Conversations with Keith

I spoke with an OSF administrator, Dr. Tim Miller, in early October, 2001, and he stated that I was right and that “OSF had ignored the main campus”. He was referring to my letter to Keith Steffen regarding lack of bed capacity in the hospital for emergency department patients. The focus had been on the Center for Health that OSF had just competed north of the City. It cost 38 million dollars. Some of our patients in the ED didn’t even have pillows on their gurneys to lie on. 

I thought the ER was quite dysfunctional and our patient satisfactions scores were 33%, the lowest at OSF. I copied excellent articles from the journal “Society for Academic Emergency Medicine” regarding ER overcrowding for multiple administrators. I heard back from no one in administration at OSF regarding the articles. 

I sent Keith this handwritten note on October 1, 2001, pleading for help for the Emergency Department from OSF administration:  

Dear Keith, 

As you may or may not know, the ER is in "tough straits" - patient care and waiting time is very lengthy. I would love to have you or another administrator spend a couple of shifts with me this week in the ER. I work 3-11 and 5-1. You would see patients with me. The objectives of this would be to: 1. See the ER from "ground zero" - this would prompt ideas on how to solve some of these issues. I will tell you how I see the issues and how time could be saved for the patient (from triage to final disposition). There is a huge crisis occurring in our ER now. 2. Your presence would definitely be a "morale improver" for the ED staff and for the patient when he realizes an administrator is personally concerned as well. I really believe an administrator's presence would be a "win-win" for OSF and ER patients. Please strongly consider joining me in the ER. 

Sincerely, 

John 

Comments in 2021--

Keith did not come to the ER when I proposed this to him in 2001. He stated that if he came to the ER other hospital departments would want his presence, and he could not be everywhere. 

As I look back at it, I doubt the ER had his full attention compared to other big money making departments (like Surgery) and the new Center for Health. The ER and its overcrowding would just have to wait. 

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My first meeting with Keith was on Oct. 5. I expressed to Keith my concerns with lack of bed capacity at OSF and the long waiting times for patients in the ER, and also discussed the fact that Hevesy had placed me on probation for 6 months on September 28, 2001, the day after I wrote the email to Keith. 

Keith told me that things were being done about the bed problem and that he (Administrator of OSF-SFMC) could do nothing about Hevesy putting me on probation. 

However, Keith changed the topic of the conversation very quickly. He seemed to be very concerned about a petition that was going around in my support and asked me the names of the nurse or nurses who started the petition. I did not tell him because I feared for their jobs if he found out their names. He repeatedly tried unsuccessfully to get their names from me. 

Keith then likened me metaphorically to an uncontrolled hemorrhage in the ED and a cancer in the ED that needs to be “cut out before it metastasizes”. I was quite surprised to hear this. I really didn’t know Keith well but figured out this was going to be tough go. 

He also was fixated on the concept of fear. He told me, “Fear is a good thing amongst employees.” Rather strange, I thought. As the next couple of months went by, very unusual things happened in Keith’s office. During one meeting with him, Keith said, “You know, John, the Apostolic community has a problem with you.”(Keith is an Apostolic Christian). This statement totally caught me off guard. 

The Apostolic Christians in the area were host families for Haitian kids and very close friends of mine. I couldn’t understand what he was talking about. Keith would look at the carpet, shuffle his feet, smile and say, “You know, John, when this comes out about you, it won’t be good.” I would ask him the same question each time—“When what comes out about me, Keith?” He would never answer but would just shake his head and smile. He went through this same ritual several times with me over the course of a couple of months.

I wasn’t the only one he planted these seeds with. My brother went in to talk with Keith during the next couple of months and he told Tom, “There is a side of your brother that you don’t know.” This disturbed my brother greatly because there is no side of me that he doesn’t know. What could Keith be doing or thinking with this mantra of his? 

On December 5 Keith had a meeting with two Apostolic Christian nurses who had important positions at the medical center to his office and stated the following: “John has done very bad things. People don’t know this side of John.” One of the nurses had helped start another petition on my behalf that really irritated Keith. Keith threatened to sue that nurse even though she had done nothing wrong and cleared it with Human Resources at OSF before she started the petition. Keith wanted to know the status of that petition as well, and the nurse told him that people were very afraid. Keith replied that was good. He then reiterated that the people did not know what they were signing and they did not know the whole story and they did not know the “real John Carroll”. 

