Doctors at Shady Grove Adventist Hospital, angry over what they say are rampant errors committed by overworked hospital employees, say patient safety is being threatened by deteriorating care at the Rockville facility.
The executive committee of the 1,300-member medical staff--in an unusually bold slap at hospital administrators--voted unanimously last week to demand that the administrators quickly improve staffing and management of the hospital, which is owned by a corporation controlled by the Seventh-day Adventist Church.
"I think it can be an unsafe environment" for patients, said Alan B. Kravitz, a Rockville general surgeon and the executive committee member who pushed for the vote. The committee, made up of 15 doctors, oversees the medical staff at the 263-bed hospital.
Its main complaint is that hospital cutbacks are forcing nurses to look after too many patients at once, meaning they don't have time to become familiar with a patient's history or to respond to anyone other than the sickest patients on their floor.
Those pressures have led nurses to give patients the wrong medications, miss signs of problems that should have been reported to doctors and violate physicians' orders, according to interviews with doctors, nurses and state health officials and documents obtained by The Washington Post.
This month, doctors say, a patient from the intensive care unit died after being left unattended elsewhere in the hospital.
Several nurses at Shady Grove said privately they share the doctors' concerns, adding they have complained about their workloads for years. Some nurses are stretched if they are assigned more than six patients, but there have been instances when Shady Grove nurses each had 11 patients at a time on night shifts, doctors and nurses said.
"Our patients are continuing to receive short shrift where their care is concerned due to the inadequacies of our staffing," 11 nurses said in a December letter to Shady Grove's administration.
Robert Jepson, a spokesman for the hospital's owner, Adventist HealthCare Inc., called the executive committee vote an emotional reaction to last week's layoff of nine employees.
"I reject the notion that there are patient care problems at the hospital," said Jepson. "I know there were some comments [at the executive committee meeting] by a particular physician [Kravitz] that were ridiculous, absolutely inappropriate and out of line."
The hospital's state license is in good standing, and the Joint Commission on Accreditation of Healthcare Organizations gave Shady Grove a high rating in its hospital performance review last year.
Jepson said Shady Grove, like hospitals across the nation, is adapting to the financial pressures created by reduced revenue from government and private health plans.
"Right now there are a lot of changes going on," he said. "Shady Grove has not been immune to that. We have to make employee staffing adjustments."
Inevitably, some of those decisions will be criticized, he said.
"Concern has been expressed about the [staff-to-patient] ratio," he said. "In comparison with other hospitals in Maryland, Shady Grove is at an appropriate staffing level."
Still, several errors have occurred there in recent months, according to doctors, nurses and hospital and state records. In April, a woman recovering from hip surgery was accompanied to the bathroom by a nurse--and then left alone. She fell and suffered fractured ribs, said Carol Benner, Maryland's chief hospital licensing official.
Medication errors have become increasingly common, doctors say. Daniel Snow, a physician who was hospitalized at Shady Grove this summer, was given the wrong drug for three days before the mistake was discovered, according to two doctors.
The Germantown family medicine specialist did not want to discuss details, saying only, "There are some problems with quality of care."
For many doctors, the last straw came about 10 days ago, with the death of a 79-year-old Potomac woman. When she was wheeled out of the intensive care unit for a test, she was without an electronic heart monitor and not accompanied by a nurse, as would be standard for such patients, doctors said. After the test was completed, radiology department staff members called for an orderly to return the woman to her room, and then left her in a hallway, doctors said.
As she lay unattended on the gurney, the woman suffered cardiac arrest and died despite attempts by the staff to resuscitate her, several doctors said.
The woman's husband could not be reached for comment, and it's unknown whether he is aware of the circumstances surrounding his wife's death.
Hospital officials said they would not discuss details of any of the incidents in this article because of confidentiality laws.
Ruth M. Jacobs, a Shady Grove infectious disease specialist, applauded the executive committee.
