MNA: Framingham Union Hospital Nurses File Complaints with State and Federal Agencies Citing Dangerous Conditions that Jeopardize the Safety of Patients Admitted to the Hospital -- Call for Immediate Intervention by DPH Commissioner to Protect Patients & End Suffering at all Tenet Hospitals

Nurses to Hold Media Briefing on the Situation

When: Monday, September 16 at 10:30 a.m.
Where:  On Lincoln Street outside Framingham Union Hospital in Framingham, MA
Who:  MNA President Katie Murphy, Framingham Union RNs and MNA Associate Director of Nursing Mary Sue Howlett, RN, PhD, who worked with the nurses to file the complaint
The event will also be livestreamed on the MNA Facebook page:
www.facebook.com/massnurses.

Nurses say patients' safety jeopardized daily under current conditions: cite specific "deficiencies in staffing, hospital policies, allocation of technology that is resulting in dangerous delays in the administration of needed medications and treatments, preventable patient falls and other complications, including sentinel events."

Framingham Union Complaint follows five rounds of complaints filed by MNA against Tenet at Worcester-based St. Vincent Hospital over the last ten months

MNA, which represents nurses at 70 percent of the state's hospitals, calls staffing and working conditions for nurses at Tenet-owned facilities "the worst among all those providers – by far" and that care conditions and practices at for-profit Tenet are worse than what have been documented during the Steward crisis

As nurses hold press briefing, the NLRB is conducting a trial against Tenet administrators for charges of violations of nurses rights in attempt to silence nurses

FRAMINGHAM, Mass., Sept. 16, 2024 /PRNewswire/ -- The nurses of Tenet Healthcare's Framingham Union Hospital (FUH), who are represented by the Massachusetts Nurses Association (MNA) have filed a number of official complaints with the Department of Public Health Division of Healthcare Quality, Joint Commission (which accredits acute care hospitals), and the Center for Medicare and Medicaid Services in response to a growing and dire crisis in the safety of care for patients admitted to the facility. Reporters who wish to receive copies of the complaints can email David Schildmeier at [email protected].

The complaints are based on official reports filed in real time by nurses over the last nine months that highlight significant deficiencies in staffing, hospital policies, allocation of technology, and a deliberately punitive management culture that is resulting in dangerous delays in the administration of needed medications and treatments, preventable patient falls and other complications, including preventable sentinel events (A sentinel event is a patient safety event that results in death, permanent harm, or severe temporary harm). 

"As the state and communities continue to focus on the impact on patients and families as a result of the unscrupulous behavior and practices implemented by Steward Healthcare, we are taking the opportunity on Monday to alert regulators and the public about another Dallas-based for-profit provider, Tenet Healthcare, whose facilities in our state have conditions for patients, particularly as regards to staffing and the safety of patient care that are significantly worse than what we have seen at Steward," said Katie Murphy, RN, president of the MNA and a Framingham resident. "As caregivers who are charged by law to serve as advocates for our patients, we are sounding the alarm once again outside a Tenet hospital in the hopes of triggering an aggressive response by our regulators to avoid, as we have seen with Steward, reading frontpage stories two years from now about a string of still more preventable patient deaths."

In fact, the MNA complaint makes clear that the care conditions for nurses and patients provided at FUH and other Tenet facilities are among the worst in the state, writing:

As an organization, the MNA represents nurses and health care professionals working in 70 percent of the state's acute care hospitals, and we can state without equivocation or hyperbole that the conditions at Tenet owned facilities are the worst among all those providers – by far. 

In the nurses 8-page complaint, they cite a number of specific instances of unsafe staffing and other conditions that violated specific regulations established by the Joint Commission, Medicare and Medicaid, and the Department of Public Health that are required by these regulators to ensure the safety of patient care, including:

The hospital continues to admit patients despite inadequate staff to appropriately meet the patients' needs, in violation of TJC (The Joint Commission) standard PC.01.01.01 "The hospital accepts the patient for care, treatment and services based in its ability to meet the patient's needs." Nurses continue to witness the violation of the hospital's handbook on Patient Rights and Responsibilities, but their concerns have gone unanswered.  The hospital repeatedly violates 105 CMR 130.311: "Registered Nurse Coverage- There shall be a sufficient number of registered nurses on duty at all times to plan, supervise and evaluate nursing care, as well as to give patients the nursing care that requires the judgment and specialized skills of a registered nurse" and 105 CMR 130.312: "Registered Nurses, Licensed Practical Nurses, and Ancillary Staff Coverage- The number of registered nurses, licensed practical nurses and unlicensed nursing personnel assigned to each nursing unit shall be consistent with the types of nursing care needed by the patients and the capabilities of the staff."