Keith told the nurses there should actually be greater fear in the hospital. Keith went on to tell the nurse that he had spoken to Representative Ray Lahood and Monsignor Steven Rohlfs and that they now understand that I have the problem. I had spoken to both of them and they were quite complimentary towards me. (I heard through the grapevine that Keith had made a very urgent phone call to Rohlfs one day to try and explain his side of things.) 

Keith even went on to say that “Rick Miller had been right all along.” When I asked the nurse if she meant that Keith was referring to me being frustrated in the ER, she said “no”. It appeared that Keith was referring to something else, something much worse than frustration. The other nurse said nothing but was listening to all of Steffens comments about me. 

A well-known lady in the Peoria community, whose family had hosted a Haitian Hearts child, told me how she went into Keith’s office and he told her that they had asked me to seek counseling and that if she knew the OSF side of the story she would agree with Keith and OSF. She didn’t know what to think. 

Keith was definitely doing some damage and spreading seeds of doubt regarding me outside the medical center. She told me this story with her husband present. I could tell they were very apprehensive about what was occurring. Her husband had no idea what to say or do. They both have excellent jobs in the Peoria community and both knew what would happen if they went to bat publicly for me. 

Another business lady in the community who had never met Keith went in on my behalf after she was told by Sister Judith Ann to do so. Keith talked a lot about the devil with her and stated, “When the devil ensnares someone and pushes him up against the wall, we find out what that person is made of.” This lady was quite scared and wanted to leave Keith’s office at that point. Keith commented to her on the way out that if she talked about their conversation “…maybe we won’t be friends anymore.” (She had never met Keith prior to this.) She couldn’t wait to leave his office. When I asked Sue Wozniak about this a couple of months later she said “ it sounded like a threat”. The business lady thought so too. 

Keith talked about my employment at his church in Washington, Il. I know who he talked to. They told me. At one point, Steffen stated, that “each time he (Steffen) sees a Haitian child, it makes me (Steffen) want to puke.” Keith’s inappropriateness knew no bounds. 

So there really wasn’t any confidentiality with Keith. OSF attorney, Doug Marshall, would monitor Keith at times in Keith’s office and tell him to watch what he was saying because I was shaking my head and writing everything down. Keith’s mantra to me about “the other side of me will come out and it won’t be good” was never said in front of Marshall, that I know of, so Keith can deny this if he wants. But he will have to deny it a lot if ever questioned under oath because he said it to many people. Does this sound like the way the CEO of the largest employer in Peoria should act? Doesn’t seem to be great management skills to me. Open and honest communication, one of the Sisters mission statements was absent with Mr. Steffen. 

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My comments in 2021--

Keith Steffen was maligning my character inside and outside the hospital. He was simply sewing the seeds of confusion and his ultimate goal was to get rid of Haitian Hearts after he got rid of me. 

A few days after I was fired in December 2001, I went to Sister Judith Ann in Corporate. She was beside herself. Things had slipped away from her and she knew what was happening to me and what was going to happen to Haitian Hearts. 

I told her that it all went back to her administrator at Saint Francis Medical Center. And she told me that I needed to forgive Keith. But she was going to do nothing about it.  I had warned her multiple times during the fall of 2001 that bad things were happening in her hospital. She did not want to listen then and was unable to listen now. 

She had promised me that she would never turn away a Haitian. Young Haitian lives were now on the line and she knew it.

It was too late.

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Skipping ahead to 2006--Journal Star

Monday, April 10, 2006

When Keith Steffen, OSF Saint Francis Medical Center CEO, got to work Wednesday morning, he was greeted with familiar news: the intensive care unit was full. Because of overcrowding, St. Francis annually diverts 200 patients to other hospitals, 100 of them children. That space crunch is precisely why Steffen would announce later in the day a $234 million expansion of St. Francis. The largest medical center in downstate Illinois isn't big enough.