"I have had patients given the wrong medication, patients given the wrong dose of the right medication and patients not given the medication ordered," she said. "I have had the wrong tests performed on my patient, and I have had entire patient charts lost by Shady Grove Hospital."
She said nursing staff turnover has been dramatic and harmful.
"New and inexperienced nurses have been brought in with inadequate training and inadequate backup and have been left to make decisions," she said. "Overworked and inexperienced nurses cannot know their patients, and they make mistakes."
Janet Kirby, whose husband had cancer surgery at Shady Grove in June, hired an aide at her own expense to sit in her husband's room overnight, when she would return to her Frederick home. Based on her own frustrations as a past Shady Grove patient, Kirby said, she wanted someone with her husband at all times.
Yet even with the aide present, during her husband's first night at Shady Grove it took more than an hour to summon a nurse to check an intravenous line that wasn't working, Kirby said. "The nurse came in and didn't know what to do with it," she said.
Christopher Sweat, 33, said he showed up in the Shady Grove emergency room at 6 one July morning complaining of weakness and vomiting. Although the nurses saw him sprawled on the floor in the middle of the waiting room, they did not approach him, he said.
After a while, a security guard gave him a pan in which to throw up, but the nurses still would not talk to him, he said. He left, and after being examined during business hours by his own doctor wound up back at Shady Grove for an appendectomy that evening.
The surgery went well, Sweat said. At 5 a.m. the next day, a nurse came to his room and changed his intravenous antibiotic.
Within a few hours, Sweat said, he became groggy and dizzy. Suspicious, he looked at the IV bag and saw he and his roommate were each taking the other's drugs. Their names were on the labels.
Sweat said he is allergic to penicillin, and the drug dripping into his vein was penicillin-based. "I even had a red allergic armband on," he said.
Sweat spent an extra day in the hospital because of the incident , but what infuriated him more was that the nurses initially denied they had made an error and no one apologized. "They could have killed me," he said, "and they couldn't care less."
Jepson said the company's two local hospitals--the other is Washington Adventist Hospital--have consistently been profitable in the 1990s. They plan to reduce expenses by $25 million more in the next three years to prepare for what they expect to be an increasingly difficult financial environment. Patient volume is growing at Shady Grove, which treated 16,507 inpatients last year.
Hospitals across the country are reeling from declines in patient volume and payments from health plans, and the pressures to do more with less are exacerbating a nurse shortage.
"It's a sad situation, but we're hearing this over and over from a lot of different places," said Mary Beachley, president of the Maryland Nurses Association. With cuts in the number of nurse slots, fewer nurses are taking care of the patients sick enough to be admitted to a hospital under tougher managed-care rules.
"We see experienced nurses leaving the bedside and taking positions at other places," she said. "Just look at the help-wanted ads and see how many hospitals are advertising for nurses."
At Shady Grove, veteran nurses have been replaced by recent nursing school graduates and temporary contract nurses, many of whom have not yet gotten into the rhythms of the hospital or grasped its quality standards, doctors say.
This summer, a charge nurse who refused to admit more patients to her floor because she felt it would be unsafe was reassigned and later resigned, doctors and nurses said.
"They tell you to just do the best you can--but that's not good enough for a lot of nurses," said one of Shady Grove's 600 staff nurses.
Hospital officials had no comment on the incident.
Kravitz said the climate is stifling. "It's incredible that a church-sponsored organization could treat its employees so callously," he said.
There is no nurse-to-patient ratio required by national accrediting agencies or state laws. But Recent studies have indicated that hospitals with fewer nurses per patient have more complications with patients recovering from surgery, said John Eisenberg of the U.S. Agency for Health Care Policy and Research.
"We're finding that the cost-cutting that is going on is, in some instances, cutting out more than fat," he said. "It's cutting out some of the muscle and bone of health care delivery."
CAPTION: Christopher Sweat, 33, says he was given medication meant for another patient after his appendix was removed at Shady Grove Adventist Hospital.