While Central Brooklyn residents rally to keep open the doors of bankrupt Interfaith Medical Center, and mayoral candidates pledge to prevent its planned closing, federal inspectors have given the hospital nine citations since January 2011 for deficiencies in patient care — more than any other facility in New York City.
One involved a baby girl who arrived at Interfaith on May 22, 2012, at 2:17 a.m. She was grunting and having trouble breathing. At 4 a.m. a nurse performed a chest X-ray. The baby’s respiratory rate was recorded as 56 breaths per minute, a sign she was in trouble. When a pediatric doctor finally arrived at 4:46 a.m, he or she requested a transfer to another hospital. An ambulance from LIJ-Schneider Children’s Hospital arrived at 6:33 a.m. A few minutes later, the infant, two months old, had a heart attack and died.
The nurses’ notes from the emergency room that night held “numerous references to the patient’s rapid deterioration over a 4 hour and 30 minute period,” a federal inspector’s report said. The infant’s parents wanted to “withhold diagnostic tests and treatment” but the inspector’s report said medical staff should have overridden that decision when it became apparent the girl needed life-saving care.
Interfaith “failed to provide timely emergency intervention” for the baby girl, the inspector found. “The emergency department medical staff did not intubate, draw blood for labs or obtain a venous blood gas, or implement intravenous access…until the patient went into cardiac arrest and expired,” the federal inspection report said.
The 287-bed Interfaith Medical Center, in Bedford-Stuyvesant, declared bankruptcy in December 2012 and will begin shutting down its operations on August 26. First the emergency department will close, and then, at intervals, the outpatient and other services will end as well. All operations are currently set to end by the end of November.
The closing is a serious blow to health care in Central Brooklyn. More than 50,000 patients pass through the doors of Interfaith’s emergency department each year, more than half of them poor enough to qualify for Medicaid.
But Interfaith, a Brutalist-style gray tower facility that occupies a city block, has, for nearly a decade, ranked below other city hospitals in key quality measures, such as preventable readmissions and emergency room wait times. Patients, too, rate the hospital poorly. Its emergency room is “chaotic,” according to a federal court–appointed patient-care ombudsman.
The U.S. Centers for Medicare and Medicaid Services perform unannounced inspections of acute care and critical access hospitals receiving Medicare and Medicaid funds every three or four years, or whenever a complaint is lodged against the hospital. If federal inspectors find deficiencies like the ones identified at Interfaith Medical Center the night the infant girl died, the hospital must file a report stating how it intends to fix the problem. If a hospital fails to take quick corrective action, the federal government can terminate its participation in the federal Medicaid and Medicare programs. Interfaith was fined $6,000 by the state’s Health Department in 2004 for failure to respond to its own survey findings in a timely fashion, a DOH spokeswoman wrote in an email.
Hospital president Luis Hernandez filed a plan of correction with the federal government in September 2012, promising to implement a half-dozen new quality controls to prevent cases like the infant girl’s death. Those plans included monitoring by the hospital’s director of quality management over a six-month interval, and writing new agreements with nearby hospitals governing the transfer of critically ill patients.
But Interfaith’s money troubles have overshadowed its quest to improve care. Three months later, in December 2012, the hospital filed for bankruptcy. Reports subsequently filed with the federal bankruptcy court found the hospital’s emergency room was often inadequately staffed and that systems for tracking and treating patients were incoherent. In late June 2013, Hernandez resigned.
Interfaith Interim President Patrick Sullivan said the hospital has addressed those problems. “I am sure you are aware patient confidentiality regulations do not permit me to talk about specifics of any case but be assured Interfaith Medical Center has adequately responded to all CMS concerns and monitor them for continued compliance,” he wrote in an email.
In January 2013, federal bankruptcy court appointed a patient-care ombudsman, a consultant named Eric Huebscher, to oversee the welfare of patients during the bankruptcy proceedings. Huebscher quickly identified serious problems at the hospital. In an initial report filed in February, he wrote, “I believe the issues in the ED [emergency department] are the most pressing for IMC.”
