“P atient 11” entered Christus St. Vincent in June 2015 with a fractured hip; she exited the facility less than two weeks later with a fractured hip, a respiratory infection, a urinary tract infection, an ulcer on her buttocks and Clostridium difficile, or C diff, a bacterium that infects the intestines and induces severe diarrhea in its victims, according to a complaint registered with the New Mexico Department of Health that fall. After she was transferred to two other undisclosed medical facilities, she also developed a blood infection. By Aug. 1, she was dead. An autopsy report listed contraction of C diff as a contributing cause of death.
Patient 11 was one of three St. Vincent patients whom the DOH reported to have contracted C diff infections through physical contact with hospital facilities that year. The hardy spore-producing bacterium, often spread via errant fecal matter, isn't uncommon in hospitals, and older patients like Patient 11 are especially susceptible if they're also taking antibiotics. St. Vincent says they've made serious efforts to improve over the last two years. The hospital has created a program to train staff on how to prevent various infections and has purchased a pricey UV light machine to eradicate pathogenic molecules in an infected room.
Anson Stevens-Bollen
In spite of these efforts, St. Vincent still has a poor street reputation. Walk into any bar and mention the hospital’s name, as this reporter did, and somebody is bound to tell you about their aunt’s horror story as a patient at “St. Victims.” Improvements have been slow to come, says St. Vincent Regional Chief Medical Officer John Beeson, because it wasn’t until the hospital’s 2008 partnership with the
network that it had access to better IT systems and management expertise, among other things.
"This hospital is not the hospital it was 10 years ago or even five years ago or even three years ago," Beeson tells SFR. "It now has more resources and more depth. … It's night and day to what it used to be."
Nevertheless, the rate of C diff contraction at St. Vincent is close to twice the national average, according to a recent grade report from the Leapfrog Group, a hospital watchdog group that represents large purchasers of health care plans. Leapfrog also found that rates of bloodstream infections from contaminated central-line catheters (CLABSI infections) and colon infections at St. Vincent were relatively high, as were "foreign object retained after surgery," pressure ulcers (bed sores) and patient falls. The latter two were the subjects of a Department of Health report from 2013 that dinged St. Vincent for not following proper documentation procedures.
Based on these and other measures, Leapfrog gave St. Vincent an overall score of a D, placing it among the bottom 7 percent of the 2,639 hospitals the group graded in spring 2017. There has been a proliferation of similar scoring systems in recent years, and because they use various methodologies to crunch different data into easily comprehensible scores, their validity is fiercely contested by poorly rated hospitals.
The in-house survey on which Leapfrog partially bases its grades is "the least-validated survey of all the ones that are out there," St. Vincent's Beeson tells SFR. He also says the grade report (which is different from the survey) uses older data that does not reflect recent changes; he claims, for example, that infection rates at the hospital are "way down" from what they were in 2015. But Leapfrog bases its scores for infection rates on federal data from early 2015 to mid-2016 as well as its own survey, and Beeson did not present SFR with evidence to prove rates of infection were declining. However, it is true that Leapfrog's assessment of other hospital-induced ailments, including ulcers and falls, comes from federal data that only spans from 2013 through the middle of 2015.
Some of the fresher information factored into St. Vincent's D score rated the hospital's communication with patients. It scored a 2 out of 5 for nurse and doctor communication, and got the same score for tracking and accounting for patients' medication records. Karen Curtiss, a well-known advocate who publishes checklists on hospital care for patients and their families, says that hospital staff members often don't realize how incomprehensible they can sound to patients who aren't versed in medical terminology.
"They not only have their own terminology, but also their own shorthand way of speaking," Curtiss tells SFR. "And often, doctors and nurses are pressed for time. When you've got five or 10 minutes to spend with a patient, and you have to express yourself quickly, who wouldn't fall back on vocabulary they use every day?"
Poor communication is part of the "cumulative conduct" for which former patient Regina Reid is now suing St. Vincent. Through her attorneys, Reid filed a complaint against the hospital last month for medical negligence and failure to obtain informed consent after a 2015 visit for chest pains and shortness of breath caused by hypotension (low blood pressure). One of her attorneys, Stephen Marshall, says that Reid suffered a severe stroke after a doctor at St. Vincent drained a "drug pump" embedded near her hip without consulting Reid's pain specialist. The pump supplied Reid's body with dependence-forming opioids that the medical staff should have handled more cautiously, Marshall says. Reid suffered permanent vision damage as a result of the stroke.
These are the kinds of anecdotes that wouldn't sit well with St. Vincent's Beeson, who acknowledges that it will take years of improvement before public perception of the hospital changes. But the stakes are rising fast now that Presbyterian Healthcare Services—whose nearest hospital in Albuquerque scored a C on Leapfrog's safety grade report—is building a new $135 million hospital in Santa Fe to compete with St. Vincent, which was the only game in town for over a century.
