State investigators swept into HCA Florida North Florida Hospital in Gainesville earlier this year and, in a single day, disposed of reports that the hospital had delivered contaminated surgical instruments to operating rooms and that upper management had pressured staff to use them anyway.  

Records newly obtained by Mainstreet Daily News reveal that investigators made their determination that complaints of unsanitary instruments and management failures to assure patient safety were “unsubstantiated” after eight hours on site at the hospital. 

The records, obtained through a Freedom of Information Act (FOIA) request, detail events surrounding two complaints and a hospital inspection that took place on Feb. 6 – almost three weeks after North Florida had halted surgeries. Two officials from the Florida Agency for Health Care Administration (AHCA) arrived unannounced and conducted a “tour” that was led by hospital leadership, including CEO Eric Lawson. 

Lawson told AHCA investigators that the pause in surgeries was due to concerns about the “overall quality of our instrumentation” and not the result of an immediate or critical incident.  

“I was notified the week that we implemented our shut down of the OR [operating room],” the surveyor notes recount Lawson saying. “We were feeling growing pains and year end surge and we had many discussions related to more time needed for OR times.” 

Lawson said there was “a corporate decision” to “pause all elective surgical procedures” due to “concerns found within the month prior to January.”  

“The senior leadership team, along with our corporate leadership team created an immediate response to address all needed equipment repairs, the overall condition of our equipment, instrumentation quality and any equipment breakage, any delays in sterile processing times related to equipment and any concerns related to staffing and training based on the overall average staff retention times,” the surveyor notes read. “This was a proactive decision based on our assessments and findings.” 

Lawson’s comments differ from surgeons who have spoken to Mainstreet and other local news outlets. But documents do not identify any interviews with surgeons, and the “investigation plan” detailed in documents does not indicate surveyors intended to do so.  

“There was nothing ‘proactive’ about the hospital’s decision,” a surgeon said in a late August interview. He said surgeons operating at North Florida Hospital had been complaining about “dull or broken” instruments and “debris” on them “for years.”  

The surgeon – and four fellow surgeons – told Mainstreet in interviews earlier this year that HCA’s North Florida Hospital created the crisis by consistently putting profits over patient care. All the surgeons said HCA had staffed its sterile processing department (SPD) with too few technicians, and those who were there were often unqualified.   

On Jan. 10, hospital leaders held an early-morning meeting with more than 50 doctors who were “up in arms” about the lack of clean, functioning instruments – and who, during the meeting, expressed no confidence in administration to fix the problems. In a contrite follow-up email on Jan. 12, Dr. Sherrie Somers, the chief medical officer, acknowledged to surgeons that “you have been promised improvements for 6-12 months.” 

The hospital declined to answer questions about the discrepancy between Somers’ email and Lawson’s statements to investigators, or about current staffing levels and training efforts. 

Instead, spokesperson Lauren Elliott issued the following statement: “HCA Florida North Florida Hospital is committed to maintaining the highest standards of patient safety and quality care, as we have continued to do for over 50 years in the north central Florida community. We worked closely with ACHA [sic] to address the issues raised in their survey, and this was resolved earlier this year. The quality of care we provide is confirmed by the national recognition we have received from independent patient safety and quality rating organizations reviewing performance on quality measures, including Healthgrades, who named HCA Florida North Florida Hospital one of America’s 250 Best Hospitals.” 

The tipping point 

Mainstreet reported in February that HCA’s North Florida Hospital, with more than 500 beds, had shuttered its operating rooms to all but emergency surgeries, and that the state was investigating the circumstances. The hospital revealed the disruption publicly only after receiving inquiries from Fresh Take Florida, a news service of the University of Florida College of Journalism and Communications, which broke the story.  

When the hospital halted surgeries, Lawson personally alerted Alachua County Fire Rescue Chief Harold Theus to not transport any critically ill patients to North Florida Hospital. That directive was lifted the next day, but elective surgeries did not fully resume for nearly two months.  

During the interim period, even requests for “emergent” procedures were subject to denial by a hospital-appointed “physician advisory panel” – a process confirmed in AHCA documents. Inspectors reported the hospital, as of Feb. 6, was operating on “only 15 cases” a day, down from an average of 50 a day before the shutdown. 

The resumption of “full operations” in March came in fits and starts as the hospital continued to struggle with a shortage of serviceable surgical instruments and ongoing problems with cleaning the ones it had. 

Mainstreet obtained internal hospital documents and conducted interviews with doctors, nurses, support staff and patients detailing the problem of tissue, or “bioburden,” remaining on instruments that had ostensibly been scrubbed and sterilized. Most of those who spoke to Mainstreet requested anonymity for fear of retribution.  

AHCA documents indicate that its probe was spurred by local news reports, which were distributed to dozens of people in an internal email on Jan. 30. The previous day, AHCA received an anonymous complaint from someone identifying themselves as an employee of the hospital, who wrote that “upper management is telling us to use this equipment that is not clean.”  

The complaint went on to describe “blood and tissues still on scalpels and other surgical instruments.” The person related an incident during which a “surgeon kicked a surgical tech out of the OR for refusing to hand him a dirty instrument.” 

The names of several technicians and an operating room nurse who were interviewed during AHCA’s Feb. 6 visit were redacted from the investigative records obtained by Mainstreet. In the interviews employees explained their roles and responsibilities and discussed procedures followed in the sterile processing department.  

