State investigating HCA surgery shutdown 

State regulators are investigating an ongoing clinical crisis at HCA Florida North Florida Hospital after surgeries were abruptly stopped almost three weeks ago.  

An undisclosed number of patients have had their surgeries put on hold since at least Jan. 17, when the hospital closed its operating rooms and told first responders to rush the critically sick or injured somewhere else.  

North Florida Hospital resumed surgery last week only for “emergency and high-acuity (critically urgent) cases,” and is apologizing for its breakdown that a spokesperson said was caused by an “operational,” primarily “equipment-related” issue.  

Mainstreet Daily News has confirmed the equipment issue involves sterilization and maintenance of surgical instruments and tools. 

Florida’s Agency for Healthcare Administration (AHCA), which regulates medical facilities in the state, told Mainstreet that it is investigating the matter.  

Meanwhile, teams of technicians from a medical support company—sometimes deployed for disaster response—are working to try to help the hospital recover.   

North Florida Hospital has declined Mainstreet’s requests for details of what led to the surgical scheduling chaos or what measures are being taken to restore order.  

“We deeply apologize to everyone who has been affected, and we are working diligently to resolve the issues,” communications director Lauren Lettelier said in a phone interview.  

Last week Mainstreet observed four large trucks at the far edge of the hospital’s rear parking lot, where technicians worked to “repair” surgical tools while couriers delivered more instruments in a continuous stream of golf carts. The trucks featured the logo of Steris Instrument Management Services, a company that operates worldwide in support of healthcare facilities.  

Steris technicians told Mainstreet they were repairing “a lot, probably thousands” of instruments from the hospital.  

The company’s website says it provides a wide range of maintenance and emergency services and is a responder for the Federal Emergency Management Agency (FEMA) in disaster situations. Company representatives declined to discuss particulars of the project at North Florida Hospital, but their technicians on site said repairs of surgical instruments include fixing “pockmarks, scrapes” and other physical flaws. 

Fresh Take Florida, a news service of the University of Florida, cited surgeons at North Florida Hospital who said some instruments had arrived at operating rooms with “blood and tissue” from previous surgery remaining on them. The surgeons, who spoke on condition of anonymity, said at least one operation was called off as a patient was on the operating table.  

Alachua County Fire Rescue Chief Harold Theus said his agency learned of the “unusual event” at North Florida Hospital when it received a Jan. 17 message from the hospital saying “there were procedures they would not be able to perform” because of “sterilization” problems.  

ACFR was told the hospital could not accept “anyone believed to be in need of surgical intervention,” including trauma, heart attack and stroke patients. Ambulances were diverted to UF Health Shands and the Malcolm Randall VA Medical Center instead, Theus said.  

ACFR records do not track how many patients were diverted or whether the diversions affected outcomes.  

“They said they expected the request to last four days,” Theus said, but it was lifted the next day.  

North Florida’s Lettelier said despite the interruption to fire rescue transports, the hospital “would not have turned away” a patient who came to the ER.  

“We never stopped caring for our community,” she said. 

Dr. Aileen Marty, a distinguished professor of infectious disease at Florida International University School of Medicine, called the reported events at North Florida Hospital “disgusting.”  Marty said sterilization machines, called autoclaves, heat surgical instruments to an extremely high temperature, destroying any bacteria or infectious agent that might be on them. Because it is so hot, producing pressurized steam, “the autoclave should destroy any tissue that might remain on an instrument,” Marty said in a phone interview.  

Marty added that instruments should be thoroughly washed and inspected for debris or defects before being sterilized. She said circumstances that led to the hospital’s surgical paralysis apparently represent “a serious breakdown in sterilization protocols.” 

AHCA correspondence manager Shelisa Coleman declined to say exactly what prompted the state agency to become involved or whether complaints had been received from patients or physicians. 

She said AHCA’s findings are made available only after an investigation is concluded. AHCA investigates complaints and performs inspections on behalf of the federal government’s Center for Medicare and Medicaid Services.   

North Florida Hospital is part of HCA, Health Corporation of America, which operates 182 hospitals and is the nation’s largest for-profit chain. According to industry research group Definitive Healthcare, North Florida Hospital, with 510 beds and more than a dozen operating rooms, has the highest net patient revenue among more than 50 facilities HCA owns in Florida.  

Some HCA facilities have come under criticism from doctors, nurses and others who have alleged the company puts profits before patient care. In North Carolina, California and Florida some doctors and nurses have complained that cost cutting to boost profit margins has at times left patients in critical care units without a nurse nearby.  

NBC News reported extensively on that and other criticisms in a series of reports last year, including accusations that HCA had a pattern of transferring patients to hospice care to reduce its in-hospital death rate. Lower mortality rates can increase performance ratings.  

HCA denied the claims in NBC’s reports, calling them “inaccurate,” and insisting that the company’s priority is patients, not profit.  

HCA has also dismissed claims of inadequate staffing levels in its Florida hospitals brought by Service Employees International Union (SEIU). The company characterizes the allegations as normal tactics in labor negotiations.  

Bayonet Point Hospital near Tampa was the object of a state investigation after doctors complained of leaky ceilings, unsanitary surgical instruments, and cockroaches in operating rooms. AHCA inspectors found that Bayonet Point had “failed to provide supervisory oversight” of its operations. The hospital’s CEO resigned but has been retained in an “advisory” position.  

U.S. Sen. Marco Rubio was among Florida lawmakers who asked the company to respond to the criticisms. HCA did, insisting the company is proud of the quality of its patient care.   

North Florida Hospital’s Lettelier said the decision to suspend surgeries there was a “voluntary, proactive” one. She declined to discuss the scope of the work being performed by the technicians from Steris Instrument Management Services and declined to say how many surgeries have been canceled, or when the hospital expects to be back to normal operations. She said hospital staff are working to re-schedule “elective” procedures as quickly as possible.  

Among those rescheduled is Clyde Smith, whose heart condition causes him to have labored breathing and limited mobility. Smith’s heart surgery, scheduled for Jan. 18, was called off the night before. 

“They told me they had an equipment problem,” said Smith, a 71-year-old Gainesville resident. He said he was disappointed that the surgery he had “waited for a long time” was put off until Feb. 13, but added, “I’m glad they told me there was a problem before I got to the operating room.” 

Editor’s note: If you or someone you know has been impacted by, or has information about, the surgical shutdown at HCA Florida North Florida Hospital, please email editor@mainstreetdailynews.com or call 352-313-3192.