HCA) don’t give a rat’s –s,” an orthopedic surgeon said. He said the hospital cut “as many corners as they could.Too many.”

Another doctor, who performs neuro surgeries, said HCA goes to extremes to keep “business in house,” pointing to operations performed at HCA-owned hospitals in Ocala and Lake City during the company’s Gainesville shutdown. Two patients said they were not given the option of going elsewhere locally, and one said her surgeon only had privileges at HCA facilities.

North Florida Hospital and its parent corporation, HCA Healthcare, Inc., have declined to say how many surgeries were moved to other hospitals.

Some doctors claimed the hospital has continued a major expansion of facilities and services—including three free-standing operating rooms and a stroke center—without adequate staff and resources to support them.

In response to these allegations, the hospital issued an unsigned statement to Mainstreet attributing its growth to population growth.

“As our communities grow, so does the demand for healthcare services,” the statement said. “To better support the healthcare needs of the communities we serve, over the last several years, we have invested significantly in the expansion of services such as stroke, orthopedics, and emergency services, as well as the resources and personnel to support those services. HCA Florida North Florida Hospital is appropriately staffed and the quality of care we provide is confirmed by the national recognition we have received from independent patient safety and quality rating organizations reviewing performance on quality measures.”

The statement lists a range of specific recognitions and accreditations, including from The Joint Commission (TJC), whose findings can make or break a medical facility.

In October, The Joint Commission found “deficiencies” in four areas at North Florida Hospital, according to a Dec. 15 letter obtained by Mainstreet. A surprise, four-day inspection revealed deficiencies in the hospital’s compliance with federal and state laws governing infection control, patients’ rights, and pharmaceutical services.

HCA would not provide details of the violations or what it did to correct them. In the Dec. 15 letter, TJC granted a three-year accreditation to the hospital effective Oct. 21, nearly two months earlier.While it appears to have been a retroactive designation, HCA’s Farmer, insisted, “There were no gaps in the accreditation status with The Joint Commission.”

HCA is the nation’s largest, for-profit hospital chain. It owns and operates 183 hospitals and thousands of other medical facilities, whichpulled in a combined $65 billion in revenue last year. North Florida Hospital is the largest, per-patient money-maker among HCA’s 49 Florida hospitals, according to industry research group Definitive Healthcare.

Last week, the federal government launched a sweeping, multi-agency “examination” of hospitals and other healthcare facilities owned by corporations.The Department of Health and Human Services (HHS), the Department of Justice (DOJ), and the Federal Trade Commission (FTC) are seeking “public comment” through May 6 to learn the extent to which companies may have prioritized profits over patient care or engaged in unlawful business practices to corner markets.

The government’s inquiry is primarily focused on “private equity” companies that have acquired significant stakes in U.S. healthcare, but it is also looking at “other corporations’ increasing control over health care,” including various “medical systems.”Spokespersons for HHS and the FTC told Mainstreet the probe could expand to publicly held, for-profit hospital chains such as HCA if that’s “where the public input takes it.”

Assistant U.S. Attorney General Jonathan Kanter underscored the importance of the probe in a March 6, multi-agency video conference.

“The stakes are about way more than money,” Kanter said. “They’re about people’s health, people’s lives.”

Editor’s note: Fresh Take Florida, a news service of the University of Florida College of Journalism and Communications, was the first to report the surgery cancellations at HCA Florida North Florida Hospital.Mainstreet and Fresh Take have joined in a continuing investigation of this healthcare issue of concern to the people of North Central Florida.