The documents did not give any indication that investigators asked the nurse or technicians if they were pressured or ordered by management to work with unclean instruments or equipment. Only one technician, a Steris Corporation worker, was asked about the decision to shut down the operating rooms. The technician said she had “been at the facility for only 1 week but understood that there were several factors that lead to the decision by management.” 

Steris, a company approved by the federal government for disaster response, was a major part of the hospital’s response to the crisis. AHCA interviewed at least one hospital manager – whose name was redacted – who confirmed that Steris had determined much of the hospital’s surgical instruments inventory was “damaged” and in need of replacement or repair.  

When Mainstreet approached Steris technicians working in trucks on the hospital’s parking lot in late January, one said they were repairing “probably thousands” of surgical instruments. 

The surgeon who spoke to Mainstreet last week said about 40% of the hospital’s instruments had to be discarded following Steris inspections, and many have not been replaced.  

“We still have instrument trays that are short,” the surgeon said. “The techs do a pretty good job, though, of scrambling to make do.” 

As of Tuesday, a large Steris trailer was still actively in use on the North Florida property.

AHCA investigators reviewed a year of the hospital’s infection reports that revealed no uptick in infections that might have been attributable to the dirty instruments.  

Documents mention three patients, only one of whom appears to have spoken with investigators. A brief narrative of a bedside conversation with “patient #1” quotes the man as saying he was “told about the operating room and that they are doing things with it. It didn’t affect me.” The patient said doctors and nurses had been “just great.”   

AHCA documented telephone calls to two patients who had been transferred to other hospitals and left voice messages. There is no indication that “Patient #2” or “Patient #3” responded. 

Records do not give any indication that AHCA interviewed patients whose surgeries had been canceled or postponed.  

An unnamed administrator told investigators that patients had been and could still be transferred to “UF, Ocala and Lake City for the needed surgical services.” (HCA Healthcare Inc., the nation’s largest hospital company and the parent company of HCA Florida North Florida Hospital, also operates hospitals in Ocala and Lake City.) 

One manager at North Florida Hospital, whose name and title were redacted from the state’s report, told investigators that “patients have not had any delays in emergency treatment since this began.”   

That claim collides with the experience of Jami Thomas, whose arm was broken in three places and displaced from the shoulder socket in a Jan. 18 tumble at her Millhopper area home. She was sent home from the HCA emergency room in Gainesville that afternoon with her arm in a sling, and with enough pain pills to last three days.  

Thomas waited for three weeks in “excruciating pain” for her arm to be put back together in an operation at HCA’s Ocala hospital, 48 miles away. 

The state report indicates that North Florida was asked to provide an accounting of all surgeries canceled since the shutdown. If the information was provided, it was not included in the investigative report. One surgical practice administrator told Mainstreet in February that the shutdown had created scheduling “chaos” for doctors and patients. 

Differing conclusions 

AHCA investigators cited actions and promised improvements by the hospital in concluding that complaints of failure to provide adequate care were “unsubstantiated.” Their report noted that “senior leadership of the hospital recognized a concern,” made the decision to halt surgeries, repair or replace instruments and equipment as necessary, add staff in the sterile processing department and improve staff training.  

On the day of the inspection, the hospital had 15 people working in its SPD but promised to add 24 more to accommodate three shifts working around the clock. HCA declined to respond to a Mainstreet question in August about current staffing levels.  

Spokespersons for AHCA have not responded to Mainstreet’s repeated requests of the agency to provide someone to discuss its enforcement policies and practices. AHCA director Jason Weida also declined an interview request. 

In an end of the day “exit conference” on Feb. 6 with North Florida Hospital’s executive team, including Lawson and Somers, an AHCA investigator announced the agency was satisfied that the hospital had identified equipment, staff and training problems and was taking the necessary actions to correct them. The investigator cautioned, however, that his finding was preliminary, pending “supervisory review.” 

It took an unnamed supervisor 30 minutes to review – and approve – the finding. 

Three weeks later, on Feb. 27, AHCA posted a two-word “inspection status” on its website: “No deficiencies.” 

Mainstreet obtained records of the state’s investigation – or survey – through a FOIA request made of the Centers for Medicare and Medicaid Services (CMS). CMS pays Florida to investigate health care facilities on behalf of the federal government. AHCA had declined to provide the records, citing what a spokesperson said were statutory and regulatory restrictions on what it is allowed to release. 

Last year Florida’s U.S. Sen. Marco Rubio sent a letter to HCA Healthcare Inc. expressing concern over NBC reports of poor conditions and patient safety issues at Bayonet Point Hospital, one of numerous HCA facilities to come under scrutiny since last year.  

Local lawmakers have mostly declined to comment on the troubles at HCA’s North Florida Hospital, but state Rep. Yvonne Hayes Hinson told Mainstreet she finds it “quite alarming” that AHCA did not interview any surgeons and closed its investigation after a seemingly cursory review.   

“The depth and seriousness of this issue requires more than a one-day inspection,” Hinson said. “These are the kind of horror stories that sometimes make me afraid to go to the hospital.” 

Hinson said she was concerned about HCA’s expansion in the region, even before she learned that CEO Lawson had cited “growing pains” as a factor in its surgery travails.  

“HCA is popping up all over my district. They are becoming huge,” she said. “If I find they can’t properly manage these facilities, I will pursue this as far as I have to go.” 

Editor’s note: This story has been updated to clarify that AHCA had declined to produce the inspection records.