The single biggest private building project in Peoria's history, if approved by state regulators, will shoehorn an eight-story building onto the Downtown campus and position St. Francis to meet the medical needs of central Illinois and beyond for the next 25 years. Once the so-called Milestone Project is done, St. Francis will have three new floors for the Children's Hospital of Illinois, three more for diagnostic services and surgery, one for adult cardiac patients and a new and bigger emergency room.

With the expansion, all of the hospital's 616 rooms - it has 560 now - will be private, which has health and customer satisfaction advantages. New surgery rooms will be large enough to accommodate robotics and other technology, some $47 million worth. A larger ER will no longer have to operate at twice capacity.

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My comments in 2021--

Finally, after many years, it was stated that the ER at OSF was operating at twice its capacity. Even Mr. Steffen stated that they would be "remiss" if changes weren't made. OSF has been "remiss" for many years now regarding excessive patients in the ER and inadequate bed capacity in the main house.

In the April, 2006 issue of Academic Emergency Medicine an article regarding overcrowding in the emergency department describes the problem very clearly. The journal reports, "The phenomenon of emergency department crowding has become recognized across the globe as a serious public health threat. ...experts widely agree that crowding in the emergency department (ED) is a system-wide problem, not one that results solely from problems in the ED or one that can be addressed using only ED based solutions. Crowding has become a shared burden for emergency providers. Each of us has a collection of stories to tell about how crowding has affected our patients, their families, our cowokers, and our own professional satisfaction."

On April 6, 2006 the Peoria Journal Star published the article below regarding the new Children's Hospital that will be built. Please note Mr. Steffen's comments regarding bed capacity problems and patient diversion at OSF. Was this institutional neglect by OSF attempting to stack to many patients inside the medical center? How many people suffered under this system? When I wrote him almost five years earlier, I was immediately placed on probation and then fired three months later. Will that be Mr. Steffen's fate as well?



Haitian Hearts obviously did not financially break OSF with the announcement of their new 200 million dollar building. It is truly a blessing for central Illinois children. However, Haitian children deserve the best available as well.

Until OSF can change its heart and return to the founding Sisters mission philosophy, they will have the technol0gy but not the touch. 

The following article abstracts were posted by me on Peoria's Medical Mafia describe system problems in medical centers and how they need to be addressed by the entire medical center.  

May 15, 2008 issue of the New England Journal of Medicine is an article written by David J. Shulkin, M.D. 

Dr. Shulkin makes late night administrative rounds at the hospital where he is president and chief executive officer. He noted the "stark discrepancy in quality between daytime and nighttime inpatient services." His goal is to improve his hospital quality of care during the nighttime hours. Dr. Shulkin writes: "The consequences of service deficiencies during off-hours include higher mortality and readmission rates, more surgical complications, and more medical errors." He feels that his midnight rounds were proving a good way to help him understand and address concerns of off-hours staff. "In order to identify problems and design effective solutions, it is critical to gather such front-line information, and to do so, senior hospital administrators need to see firsthand the working of the "other hospital". I strongly encourage my counterparts else-where to conduct at least 1 week's worth of night rounds each quarter." "Close attention should be paid to the needs of patients and their families, any procedural and communications issues among staff members, and most important, the quality of dialogue between administration and staff members regarding the organization's inpatient service and safety priorities."

May 14, 2006 In this weeks New England Journal of Medicine, George Annas wrote an article, "The Patients Right to Safety--

Improving the Quality of Care through Litigation against Hospitals. Annas reports, "...safety must be an explicit organizational goal that is demonstrated by clear organizational leadership...This process begins when boards of directors demonstrate their commitment to this objective by regular, close oversight of the safety of the institutions that they shepherd." 

He continues,"...(hospital) safety cannot become an institutional priority without more sustained and powerful pressure on hospital boards and leaders---pressure that must come from outside the health industry. In hospital care the challenge is to reform corporate governance to make hospital boards take their responsibility for patient safety at least as seriously as they take the hospital's financial condition."

