Email to Keith Steffen–September 27, 2001--December 2019

 

EB 1574--Email to Keith Steffen–September 27, 2001--Dec 2019

OSF Gazing Down on Peoria (Photo by John Carroll)

On September 26, 2001, I worked the 3-11 shift in the Emergency Room at OSF. I had sick elderly patients as usual and several signed out and went home when they got tired of waiting in the ER for an inpatient bed. I intended to admit them to the hospital, but they couldn’t continue lying on a stretcher in the ER hallway for many hours, and so politely told me that they “needed to go home”.

The ER had an OSF administrator on call every night to call at home if there were problems in the ER. However, these calls usually did not help.

The next day on September 27, 2001, I decided that Keith Steffen, CEO at OSF-SFMC, should be aware of my concerns regarding the long ER wait times. So I wrote an email and copied all of my colleagues in the ER and several other OSF administrators. (See letter below.) The secretary who typed the email casually told me that I would get fired if I sent it. I thought she might be right but I asked her to send it anyway.

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September 27, 2001

Keith Steffen, Administrator

OSF Saint Francis Medical Center

Peoria, Illinois 61637

Dear Keith:

I started working at OSF-SFMC in 1971 as an orderly on 8B. Most of my last 30 years have been spent inside this building. OSF-SFMC means everything to me. Please interpret the following knowing my heart and spirit are with St. Francis and always will be.

I worked 3-11 last night in the main ER. The ER mayhem and disarray that usually exists was actually somewhat manageable. However, patient-waiting time from disposition to arrival on the floor was unbearable. Two sick patients of mine, rather than staying in the ER all night, politely decided to sign out, go home, and hope for the best.

Giving appropriate care in the ER can be challenging but having no room upstairs to admit the patient can be life-threatening to the patient. Should I call other medical centers around the area/state for their admission and subsequent care before I see the patient or after? Studies have shown increasing time spent in the ER increases patient morbidity. Obviously, I don’t want to do this. Please tell me what to do.

An ER crisis has been occurring for many years in our ER. But last night with “home diversion” of patients we have reached an all time low. This cannot continue.

I need an immediate answer from you today as to how I should approach these sick patients and their families. I will meet with you any time today or tonight.

My pager is always on (679-1980.)

Sincerely,

John A. Carroll, MD

cc: Sue Wozniak, Chief Operating Officer

Tim Miller, MD, Director of Medical Affairs

Susan Ehlers, Assistant Administrator Patient Care Delivery Systems

Paul Kramer, Executive Director of Children’s Hospital of Illinois .

Lynn Gillespie, Assistant Administrator Organizational Development

Emergency Department Attendings

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I did not hear back from Keith but the next day I did hear from Dr. George Hevesy who had been promoted to ER Director on August 1 to replace Dr. Rick Miller. His secretary handed me his written letter as I was starting resuscitation attempts on a man in the ER who was just brought in by ambulance and was in cardiac arrest.

George put me on probation for six months. His letter stated that starting in November, I would only work in OSF Prompt Care. Hevesy told me that he did not disagree with the content of my email but told me that I had gone around normal communication channels. After I read his letter, I called George at OSF’s new Center for Health where he was working and asked him if he was really serious about what he had written. He said that he was and for me to stop in and see him some time so we could talk.

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So there we are. This was the scenario in the fall of  2001.

This was my 13th year working in the OSF-ER and I loved my job. However, the OSF Emergency Department had the lowest patient satisfaction scores in the hospital. And the Emergency Department had the lowest employee satisfaction in the hospital also. Dr. Miller had been pushed out earlier in 2001 and Hevesy put in his place by OSF Administration.

All of us who worked in the ER knew that it was often overcrowded with patients and staff and that our patients were waiting too long to be seen and then admitted if necessary.

This was not just a problem caused solely by the general dysfunction of the ER. The entire medical center was involved and played a significant role in the gridlock in the ER. And this is why I emailed Keith Steffen, the OSF Administrator.

I want to be clear that OSF was not the only hospital in the country where sick patients experienced long wait problems in the ER. This was (and is) a national problem. And research done in the years to come in Emergency Rooms across the country showed that patients who were boarded in the ER, had more medical problems.

In May 2006, George Annas wrote in the New England Journal of Medicine– “The Patients Right to Safety–Improving the Quality of Care through Litigation against Hospitals.

“…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.”

During one of my first meetings in October 2001 with Keith Steffen, I told him I was worried about “institutional malpractice” at OSF because of ER overcrowding and boarding of patients.  He asked me to define “institutional malpractice” and I replied that he would understand the concept better than I would.

I simply thought that many patients were being kept for long periods of time in the ER in 2001 to their detriment. I realized that Mr. Steffen was a small player in the entire OSF HealthCare System, but I needed to start somewhere. Goerge Annas would have agreed that the OSF Board of Directors needed to play a bigger role in guaranteeing safety of patients at OSF–especially Emergency Department patients.

Unfortunately, I don’t think Steffen was serious about improving the OSF-ER. He was concerned about the OSF bottom line and stopping the Haitian Hearts program from continuing at OSF.

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Next: Peyton Place and OSF

 

John A. Carroll, MD

www.haitianhearts.org