National Nurses United

interviewed for this story remarked at how poorly their units came to be staffed after CHS bought their facility, and how services that may not be as profitable but are important to keep at a community hospital were eliminated after CHS took over. Rose Anne Wilson works in the ortho-spine unit at Affinity Med- ical Center in Massillon, Ohio, but has actually been with the origi- nal hospital that CHS bought from Triad Hospitals in 2007, Doctors Hospital of Stark County, since 1971. "I started there when the ink was still wet on my nursing diploma," said Wilson. Wilson said that once CHS took over the hospital, it immediately cut RN staffing. "We were told right away when CHS came that we had too much staff," said Wilson, who said that they used to have anywhere from four to six patients, depending on acuity. "We thought we were safe and manageable, but they said we had too much staff. Now you don't ever hear anything about acuity." Wilson reports that now, for Affinity's 10-bed ortho-spine unit, manage- ment will never staff more than two RNs—even if the majority of beds are filled with fresh post-operative patients or ones who have had total joint replacement, or if acuity is just high. If the unit has more than seven patients, the nurses are supposed to get a nurse's aide, but that often does not happen. "There are days when surgeries are heavy, like Thursdays and Fridays are busy days for us, and there's only two of us," said Wilson. "We can't leave the floor. We're doing total patient care and all the orders. It's not safe." Despite the dangerous conditions, CHS manage- ment—especially at the more recently unionized facili- ties such as Affinity, Bluefield, and Greenbrier—refuse to accept nurses' assignment despite objection forms (ADOs), legally admissible documents commonly used by NNU members to record unsafe situations. Veroni- ca Poss said that at Fallbrook, the managers would ask nurses to fill out staffing forms, then "stick them in a drawer. It's just for JCAHO [the Joint Commission]." Understaffing is a common pattern throughout CHS facilities. Meadwell said that her labor and delivery unit at Bluefield Regional used to be "well staffed" and the nurses always felt prepared to deal with unexpected situations such as emergency cesarean sections and high-risk pregnancies. For a total of 18 beds between labor and postpartum, the hospital used to staff six RNs no matter what. "I was able to educate my patients better and actually have a conversation with them," said Meadwell. "A lot of them are new moms. It's a very intimate and life- changing time for a woman." Now, CHS staffs those beds on a bare-bones basis. The unit is lucky if it has more than four nurses. Mead- well said that staffing has been so low, particularly on night shift, that postpartum patients have been left unattended for as long as 50 minutes because the RN assigned to them was pulled away to help with a labor and delivery emergency. "This has happened on more than one occasion," she said. When the RNs raised con- cerns with management about how at current staffing levels they are unprepared for emergencies, she said that they replied, "We don't staff for 'What ifs.'" One day in 2011, Meadwell said the unit was so understaffed that a surgery patient bled out and died. Before the patient died, the nurses had known the situation was unsafe and called managers for more nurses, but their requests fell on deaf ears. "CHS would rather cut off its right arm than staff us properly," said Meadwell. "There was no help." After the incident, the hospital reported Meadwell, another RN, and some LPNs to the West Vir- ginia Board of Examiners for Registered Professional Nurses. All of them had to fight to keep their licenses. Meadwell was finally cleared of any blame in September 2013, but the experience left her angry and determined to reform her facility. "The patients pay for top of the line, but they don't get it," she said. "They are fleecing the patients by not providing the care that they deserve. They still con- tinue to play Russian roulette with the staffing." C ommunity Health Systems' business practices have been so egre- gious that the corporation caught the attention of federal investi- gators in April 2011, which started looking into the company for potentially defrauding Medicare and Medicaid by unnecessarily admitting patients through its emergency departments. Tenet Healthcare initially made these charges of CHS in a lawsuit it filed that same month to fend off a hostile $7 billion takeover by CHS. The 14 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J U N E 2 0 1 4 Serious Questions About Quorum In addition to the 206 hospitals CHS owns, it also manages more than 150 other hospitals through a subsidiary called Quorum Health Resources. Quorum is a hospital management and consulting company with its own growing track record for mismanagement. In February 2014, Hancock Medical Center, a not-for-profit community hospital in Bay St. Louis, Miss. filed a lawsuit against CHS subsidiary, Quorum Health Resources, for cost- ing the hospital "millions of dollars in losses." According to the complaint, Quorum's man- agement was "abysmal," and "utterly failed to operate Hancock Medical in a manner that would maintain its financial stability and ensure long-term viability." In an earlier lawsuit that is still ongoing, Natchez Regional Medical Center in Natchez, Miss. sued Quorum for "monumental harm to a fifty-year old non-profit institution caused by the Quorum Defendants' negligence, breach of fiduciary duties, fraud and other wrongful acts and omissions." Other hospitals under Quorum management have been forced into bankruptcy, including Gerald Chapman Regional Medical Center in Alamogordo, N.M., after facing more than 70 malpractice lawsuits from patients subjected to an "experimental" spinal surgery. In a partial settlement of the claims in August 2012, Quorum has already agreed to pay $13.5 million, while additional litigation continues. An ongoing case regarding Quo- rum's corporate liability is scheduled for a nine-day trial scheduled to start June 23, 2014. CHS hospitals aren't cheap Six CHS and HMA hospitals are among the top 10 most expensive in the United States, according to a 2013 NNU analysis of hospital charges. In the list below, the number after the facility represents how much more the hospital has priced its services compared to actual costs. Using the first entry as an example, Paul B. Hall charges $1,186 for every $100 of costs. Paul B. Hall Regional Medical Center, Painsville, Ky. 1186% North Okaloosa Medical Center, Crestview, Fla. 1137% Gadsden Regional Medical Center, Gadsden, Ala. 1128% Brooksville Regional Hospital, Brooksville, Fla. 1083% Heart of Florida Regional Medical Center, Davenport, Fla. 1058% Chestnut Hill Hospital, Philadelphia, Penn. 1058%

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