Surgeons: HCA North Florida Hospital ‘dirty instruments’ issue dates back a year

For at least a year, surgeons at HCA Florida North Florida Hospital in Gainesville battled the problem of “dirty” instruments being delivered to operating rooms and pleaded with administrators to fix it. Doctors vented their “disgust” over the “festering” problem in an extraordinary, early morning meeting with administration on Jan. 10.

One week later the hospital suspended all surgeries. A long-simmering crisis had boiled over.

Emails obtained by Mainstreet Daily News show a reeling hospital administration that launched a “blitz” response to try to recover from a debacle that, one doctor said, “has damaged their reputation and mine, in the process.”

State and federal regulators are investigating the hospital where elective surgeries were suspended for at least three weeks and have resumed at half of their previous volume—if that. Mainstreet previously reported that internal emails showed the hospital planned to restart elective surgeries on Feb. 9, but HCA has declined to confirm whether that actually occurred.

The hospital is now also rushing to complete construction of a new “temporary” facility to handle the washing and sterilization of its surgical instruments.

An orthopedic surgeon and another surgeon who has operated at several other HCA Healthcare hospitals told Mainstreet the company embraces a “corporate culture” that “puts profits before patients.”

A surgeon told Mainstreet that, in the time leading up to the “unprecedented” action of the surgery suspension on Jan. 17, it was not uncommon for operations to be delayed when instruments with human remains on them from an earlier surgery were brought to a surgical suite. A neurosurgeon likened the improperly cleaned instruments to “dirty dishes, allowed to stack up on the kitchen counter. Stuff hardens on them.”

Mainstreet interviewed a dozen doctors, hospital staff, medical practice staff and others, most of whom spoke on the condition of anonymity for fear of reprisals.

“We have been threatened not to talk about this with anyone, especially you,” said one surgical practice administrator of many years. “If we can’t operate, we can’t survive. And they decide who gets to operate.”

A cardiologist said surgeons were increasingly “up in arms” in the weeks leading up to the closure of operating rooms.

North Florida Hospital and its parent company, HCA Healthcare, Inc., have issued two statements to inquiring media over the last month, revealing only that surgeries were suspended due to an “operational” issue that was primarily “equipment” related. The company has insisted that the “well-being” of patients is its highest priority.  

But more than a month after the surgery shutdown began, the hospital’s homepage and newsroom page still make no mention of the surgery delays. Communications staff and hospital leadership have not answered Mainstreet’s repeated requests for additional information, including how many surgeries were derailed and details of what led to the crisis.

A trove of newly obtained emails sheds light on what transpired in January. After months of increasingly urgent entreaties from surgeons and others, HCA North Florida CEO Eric Lawson called a 6:30 a.m. meeting with doctors and other hospital administrators on Jan. 10.

More than 50 surgeons attended the meeting, which was assembled on less than two days’ notice. Surgeons told hospital bosses they were “fed up” with their concerns being ignored. In a show of hands, they expressed no confidence in the hospital’s administration, according to a doctor who was present. 

Hospital administrators moved quickly to try to quell the uprising. Dr. Sherrie Somers, the hospital’s chief medical officer, was contrite in a Jan. 12 email addressed to “Surgical colleagues.”

“We hear loud and clear that you have been promised improvements for 6-12 months,” she wrote. She said the administration was appreciative of the doctors’ “candid” conversations in the Jan. 10 meeting.

Somers said a review to identify the “root” cause of the surgical woes determined there were “leadership, people and process problems.” She said a variety of corrective measures were taken, including “executive leadership changes.” 

Multiple sources have told Mainstreet that North Florida Hospital removed its vice president for surgical operations, Patty Gursky. Gursky has not responded to voicemail messages seeking comment, and HCA has not responded to Mainstreet’s inquiry about her status.

“I spoke to her [Gursky] almost every day for weeks, trying to get the tools I needed to do my job,” a surgeon told Mainstreet.

One doctor said he views Gursky as a “scapegoat” for upper management that, he said, failed to properly fund the hospital’s sterile processing department (SPD).

“Over time, they replaced qualified, experienced SPD people with less expensive—some of them untrained—technicians,” the doctor said. “And there weren’t enough of those they had.”

Another doctor told Mainstreet, “It’s hard to fix stupid.” The surgeon said that administrators cut costs to boost their performance bonuses: “They cheaped out and benefited financially from it.”

The doctor said he believes the cure for North Florida’s unclean surgical instruments is a housecleaning in management.

“They have to go away,” he said. “The hospital is not going to be fixed by the people who broke it.”

In her Jan. 12 email, Somers, who became the medical chief last August, referenced an operating room “action plan” to deal with the crisis, saying the “best course of action is to stay open” for surgeries. But the hospital reversed that course just days later, shuttering its operating rooms and canceling all surgeries scheduled for the coming weeks.

As Mainstreet reported on Feb. 5, the hospital called in the medical cavalry, enlisting the help of pros from Ireland-based Steris Corporation. Steris is a medical device and services company with operations worldwide and is an approved disaster response provider for FEMA, the Federal Emergency Management Agency. 