 “The major safety-related reasons for which hospitals have been successfully sued are inadequate nursing staff and inadequate facilities. Since providing a safe environment for patient care is a corporate responsibility, understaffing is corporate negligence. “

" In 1991, for example the Pennsylvania Supreme Court stated simply, “Corporate negligence is a doctrine under which the hospital is liable if it fails to uphold the proper standard of care owed the patient, which is to ensure the patient’s safety and well-being while at the hospital.” 

June 16, 2006
Emergency System Called Very Ill

On June 15, 2006, USA TODAY had the above headline over an article on their front page.

The nation’s emergency medical system is in a dangerous state of crisis, says a new series of landmark reports. The Institute of Medicine recently released extensive reports which were prepared by a 40-member board after a two-year investigation. The IOM report states that the U.S. life saving system is failing.

The IOM reports detail how hundreds of thousands of lives are affected every year by EMS deficiencies that are not obvious. The chair of the panel, Gail Warden, stated that “in most communities, there is a crisis under the surface.”

Many emergency rooms barely can handle their daily patient loads, children don’t always get good care, and the quality of rescue services is erratic, the report says. A USA TODAY probe found a 10-fold difference between major cities in cardiac arrest survival rates.

Dr. Arthur Kellermann, director of the Center for Injury Control at Emory University School of Medicine in Atlanta stated that the problem with hospital bed capacity slows the emergency department admission of sick patients and more patients are diverted to other hospitals. In every minute of every day, an ambulance carrying a patient is turned away “diverted” when an emergency room says it is too full to take patients.

This sounds very much like OSF in Peoria. Throughout this website, I have questioned the monopoly of paramedic transport care in Peoria. The IOM report mentions, crowding and ambulance diversion also occur because of lack of coordination among emergency medical response teams and hospitals…as well as entrenched professional interests. With regards to Peoria, I would say the “entrenched professional interests” are centered around the medical centers and their relationship with Advanced Medical Transport.

There is a “crisis under the surface” in Peoria.

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Emergency Medical News
October, 2008

In 2006 there were 119.2 million ED visits in the United States.

Dr. Arthur Kellerman agreed that it was easy to blame the problems of crowding on the uninsured. "It gives the decision-makers an excuse to ignore it or blame an unempowered segment of society. These aren't contributing to the growth of emergency department visits," he said. "We know the major problem in crowding is the boarding of patients."

Dr. Peter Viccellio commented on crowding in the ED: "...the problems and solutions are necessarily institutional, and cannot be addressed by focusing on the ED in isolation."

I believed in 2001 and still believe in 2008 that my letter to Mr. Steffen, other OSF administrators, and to my colleagues in the ER was was appropriate and that changes needed to be made to protect our ER patients.
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In September, 2001 I wrote a letter to OSF-SFMC administrator Keith Steffen.

I thought that OSF-SFMC had too many elective inpatients which dangerously slowed moving sick Emergency Room (ER) patients to inpatient beds. I also thought that OSF was stacking insured patients in inpatient beds to the detriment of the ER patients. Sick patients at OSF were waiting a long time to be admitted.

I was put on probation the day after I sent the letter, and during my first meeting with Mr. Steffen he likened me to a cancer that needs to be cut out "before it metastasizes".

I was fired from OSF-SFMC three months later.

Below are bullet points from an article in the Annals of Emergency Medicine, February 2009:

1. There were 119 million visits to U.S. Emergency Rooms in 2006.

2. Emergency Departments are part of the nation's early warning system of the severity of our socioeconomic problems. The nation's Emergency Departments are uniquely responsive to the symptoms of a diseased economy.

3. Employer-insured people are one layoff away from having no health insurance.

4. Mortgage foreclosures could produce social dislocation in both forms and degrees that threaten the quality of medical care for large parts of the population.

5. Crowding in the entire hospital produces crowding and boarding in the Emergency Room.

6. It is possible that hospitals allow themselves to be over capacity with elective insured patients because that maximizes profits. In my opinion this is one of the main reasons OSF-SFMC in Peoria's Emergency Room was/is so dysfunctional.

7. Rising numbers of uninsured people heighten the pressure in Emergency Departments. There is also increased use by middle-class patients whose usual source of care is the private physician's office.

