MNA: Hospital Accrediting Agency (Joint Commission) Issues Findings Supporting St. Vincent Hospital Nurses' Complaints about Unsafe Patient Care, Stating that SVH was Found to Be Non-Compliant with Applicable Patient Care Conditions for Medicaid and Medicare Services

In another case, an arbitrator ruled Tenet illegally fired a long time RN and union leader without just cause as "an act of punishment and thinly veiled retaliation, " yet Tenet doubles down on acts of retaliation, firing nine nurses who raised safety concerns 

The decisions come as nurses file yet another round of complaints to state and federal agencies regarding ongoing concerns about "abnormally dangerous patient care, with both patients and nurses at risk for imminent harm at the hands of an administration that fails to meet the most basic standards of patient care delivery."  

WORCESTER, Mass., March 6, 2024 /PRNewswire/ -- Nurses at St. Vincent Hospital, who have filed a number of official complaints and gone public with their serious concerns about patient care conditions that are harming patients at the Worcester-based facility, have had their claims validated by The Joint Commission, which conducted an investigation into the nurses complaints and found the hospital to be "non-compliant with applicable Centers for Medicaid and Medicare Services (CMS) Conditions."

In an email to the staffer at the Massachusetts Nurses Association (MNA), who filed the complaints on behalf of the nurses in December and January, the TJC stated: 

As part of our evaluation, your concerns were shared with our survey team during an onsite review of this organization, which was conducted on 2/14/2024. At that time, our surveyor(s) focused on the concerns you communicated and used that information to evaluate the organization's compliance with The Joint Commission standards related to your issues. Your report was used to assist our team to better understand the organization's systems of providing care. During the onsite review, the organization was found to be non-compliant with applicable Centers for Medicaid and Medicare Services (CMS) Conditions. As a result of this survey activity, the organization will need to demonstrate evidence of standards compliance to maintain accreditation by The Joint Commission

The violations of safety standards were documented and reported first to hospital administration, and when ignored by hospital leaders, to appropriate regulatory agencies including the Department of Public Health Division of Healthcare Quality, Joint Commission (which accredits acute care hospitals), the Center for Medicare and Medicaid Services and the Mass. Board of Registration in Nursing.  The complaints detailed a serious and ongoing degradation of care, which were based on more than 600 official reports filed by nurses over the last six months.  Those reports highlight 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 patient deaths.  For media who wish to view all the complaints, along with other information about these issues, which contain numerous examples of unsafe patient care conditions, visit this page, or contact David Schildmeier at [email protected].

The standards violated by SVH referred to in the Commission letter, and cited by MNA in the complaints to other agencies include the following:

The hospital continues to admit patients despite inadequate staff to appropriately meet the patients' needs, in violation of TJC PC.01.01.01 "The hospital accepts the patient for care, treatment and services based in its ability to meet the patient's needs." 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."

In addition to the Joint Commission, investigators from the Department of Public Health have also been investigating the nurses' complaints, including a horrific, preventable patient death in late December. 

"While it is encouraging to see independent investigators validate our concerns and our claims, the fact remains that nearly every day on nearly every shift, our administration continues to violate these safety standards, and other mutually negotiated contractual commitments designed to ensure safe patient care, which continues to cause preventable harm and unnecessary suffering for those under our care," explained Marlena Pellegrino, RN, co-chair of the nurses local bargaining unit with the Massachusetts Nurses Association (MNA).  "We can only hope all these agencies, who have a responsibility for holding hospitals accountable for keeping our patients safe, take immediate steps to end this suffering."

As Conditions Continue to Deteriorate, Nurses File Yet Another Complaint Citing Unsafe Care

In the wake of initial findings of noncompliance with care conditions, nurses continue to document and report any and all instances of poor patient care and violations of required safety standards.  Since the nurses held a press conference about their concerns on Jan. 30, 2023, nurses have filed an additional 97 reports of unsafe conditions that jeopardized the safety of their patients, and on Wednesday, the MNA filed yet another round of complaints to the Joint Commission (the fourth such complaint) as well as to the Mass. Department of Public Health. 