Mainstreet photographed multiple Steris Instrument Management Services trucks at HCA North Florida soon after surgeries were halted. Workers ferried golf cart-sized loads of instruments back and forth between the trucks and the hospital. Steris technicians told Mainstreet they were cleaning and repairing “probably thousands” of medical instruments and tools that had “pockmarks, scrapes” and other physical flaws.

In her Jan. 12 email, Somers said Steris Corporation “educators” and “supervisors” would “train existing staff” in how to do their jobs and to “assure correct processes”—confirming what doctors described as untrained staff in the sterile processing department.

Somers wrote that a “Steris Blitz” team would sterilize a “backlog” of uncleaned medical instruments. The hospital, she said, also asked its parent company, HCA Healthcare, to send in additional SPD technicians to aid in the recovery. Contract, or “traveling,” SPD techs were also approved.

Two days, later, Somers acknowledged the problems were worse than they realized.

“We discovered additional layers of vulnerability and have worked diligently to change our processes,” Somers wrote to “Surgical Colleagues” in a “high priority” email on Sunday, Jan. 14. Among the discoveries: “Rusted instruments were more severe than anticipated.”

Among other things, the email noted a lack of best practices, absence of a water softener, and “temperature issues” with equipment in the cardiovascular sterilizing room “because of a broken valve.” 

Dr. Aileen Marty, a distinguished professor of infectious disease at Florida International University, told Mainstreet that extremely hot steam, under pressure, is required to properly sterilize surgical instruments. She said a complete cessation of surgeries could be prompted by “an unexpected or inordinate number” of infections. 

Doctors at North Florida Hospital told Mainstreet they were unaware of any increase in infections and that sterilizing devices—called autoclaves—should neutralize any infectious agent, “even tissue,” that might remain on instruments.

Internal emails repeatedly referred to “bio-burden” found on ostensibly sanitized surgical instruments. A surgeon told Mainstreet that “bio-burden” is the “sanitized” term the hospital took to using for “blood or other tissue.” 

In her Jan. 12 email, Somers said instrument trays headed for heart and spine surgeries appeared to be “experiencing the highest degree of bio-burden.” 

Somers wrote that the hospital was evaluating “staffing levels,” which every doctor who spoke to Mainstreet cited as their chief concern.

Along with bio-burden, some doctors and patients have been burdened by long drives and overnight hotel stays as surgeries that would have been performed at the stricken Gainesville hospital are instead moved to HCA’s hospitals in Ocala and Lake City. A doctor said the company has offered to “let us do our surgeries there, to keep their business in house,” while the logjam waits to clear in Gainesville.

Surgeons told Mainstreet that HCA Healthcare in general—and in recent years North Florida Hospital—has “cut corners” to improve profitability. One said Gainesville administrators “were asleep at the wheel” as “soiled instruments stacked up,” amid a cacophony of consistent complaints. 

“It’s not new. It was a festering problem that should have been addressed a year and a half ago, maybe two years ago,” the surgeon said. He said Somers, the chief medical officer, is a “good person, a good doctor,” but not “qualified for her position.” The surgeon said Somers is an internist—not a surgeon—in a role “outside her sphere of knowledge and experience, doing the best she can with the support she has.”

Reached by phone in early February, Somers would not take questions: “You know you should not be calling this number.” 

One orthopedic surgeon said he feels HCA eagerly invests in expansion projects that increase revenue, but the company sees “nothing sexy about building on to its sterile processing department. It’s not a sexy remodel.”

The remodel, in unfinished wood, is happening now. Crews recently constructed a “temporary” central sterile processing department “almost overnight” outside the hospital, a surgeon said. A hospital staffer said the temporary operation will take over while the existing sterilization facility is “totally ripped out and redone.”

As Mainstreet reported on Feb. 5, Florida’s Agency for Health Care Administration (AHCA) is investigating events and circumstances before and after the Gainesville hospital was forced to put down its scalpels. AHCA spokesperson Brock Juarez told Mainstreet that agency personnel were on the ground at the hospital Feb. 6. He said agency rules won’t let him say how long they were at the hospital or provide further details on how the investigation is being conducted. 

Juarez said AHCA’s preliminary report to the federal government’s Center for Medicare and Medicaid Services (CMS) could be completed as early as this week and would then be public.

CMS regulates facilities that get Medicare and Medicaid money and can cut off that lucrative revenue stream if violations warrant. For example, this month the agency told HCA’s Mission Hospital in Asheville, North Carolina, that it will be decertified by the end of February if six major areas of deficiency were not corrected.

Lawson, who assumed his post in 2018, would not discuss the investigation, or his hospital’s ongoing travails, when approached by a Mainstreet reporter on Feb. 7.

In a Jan. 18 internal email addressed to “Dear colleagues,” Lawson alerted doctors that a news outlet—WUFT/Fresh Take Florida—was asking questions about the “matter that we are proactively addressing.”

The email was met with derision by some doctors.

“There was nothing ‘proactive’ about it. They did it because they had no choice,” an orthopedist said. “I would like for them to accept their responsibility in this. I would like for them to acknowledge that they’re accountable.”

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.