‘Third world medicine’: inside a troubled north La. hospital | Health care/Hospitals

The financial crisis plaguing a national for-profit health care chain has hit patients in northeast Louisiana, where one of the company’s hospitals has faced recurrent supply and staffing shortages and is restricted to one-third its capacity as part of an agreement with the Louisiana Department of Health. 

Glenwood Regional Medical Center, a 278-bed hospital in West Monroe, is one of 33 hospitals owned by Steward Health Care, a private-equity-backed system based in Dallas with a large presence in Massachusetts. Glenwood is a key health care player in northeast Louisiana, serving not just western Ouachita Parish but also patients from numerous rural parishes in the region.

A litany of problems at the facility were detailed in over 30 pages of federal inspection reports compiled in December by state health officials working on behalf of the Centers for Medicare and Medicaid Services. The reports, which were obtained through a public records request, paint a troubling picture of a medical facility where doctors were forced to transfer patients out for emergency procedures, staff often had no idea what supplies they would have from week to week, and critical equipment stayed broken for days at a time.

One physician told an inspector that the hospital was performing “third-world medicine,” according to the reports.

In response to questions, Steward issued a statement saying they are working with the state health department to improve conditions and begin accepting more patients.

‘Collapse era’

Steward, which has 30,000 employees, has been under fire in Massachusetts for the financial mismanagement of its hospitals while continuing to pay dividends to stockholders and provide generous benefits to its executives, according to reporting from The Boston Globe.

The implosion has brought into question the stability of private equity health care deals. A study published in JAMA last year found that serious medical errors, including those that led to surgical infections and bed sores, rose 25% in the three years after a private equity fund bought a hospital.

Louisiana has the second-highest number of private-equity-backed hospitals compared to other states, according to the Private Equity Stakeholder Project. There are 27 such hospitals in the state.

This is the “collapse era” of such deals, said health policy expert John McDonough, a professor of public health practice at Harvard University.

“This is a familiar phase in the life of a private equity investment where all of the house of cards, or the Ponzi scheme, begins to collapse,” said McDonough. “The question is how easily and quickly can the entities holding on to the properties get out of it.”

The overleveraging is a purposeful trend in health care, said McDonough.

“You don’t look at your hospital as a place of medical care,” said McDonough. “You look at it as a business opportunity to make as much money as you can as quickly as you can.”

Officials alarmed

In other states dealing with similar problems, regulators are considering everything from bankruptcy declarations to criminal charges. In Massachusetts, where Steward owns nine hospitals, a woman allegedly died a day after giving birth when doctors realized mid-surgery that the supplies needed to treat her were repossessed the week prior, according to The Globe.

In West Monroe, local officials say they are alarmed, and watching the situation at Glenwood closely.

“I would love it if things could get on the right track,” said Alderman Ben Westerburg, who represents a city-wide district. “If that does mean selling to another owner, then yes, that’s what I’d like.”

West Monroe Mayor Stacy Albritton Mitchell would like to see the hospital service district — a political subdivision of the state which sold the hospital to IASIS Healthcare in 2006 — reacquire the property and hire an operator to run it, she said.

“I am not a fan of the for-profit hospital model at all,” she said. “They take out the profits and they take out the dividends.”

Warning signs

Even before inspectors stepped in, doctors at Glenwood were worried. Last April, 10 physicians expressed ”deep concern” over a lack of supplies and staff in a letter to the hospital’s governing body, according to the reports.

At times, medical personnel couldn’t perform certain basic blood and urine lab work or test on site for common infections like COVID, staph or strep, according to the inspection reports. The documents also alleged that vendors hadn’t been paid.

Then there were the documented problems with staffing.

Late last year, a patient at Glenwood complained of chest pain and was taken for an EKG.

According to the documents, the test results showed abnormalities. The doctor recommended emergency surgery. But Glenwood didn’t have available staff to do it, and a transfer wasn’t safe for the patient, according to a doctor interviewed by federal inspectors.

The doctor said he frequently transfers patients out of state because Glenwood isn’t properly staffed. The physician also hadn’t received on-call pay in three months.

One employee told an inspector that the situation was “just tragic,” according to the reports.

‘Immediate jeopardy’

On December 8, state inspectors determined the hospital put patients’ health and safety in “immediate jeopardy,” saying they were “denied services and/or delayed treatment due to inadequate staffing and/or supplies,” according to the reports.

They found the radiology lab had run out of the suction canisters that keep patient airways clear. Basic supplies – biopsy needles, catheters and central lines – were not delivered due to credit holds with unpaid vendors.

Shipments of food were paused. Staff started scrambling to provide basic services as vendors repossessed critical medical equipment. Patients in need of dialysis, a blood cleaning process for kidney issues, were denied admission.

In response, hospital leaders vowed to personally monitor supply levels and staffing levels.

Six days later, the “immediate jeopardy” status was lifted.

‘Get out of our city’

But in February, Glenwood was cited again. A public records request for those inspection reports was pending at time of publication. But sources said the issues were similar.

The situation again improved by the end of February, the sources said. But the hospital remains limited to 91 patients, including 16 intensive care beds. Glenwood’s 40-bed behavioral health facility is also still operating, the company said. 

St. Francis Medical Center, a hospital in nearby Monroe, has seen a 30% uptick in patient volume in recent months, a spokesperson said. St. Francis has added contracted staff to help care for the extra patients, the spokesperson said.

Steward did not respond to questions about the availability of services and supplies, employees, immediate jeopardy situations, plans of correction or potential buyers. 

Mitchell, the West Monroe mayor, said getting Glenwood back into the hands of the local district could give the community a “relationship and maybe even a say-so” in how it’s run.

And she’s clear on one thing.

“We would like Steward to go,” the mayor said. “We want them to sell the hospital and get out of our city and northeast Louisiana.”