Nine registered nurses who work at Summa Akron City Hospital’s emergency room said they believe some of the physicians who took over the ER Jan. 1 put patients’ lives in danger.
Some of the doctors are out of practice or seem unprepared to lead a fast-paced, regional trauma center, the nurses told the Akron Beacon Journal.
The nurses said they have witnessed and intervened when some of the new doctors delayed time-sensitive treatment for stroke patients, prescribed potentially fatal overdoses of common drugs like insulin and heart medication and misread EKGs, a medical test that can reveal whether someone is having a heart attack.
Officials from Summa and US Acute Care Solutions (USACS), the new ER physician staffing group, strongly dispute the nurses’ allegations. They point out that every doctor working at Akron City is board certified in emergency medicine and competent.
They said data collected from Akron City’s ER show that care under USACS — including that for strokes and heart attacks — is on par with the former physician group at Akron City.
Yet all nine ER nurses said they are telling family and friends to go to another ER if they need help for anything other than a minor health problem.
“I’m astonished by how much [the USACS physicians] don’t know about how to take care of patients,” one of the ER nurses said. “It’s mind-blowing.”
The nine RNs said they have repeatedly raised their concerns to supervisors and administrators since Summa contracted with Canton-based USACS to provide physician staffing, but no significant changes have been made.
The RNs — who make up 10 percent of Akron City’s ER nursing staff — asked that their names not be published because they fear losing their jobs. The Beacon Journal granted their request so this story could be told.
Ongoing issues in ER
The stark disagreement over the quality of care now provided at City’s ER is the latest chapter of a crisis that’s caused an uproar at Summa Health, Summit County’s largest employer with about 7,000 workers at its hospitals, health facilities and insurance business.
Summa and USACS officials disputed many of the ER nurses’ complaints, saying they are medical misunderstandings caused by working with a new group of ER physicians who may do things differently, but just as well as Summa’s former ER physicians, Summa Emergency Associates (SEA).
The ER nurses acknowledge missing the old ER doctors. But they said their overriding concern is a lack of confidence in the new doctors.
“We’re not out to hurt anybody or do this just to get SEA back,” one nurse said. “We’re doing this because patients are being affected.”
USACS staffs 170 ER facilities nationwide. Of those, five — including Akron City — are Level 1 trauma centers, a designation reserved for ERs capable of handling the most serious injuries. Another 16 facilities staffed by the physician group are Level 2, which can handle most traumas.
The overwhelming majority of facilities USACS staffs are places like Summa’s suburban ERs. The quality of care may be equivalent, but these ERs don’t provide the depth of resources. These facilities treat and stabilize severely injured or ill patients before transferring them to trauma facilities.
All of the Akron City ER nurses interviewed said they have caught errors in drugs ordered for patients by the new physicians, some of which could have been life-threatening.
Mistakes happened with the former ER doctors, but not as frequently, one nurse said. Now, nurses said, they go around the USACS doctors to check orders with in-house pharmacists. Other times, they refuse to give the drugs as ordered.
“Every single shift I work I’m exhausted at the end because I argue with these physicians,” a nurse said.
Summa officials said they were unaware of ongoing issues with physician drug orders since the staffing change.
ER contract dispute
The problems began after failed last-minute negotiations in late December between Summa and SEA, a group of doctors that staffed City’s ER for nearly 40 years.
Summa quickly contracted with USACS. Critics cried foul because the new group’s CEO is married to a Summa leader, but the health system has repeatedly denied any conflicts.
Similar changes at ERs often take 90 days. Summa switched doctor groups in moments, causing deep divisions among staff and ultimately the resignation of Summa’s CEO, Dr. Thomas Malone. Interim CEO Dr. Cliff Deveny takes over the role Monday.
Summa and USACS officials thanked the ER nurses and staff for helping during the transition.
“The change was very difficult, particularly for the nurses in the Akron City Emergency Department because of the long-standing relationship and trust they had with the previous physicians,” said Lanie Ward, Summa vice president and chief nursing officer.
The nurses who spoke with the Beacon Journal said their complaints about patient care have nothing to do with contract disputes or SEA.
“When [the new physicians]came, we had open minds. We wanted to help them. We want it to work. We wanted them to be good doctors. And that has not been the case,” one nurse said.
Stories of treatment delays
“Time is brain.”
It’s a mantra nationwide among health care workers who handle strokes. When someone comes into Akron City’s ER with stroke symptoms, an announcement prompts a team of nurses, residents (doctors-in-training) and an attending physician from USACS to scramble to the patient’s bedside.
Every minute of delay in treatment can cost a stroke patient 1.9 million brain cells, medical research says.
But nurses said some of the new doctors don’t always respond, or they arrive late or do not recognize stroke symptoms.
One nurse provided an experience she said she had recently:
“I’m looking around and I see residents, I see nurses, but I don’t see an attending,” the nurse said. Because USACS has staffed the ER with many different physicians — many from out of state who fly in for a few days — nurses said they don’t know them all.
“I said, ‘Is there anyone here who is an attending I’m not recognizing?’ ” the nurse recalled. When no one responded, the nurse made another overhead page urging an ER doctor to hurry to the room.