The complaint states in part: "We have already reported to your agency and all other applicable agencies specific 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.  We issue this complaint as a measure of last resort as the nurses have exercised a good faith effort to alert our administration of the dangers these conditions pose for their patients and themselves.  The patients of Saint Vincent Hospital in Worcester, MA continue to be at risk for harm despite multiple recent onsite inspections by The Joint Commission inspectors and notice of ongoing deficits to The Joint Commission, CMS, and the Division of Health Care Facility Licensure and Certification in Massachusetts in December of 2023 and January of 2024. In the weeks since your findings were reported, conditions at St. Vincent Hospital have not improved."

Retaliatory Tactics by SVH Administrators Exposed in Arbitrator's Ruling in Firing of Union Nurse

The week prior to the Joint Commission finding, the MNA received a decision in an arbitration regarding unlawful firing of a 40-year St. Vincent nurse and an elected union leader for MNA at the hospital, Marie Ritacco.  Ritacco was a vocal leader during the historic nurses strike, and was in charge of handling contract grievances for nurses in the months following the end of the strike.  While Ritacco was on a contractually sanctioned leave from the hospital, Tenet terminated her employment, in a move the independent arbitrator ruled was without just cause and "an act of punishment and thinly veiled retaliation." He further ordered that she be reinstated. 

While the MNA hoped the recent arbitration decision and other regulatory actions against the hospital, as well as the delivery of a petition on Feb. 14^th to management signed by 90 percent of the nurses calling for a renewed commitment to collaboration to ensure the safety of patients and dignity of staff, Tenet administrators have only stepped up their campaign of intimidation and retaliation against nurses for exercising their legal and professional obligation to advocate for their patients.

Last month, after the nurses filed their complaint with the Board of Registration in Nursing and other agencies, and shortly after the BORN began its investigation of the complaint, three nurses in the emergency department involved in the complaint were terminated, and six nurses on other units in the hospital, including Local bargaining unit Co-Chair Dominique Muldoon were suspended without pay for their efforts to object to unsafe patient assignments.  Shortly after TCH findings, and after the MNA and SVH was notified about the arbitrator's decision regarding Ritacco, the hospital sent letters to the six nurses on unpaid leave that they too were being terminated.

The MNA has responded to the firing and discipline of nurses with a charge of unfair labor practice against Tenet and is seeking injunctive relief to reverse the terminations and suspensions.  The MNA is also preparing an official complaint under the state's Healthcare Whistleblower law, which will be filed with Superior Court against the retaliatory terminations. 

Tenet's Record of Alleged Corporate Malfeasance is Long and Well Documented

Tenet's propensity for questionable and unlawful behavior is well documented, as the corporation has been subject to fines and other judgements from courts and governmental agencies totaling more than $1.8 billion over the last 20 years alone. A listing of those decisions can be found here.  This includes the award in February 2021 of $10.6 million to two cardiologists at Tenet-owned Detroit Medical Center after a federal judge upheld an arbitrators' decision that the hospital and Tenet acted with malice in firing them as retaliation for reporting violations at the facility.  Four nurses at a Tenet facility in June of 2020 have also filed $25 million lawsuit against Tenet for alleged wrongful discharge, retaliation against whistleblowers, and intentional and/or reckless infliction of emotional distress, after the nurses reported preventable patient deaths in their emergency department due to understaffing during the height of the COVID crisis.  And in February of 2020, Tenet and one of its California hospitals agreed to pay $1.41 million to settle false claims allegations brought by the federal government for knowingly charging Medicare for implanting unnecessary cardiac monitors into patients.

"None of these issues are acceptable on any level and any administrator responsible for these conditions must be held accountable," said Muldoon, "Our nurses have always taken such pride at being a St. Vincent nurse and we are appalled to see what this administration is doing to our community hospital and the patients we serve every day."

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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