Recent Complaint Represents a Pattern of Patient and Nurse Abuse at all Tenet Facilities in MA

The round of complaints to state and federal agencies by the Framingham nurses is the latest in a series of complaints the MNA has been forced to file against administrators for Tenet Healthcare, including five rounds of similar complaints the MNA nurses at St. Vincent Hospital (SVH) in Worcester have filed since December of last year, which included a preventable patient death. For all the complaints, the MNA points to one common denominator as responsible for the pain and suffering for patients at both facilities, which is the punitive, uncaring leadership by Tenet CEO Carolyn Jackson and her Chief Nursing Officer Denise Kvapil. The nurses point to the recalcitrant duo's effort to implement a concerted campaign to cut staffing levels, increase nurses' patient loads, refusal to maintain vital equipment and supplies, while meeting all efforts by nurses to address these issues with, as the recent complaint states, "rancor and recrimination."

At both facilities, at a time when hospitals across the Commonwealth are going to great lengths to recruit and retain needed staff, particularly to provide life-saving care to patients waiting hours for care in overcrowded hospital emergency departments, Tenet has actually cut ED staffing levels by up to 40 percent.  Coincidentally, the Administrative Director of Critical Care and Emergency Services hired to manage the Framingham Union Hospital was employed by Tenet while his license to practice nursing had been revoked. He was only removed from hospital when a nurse discovered the issue and alerted management that his license was revoked.

Earlier this year, a shift for the emergency department at St. Vincent Hospital had just four nurses for more than 90 patients.  Professional standards for ED nurses require that no nurse should have more than five patients at one time. 

In Worcester they have taken the extreme step of firing nine nurses who had participated in the original complaints, triggering a lawsuit by the MNA against Tenet under the state's Healthcare Whistleblower law.  In that case, the emergency department nurse manager at St. Vincent Hospital was also fired earlier this year as she was under investigation by the Board of Registration in Nursing, based on an MNA complaint against her for her failure to uphold adequate standards of care and her firing of four nurses for attempting to advocate for safer care.   

As RNS Hold Briefing on Conditions, NLRB Conducts Trial Against Tenet for Violating Nurses Rights

Tenet's actions have also resulted in formal charges by the National Labor Relations Board against the hospital, and the federal agency is currently conducting a trial against the SVH administration for numerous violations of the nurses' union rights, validating what the nurses allege is an ongoing effort to silence the nurses and prevent them from addressing unsafe working/patient care conditions at the facility. The trial, which began on Sept. 9^th, follows the NLRB's issuing of a formal complaint against the hospital, which was issued in late March, consolidating six cases based on charges filed by the nurses, between 2022 and 2024.  After a lengthy investigation federal NLRB agents found merit to the charges and the case has now been taken over by Government Attorneys who are now prosecuting the case at a trial before an administrative law judge at the NLRB Region 1 office in Boston.

Previous Complaints Trigger Initial Findings that Tenet Violates Standards of Care

Two agencies have already validated the concerns raised by nurses following submission of previous complaints. In March, the Joint Commission, which conducted an investigation into the nurses complaints found the hospital to be "non-compliant with applicable Centers for Medicaid and Medicare Services (CMS) Conditions".

And in April, as reported by MassLive, in response to reports by the nurses, the Department of Public Health conducted an investigation and interviewed several nurses, ultimately citing the hospital for its failure to provide appropriate telemetry boxes, essential devices that are used to monitor patients who have been admitted for serious cardiac conditions. 

According to the DPH findings, "Based on interviews and medical record review, the hospital failed to provide care in a safe setting.  This nurse stated that the situation comes up often where a patient arrives to the telemetry unit with telemetry orders and the nurse has to either wait for an available tele-box or go hunting for a tele-box." When patients go without appropriate monitoring their lives are placed at risk, as an ensuing cardiac arrest could go undetected until too late.  "The patient has the right to receive care in a safe setting," the report reads. "This standard is not met as evidenced by interviews and medical records."

The nurses at SVH continue to report serious problems with the hospital's outdated telemetry and other cardiac monitoring equipment that are impacting the care of cardiac patients. 

Despite Previous Investigations by State and Federal Agencies, More Needs to be Done

While the nurses appreciate efforts by some agencies to investigate Tenet in response to their complaints, they believe much more needs to be done to protect the patients under their care. 

In fact, conditions are so bad, the nurses' complaint includes a direct appeal to DPH for the assignment of investigators at the hospital on a daily basis to ensure the safety of patients in keeping with a similar approach taken by DPH in the wake of the Steward crisis, with an additional request for direct intervention by DPH Commissioner Robert Goldstein.  The complaint concludes:

We believe the DPH, as they have done in the case of the Steward facilities, should immediately assign DPH inspectors on site on a daily basis to ensure that this administration fulfills its responsibility to provide the care these patients and this community deserves. We would also request an opportunity for the DPH Commissioner to meet with some of the frontline nurses at both facilities to hear their reports first-hand…As an agency responsible for holding providers accountable for the care they provide, we reiterate our call for your immediate intervention, as without proper oversight, we fully expect many more patients to be harmed, and tragically, a number of our patients will die.

Reporters who wish to review all the complaints filed against Tenet at St. Vincent Hospital can access the information here or email [email protected].

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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

SOURCE Massachusetts Nurses Association