“Finally, he’s coming, walking slowly, no rush,” the nurse said.
Once the physician arrived, the nurse said, he didn’t label the patient as a possible stroke patient, action that would have triggered an immediate brain CT scan and blood testing, clearing the way for what can be life-saving clot-busting drugs.
Summa’s neurology department was contacted and asked to examine the patient. A neurologist quickly determined the patient could be having a stroke and rushed the patient for tests about 35 minutes after arrival in the ER, the nurse said.
The nurse doesn’t know what happened after the patient left the ER.
Almost all of the eight other ER nurses told similar stories about delays, not only in stroke care, but also for patients with heart attack symptoms.
In three cases, nurses said they challenged USACS doctors who didn’t call for urgent intervention after examining the patients’ EKG for signs of a deadly type of heart attack. In two of those cases, the nurses said, ER residents intervened and the patients were sent to cardiology.
In response to these allegations, USACS Chief Administrative Officer Dr. Dave Scott said he’s confident all of the physicians working at Akron City’s ER can read EKGs. Summa officials also pointed to statistics that they say show patient care continues to exceed national benchmarks for quality.
Last year, patients who showed up in City Hospital’s ER with heart attack symptoms typically had a catheterization to check for blood flow to the heart 46 minutes after arrival, said Dr. Dave Custodio, interim chair of the Akron City’s Emergency Department. This year, the average “door-to-balloon” time is 50 minutes, which remains 10 minutes faster than the 60-minute national standard.
Similarly, the national goal for stroke patients to get intravenous drugs after arriving in a hospital ER is 60 minutes.
Akron City’s “door-to-needle” time in 2016 was 47 minutes, Summa officials said. During the first two months of 2017, it was 56 minutes.
Summa officials pointed out, however, that the door-to-needle time would drop to 40 minutes if one patient’s time was removed. In that case, officials said the patient had vague symptoms and was monitored in the ER for a couple of hours before being diagnosed with a stroke.
Chief Nursing Officer Ward said that everyone at Summa — from custodians to executives — has had stroke training, so any employee, including nurses, can call a stroke team into action.
The ER nurses said they were unaware of this companywide training or the power for anyone to call a stroke team. But, the nurses said, it follows a pattern that their bosses blame them for any problem they raise.
“It’s like working in a mini Russia. You can’t say anything bad about anything,” one nurse said. “Everyone is terrified. Everyone is afraid they’re going to get fired.”
Ward said she was disappointed nurses feel that way. She said nurses have a variety of ways to express their concerns, beginning with challenging a physician at the time of a medical incident. From there, nurses can complain to supervisors or lodge an anonymous complaint.
Nurses said they’ve complained for weeks to everyone in Summa’s chain of command.
Turnover in staffing
The ER nurses said they’re going public about their concerns over patient care as a final attempt to make things right.
All nine Summa ER nurses said they are looking for new jobs. Some have started interviewing.
The nurses also worry about what will happen when Summa’s ER residents leave.
In February, a national accreditation board stripped Summa of its ability to train emergency medicine residents beginning July 1, in part because Summa lost its faculty when it couldn’t come to terms with its former ER staffing group.
Summa is appealing.
“The residents are running that ER right now,” one nurse said.
Nurses said they turn to the residents when they fear USACS physicians are doing something wrong, and the attending physicians depend on residents to lighten their patient load.
The churn of out-of-state doctors — who often work four to six days at a time, two to three rotations a month — had been difficult during January and February as the new emergency medicine physician group was ramping up service, acknowledged Dr. Scott, the most senior USACS physician now working regularly at Akron City’s ER.
“I understand the stress that puts on the staff just with new people and new faces,” he said.
Nevertheless, it’s gone well, Scott said. “I’m very pleased we’ve been able to maintain metrics, maintain the high quality of care with all of [the SEA] doctors leaving.”
In March, only three USACS physicians who haven’t worked at Akron City will be in the ER, Scott said.
The ER physician staffing company estimates 50 percent of its doctors now working in Akron City’s Emergency Department live in Northeast Ohio.
“I hope there will be a lot of new full-time docs living here locally,” said Scott, who lives with his family in Greater Akron. “I’m still hopeful some of the former SEA physicians will come back and work for City.”
SEA physicians have repeatedly declined to join USACS, although they have said they’d be willing to take over Summa’s emergency room contract again and save Summa’s emergency residency program.
But Custodio confirmed the Summa board’s position: Summa is sticking by a three-year contract with USACS.
Custodio, a former SEA physician himself, said he’s witnessed Akron City’s ER operations smoothing out as USACS physicians and staff get to know each other.
“We’re also seeing decreasing patient complaints from the first month to the second month,” he said
But the ER nurses interviewed by the Beacon Journal insist patient care issues persist.
“We’re nurses. This is not a job, this is who we are,” one nurse said, “We feel like Summa doesn’t care, like they’re throwing us away, like they’re throwing our ER away and no one cares.”
Amanda Garrett can be reached at agarrett@thebeaconjournal.com. Betty Lin-Fisher can be reached a blinfisher@thebeaconjounral.com