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October, 2009

Annals of Emergency Medicine, October, 2009

ED crowding affects care negatively.

Not only does it reduce access to emergency medical services, but also it is associated with delays in care for cardiac, and stroke patients, as well as those with pneumonia, and is associated with an increase in patient mortality. ED crowding has been associated with prolonged patient transport time, inadequate pain management, violence of angry patients against staff, increased costs of patient care, and decreased physician job satisfaction.

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www.medscape.com
From American Academy of Emergency Medicine
Washington Watch: CDC Report on ED Capacity
Kathleen Ream


Posted: 02/05/2010

The Centers for Disease Control and Prevention (CDC) recently released a report entitled Estimates of Emergency Department Capacity: United States, 2007. This report is based on data from the CDC's 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Inaugurated in 1992, the NHAMCS is now the longest continuously running national survey of hospital ED use.

The report notes that over the last several decades, the role of the ED has expanded from primarily treating seriously ill and injured patients. The report recognizes that EDs now also provide urgent and unscheduled care to patients unable to access their providers in a timely fashion and provide primary care to Medicaid beneficiaries and uninsured patients. As a result, EDs are frequently overcrowded with the most common contributing factor being the inability to transfer ED patients to an inpatient bed once the decision is made to admit them. "As the ED begins to 'board' patients, the space, the staff, and the resources available to treat new patients are further reduced," the report states. It continues, "A consequence of overcrowded EDs is ambulance diversion, in which EDs close their doors to incoming ambulances. The resulting treatment delay can be catastrophic for the patient."

Strategies to decrease ED wait times included increasing the speed with which laboratory results are available, accelerating care during the triage process by eliminating some of the administrative work associated with patients entering the ED, and implementing a system allowing non-urgent patients to be seen by a medical provider other than a physician. However, none of the strategies to address crowding have been assessed on a state or national level.

The GAO found that there are several other frequently reported causes for ED crowding, including a lack of access to primary care; a shortage of available on-call specialists; and difficulties in transferring, admitting, or discharging psychiatric patients. Less commonly cited causes of ED crowding included an aging population, increasing acuity of patients, staff shortages, hospital processes, and financial factors.

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The following few paragraphs were written by Dr. Shari Welch in the June, 2010 issue of Emergency Medicine News.

ED overcrowding is an issue that all medical center administrators need to understand and be proactive to protect their patients and their community.

Dr. Welch:

Another innovation, the Full Capacity Protocol, shows that patients can be safely boarded in hallways upstairs with excellent results when all hospital beds are full.

A patient with a hip fracture would be boarded on the orthopedics floor, a TIA patient would be boarded on a neurology floor, and so forth.

Peter Viccellio, MD, at the State University of New York at Stony Brook has written several articles demonstrating that there is no increase in the mortality rate and that length of stay is shortened when patients are boarded upstairs instead of the ED. (Many of Dr. Viccellio's articles are available on www.EM-News.com; type “Viccellio” in the search box.)

Patients actually spend very little time in the hallways upstairs; somehow the system finds a bed for them. Boarding on the floor is usually done with the patient occupying an actual hospital bed. It is quieter than the ED, and patient satisfaction improves with the adoption of the policy and procedure. A copy of the full capacity protocol is available on Dr. Viccellio's web site (www.hospitalovercrowding.com).

Another cause of delays is patients occupying beds waiting for a resident workup. Just say “no!” It might be possible to allow this practice in an Express Admission Unit, but admitted patients must not occupy precious ED beds for the convenience of the house staff.

Boarding admitted patients in the ED is bad for patients, bad for departments, bad for the community, considering the direct connection between boarding and diversion. Low-acuity patients at your door have little to do with the solutions to boarding. Boarding relates to flow, and is a system problem with system solutions.

Improving admission operations is the one thing you cannot fix in a vacuum. Start by educating the leadership of your organization about the bad outcomes associated with boarding. Introduce them to data-driven solutions that are system solutions. Show them the compelling data on the subject.

Above all, be vigilant about ED bed minute utilization. ED bed minutes are for diagnosing and treating patients, not boarding them!