Surgery crisis persists at HCA’s North Florida Hospital

HCA Florida North Florida Hospital canceled more than half a dozen major surgeries Thursday, compounding a crisis of “dirty” surgical instruments that has left patients in a lurch and doctors reeling from disrupted schedules. 

At least three surgeons “unloaded” on hospital administrators Thursday after work was halted because of “residue” on instruments that were purportedly cleaned and sterilized.   

The clamps and other surgical tools had an orange or black film on them that left smudges on gloves and gauze. Mainstreet obtained photos of the dirty tools but is not releasing them to protect the identities of those who took them.  

Patients whose operations were canceled Thursday included a woman who traveled from South Florida—the second time her surgery has been aborted since the hospital’s operating rooms debacle began to publicly unfold in mid-January.  

“Hundreds of patients have suffered because of this,” one surgeon said. He said he “couldn’t begin to estimate” how many operations have been disrupted in the “year or more” that doctors have complained about “blood and other tissue” left over from previous surgeries. 

In an extraordinary display of frustration, “surgeons were yelling” at the hospital’s chief operating officer Thursday morning, according to one who was present.  

Heart, spine and breast reconstruction surgeries were among those scrapped on Thursday. 

HCA North Florida canceled all elective surgeries on Jan. 17 after admittedly giving doctors unfulfilled promises of corrections for a period of “6-12 months.”   

The hospital resumed surgeries in increments starting on Feb. 5, returning to what a spokesperson called “full operations” eight days ago. The problem of tissue and other substances—collectively called “bioburden”—remaining on sterilized surgical tools has continued intermittently, however, despite a “blitz” effort to solve it.   

In January, HCA North Florida Hospital said only that “operational” and “equipment” issues caused surgeries to be suspended.   

On Feb. 20, CEO Eric Lawson said in an email to employees that the hospital had acquired additional staff, new sterilization equipment and new instruments to address the immediate crisis and provide for future expansion.  

Mainstreet’s reporting has relied on sources who spoke on condition of anonymity for fear of retribution. Mainstreet has obtained internal hospital documents that corroborate and expand on much of what the sources reported. 

In an email to Mainstreet late Thursday, HCA Healthcare spokesperson John “Trip” Farmer said that the hospital recently “rescheduled a small number of elective surgeries” while installing a new water filtration system.  

But two surgeons told Mainstreet the new water filtration system has not solved the problems. Instruments with residue on them that were sent back to be reprocessed—using the newly installed system—still came through contaminated. 

“All surgical specialties are still being affected,” one surgeon said, adding that the hospital “still has inexperienced, unqualified people” working in its sterilization unit, causing “trays missing instruments or with contaminated instruments” to be delivered to operating rooms.  

As Mainstreet previously reported, the hospital called in Steris Corporation, a company approved for federal “disaster response,” to clean and repair surgical instruments and tools, and train existing hospital staff how to do their jobs. How the training is going is not known, although a large Steris mobile sterile processing facility continued to operate in the back parking lot Thursday. 

A surgeon said the hospital cannot continue to try to “rely on the kindness of strangers.” He said trays arriving without the correct instruments on them have left surgeons having “to piecemeal surgeries together.”  

The surgeon said the hospital’s administration has displayed a “culture of indifference” to concerns repeatedly raised by physicians, nurses and staff.  

“It’s almost like they just don’t care,” he said. 

The long-simmering instrument issues came to a head while the hospital was without a chief operating officer, after former COO John Gerhold accepted a promotion to another HCA facility in December. In a March 1 email to Mainstreet, North Florida Hospital spokesperson Lauren Lettelier said the hospital was excited to welcome a new COO, Mark Amox, starting March 11. 

Two doctors told Mainstreet Thursday they are disappointed that the new COO has been “AWOL” from the operating suites. “Coming in when he did, in the middle of a crisis, you’d think he’d be up there every day,” a surgeon said. “He hasn’t been.”   

HCA’s Farmer countered that the new COO “has been highly engaged with physicians and staff since he started in his new role less than two weeks ago.” 

Florida’s Agency for Health Care Administration (AHCA) inspected the hospital on Feb. 6, the day after Mainstreet reported the state was investigating.  

In a status report AHCA found “no deficiencies.”  A source in a position to know told Mainstreet that AHCA investigators didn’t see visible violations and were satisfied with the hospital’s plan for recovery.   

It is not uncommon for AHCA, the federal government’s Centers for Medicare and Medicaid Services, or The Joint Commission (TJC) on hospital accreditation to further investigate facilities where deficiencies might be ongoing. Various statutes and rules limit the agencies as to what they can reveal publicly. 

A doctor said TJC investigators were at the hospital Thursday.  

Meanwhile, North Florida’s CEO Lawson had hip surgery at his hospital Monday. It was performed by Chief of Surgery Dr. Tristan Altbuch, who also chairs the hospital’s surgical quality committee. 

The boss’s operation reportedly went smoothly.  

“He had an OR full of nurses and staff,” a doctor said. “The instruments were clean.” 

Editor’s note: Fresh Take Florida, a news service of the University of Florida College of Journalism and Communications, was the first to report the surgery cancellations at HCA Florida North Florida Hospital. Mainstreet and Fresh Take have joined in a continuing investigation of this healthcare issue of concern to the people of North Central Florida.