“During several personal observations, I noted a more chaotic and disorganized working environment than I have observed in other emergency departments. Routinely, particularly at busy times, there did not appear to be a coherent process of triage and patient management through discharge or admission. In several instances I observed patients who were not attended to promptly,” he wrote.
Interfaith, which serves a large base of psychiatric and drug detox and rehab patients, also needed more security, Huebscher wrote.
The hospital’s emergency room and psychiatric wards lacked security guards, despite “potentially volatile” patients, Huebscher noted. “One patient pulled a staffer’s hair off to “below the scalp line.” Another ripped “a part of a staff’s ear lobe off from a dangling earring.”
The hospital’s security chief was unfazed. He “felt that the hospital was appropriately staffed and was committed to provide a safe environment for all personnel and patients,” Huebscher reported.
Even in the usual course of business, ER care falls well short of New York City and national norms. Like the baby girl who died in May 2012, patients at Interfaith often wait hours for care, according to sample data provided by the hospital to the federal Centers for Medicare and Medicaid Services.
It takes two hours on average before patients in the ER receive their initial assessment — four times as long as the national average. Patients with broken bones wait on average more than an hour and a half to receive pain medication.
Some patients give up before they can be seen. A little after 7:15 p.m. on September 30, 2011, a woman entered the ER complaining of vaginal bleeding. She was pregnant for the first time. Hospital records from 11 p.m. that night show she left the emergency department without telling anyone. She had waited more than three hours without ever being seen by a doctor.
In October 2011, a patient was brought into the emergency department with severe chest pain at around 4 p.m. in the afternoon. A doctor never assessed the patient and hospital records show the patient left the ER at 2:17 a.m., more than 11 hours later. Records reviewed by a federal inspectors show at least 17 patients over a month-long period in 2011 simply walking out of the emergency room after triage, without being seen by a physician.
And even those who stick it out will only find themselves waiting longer. Last year Interfaith patients spent, on average, nearly 10 hours in the emergency room before they were admitted as inpatients, more than twice the national average of about 4.5 hours. Interfaith patients who were discharged from the ER without being admitted waited an average of over five hours in the hospital before being sent home, compared to a national rate of just over two hours.
Huebscher reported seeing two patients whose blood pressure was so high it put them at risk for a stroke, who hadn’t been seen in three hours. A third patient lay on a gurney in the emergency department for three hours, and had “neither been assigned to, nor treated by a doctor.”
The hospital’s staff assured Huebscher they were aware of these issues and are “working diligently to cure them.”
Ironically, the planned closure of the hospital may be helping turn things around for Interfaith. In June, the medical center, already under massive scrutiny from state, federal and local officials in the wake of the order to close, added more medical and nursing personnel and changed its nursing leadership, according to the patient care ombudsman. After state officials and the hospital’s board of trustees began to intervene in care, Interfaith “began to show markedly improved results in virtually all measured categories” by the end of June, patient care ombudsman Huebscher wrote in a report filed August 15. The hospital’s psychiatric ward, closed since March after the patient homicide, is finally cleared to re-open, but with the facility slated to shut down in weeks, no staff has been hired to run it.
The state’s Health Department will keep working with Interfaith to ensure continuity of care throughout the closure, a spokeswoman wrote in an email.
“This includes behavioral and physical health and the transfer of services to other providers to ensure the communities health care needs are being met,” she wrote.
To some of the hospital’s patients, losing the hospital is a significant disruption in an already unstable life. Days after news broke of the hospital’s impending shutdown, Debbie Garrett, 49, stood leaning on her cane with a handful of other patients near the outpatient entrance to the hospital at Atlantic Avenue.
She’d just left a treatment for chronic neck pain, but said she’d been to the hospital many times, for mental health counseling, for broken bones. She didn’t have anything bad to say about her doctors and her treatment. She didn’t have much to compare it to, because she’s been coming to Interfaith her whole life.
“This is the only hospital right now in this area,” Garrett said. “My sister was born here. This is like our family history.”