Thursday, October 19, 2017
Highly Critical Einstein Report Pulled Back
By Walter F. Roche Jr.
A highly critical inspection report on the Albert Einstein Medical Center has been taken of the Pennsylvania Health Department web site and an agency official says it had been posted prematurely.
The report, which was posted in early August, cited the 701 bed facility for failing to adequately investigate four unexpected patient deaths.
The report also charged that Einstein refused to allow state surveyors to interview key staffers and examine records.
Einstein declined comment when first contacted by this blog prior to the posting of a report on the report in early August.
April Hutcheson, spokeswoman for the state Health Department said the report had been posted "inadvertently. It was not complete. It will be posted 41 days after is complete."'
Although that report was based on a May visit to Einstein by state inspectors, the state has posted a subsequent Einstein report based on a visit in August. In addition the now withdrawn report was based on cases dating back to 2016.
The withdrawn report cited Einstein for failure to comply with state and federal requirements in serious cases "involving the clinical care of a patient that results in death or compromises patient safety."
The report included a plan of correction filed by Einstein in which they promised to institute new patient safety protocols and to use those new standards for all serious events beginning on July 1.
The hospital, however, repeated the assertion that some of the records sought by state inspectors at the time of the inspection are "peer review, protected, privileged documents, entitled to protection under federal and state law."
The first case cited was of a patient who was admitted in July of 2016 was found looking pale and unresponsive on Aug. 7, 2016. Records examined by the surveyors attributed the death to "excessive sedative use leading to hypo-ventilation and brain anoxia."
The second case involved an unidentified patient who underwent a colonoscopy on Sept. 23, 2016 only to return "with worsening abdominal pain." The report states.
The patient, who had apparently suffered a colon rupture, did not survive. The report states the patient had gone home the same day as the procedure against medical advice.
In the third case a patient reported to the emergency room on June 21, 2016 with "agitation and psychiatric symptoms."
When the patient asked for something to eat a sandwich was provided. The patient was choking by the time the nurse returned. The patient subsequently expired.
State inspectors asked for records showing required reviews were performed following the death. "None were provided," the inspection report stated.
Another death occurred following an esophageal intubation in February. When state surveyors asked for documentation and the results of a "root cause analysis," they were told the documents were confidential and "protected."
In addition, the report states, that no completion dates were included for "action items" set to be implemented as a result of the incidents.
Cited in the report was a requirement by licensed health facilities to "track medical errors and adverse patient events, analyze their causes and implement preventive actions and mechanisms."