Staffing problems at a Prospect-owned hospital in Connecticut are affecting patients and practitioners, according to the hospital’s nursing and technicians union.
The concerns at Waterbury Hospital — one of three hospitals in Connecticut owned by the private equity firm Prospect Medical Holdings — continue after unannounced inspections last year found a staffing shortfall at the hospital’s emergency department.
Public records obtained by Connecticut Public stated the department was understaffed by between one and four registered nurses on 80% of the reviewed shifts in October and November.
Union officials say those staffing problems continue this year, even after a state law was passed in 2023 to try to fix the problem of staff-to-patient ratios at hospitals statewide.
In a statement, Waterbury Hospital said it continues to work to recruit nurses despite national shortages. It says “providing safe, quality patient care is our top priority” and that the hospital remains in compliance with state and federal care guidelines.
Private equity and persistent problems at Prospect
As Connecticut Public has reported, state investigations at two Prospect-owned hospitals in Connecticut, including Waterbury, unearthed a pattern of alleged patient abuse and a failure by hospital staff to conduct timely investigations in accordance with hospital policy.
A sale of the three Prospect-owned hospitals in Connecticut — Rockville General, Manchester Memorial and Waterbury Hospital — to Yale New Haven Health is also currently in jeopardy.
In May, Yale sued Prospect alleging mismanagement. Prospect countersued, saying Yale was breaching its contract on the $435 million deal.
The multimillion-dollar deal has caught the attention of lawmakers. In September, U.S. Sen. Chris Murphy told members of the Senate Health, Education, Labor, and Pensions Committee that private equity firms like Prospect are cutting staff and gutting services at hospitals to boost profits.
“Are you making money for the purpose of providing good health care or are you making money for the purpose of making the owners filthy rich?” Murphy said.
‘I was hopeful’
State law mandates hospitals formulate staffing committees to ensure each unit has a healthy ratio of patients to nurses or medical assistants. The staffing committee is evenly split between hospital administrators and nurses, but nurses get a "plus-one" vote. In a union hospital like Waterbury, the union selects the nurses on the committee.
In July, the administration and nurses at Waterbury Hospital met to hammer out a new agreement on staff-to-patient ratios and a plan was agreed upon.
Staff at the hospital were optimistic.
“It was a unanimous vote in favor of the plan, and I was hopeful that staffing would get better at that point,” said Edmund Gadomski, executive secretary at the Connecticut Health Care Associates District 1199.
But Gadomski says the hospital is “not complying with the staffing plan submitted and that is leaving the staff short staffed and working in a dangerous work environment on a daily basis.”
In a statement, the hospital said “any issues that are self-identified or noted by the Department of Public Health (DPH) are immediately addressed.”
“We continue to work with our unions and our regulators to meet all regulatory requirements,” the hospital said.
Medications not administered on time, not documented
Medication administration and documentation were also a problem at Waterbury Hospital, according to records obtained by Connecticut Public of unannounced state inspections of the hospital in 2023.
One nurse said she was unable to administer on Aug. 7 an intravenous antibiotic to a patient whose palm fell onto nails because “she was busy.”
That same patient, who was diabetic, also lacked documentation of proper blood-glucose monitoring, public records showed.
In a response to DPH investigators, the hospital on Aug. 8 said it provided education on dose timing to all nursing staff, and supplied a posted reference chart to each of the nursing units as a job aide.
One shift per day was also assigned to complete verification of the medication administration record to the physician’s orders. And the pharmacy and nursing unit would no longer accept medication orders if they were not complete or compliant with the guidance that was put in place, the hospital said.
‘The danger of a medical error occurring’
Gadomski, with the hospital’s nursing and technicians union, said when staff is stretched thin, problems can develop.
“If you’re working short staffed it certainly increases the danger of a medical error occurring and that’s what we’re trying to avoid,” Gadomski said.
He said the shortage — also comprising patient care assistants — persists across departments at Waterbury Hospital, including at a unit where patients need continuous cardiac monitoring.
A complaint by the union has been pending with the state Department of Public Health (DPH) since January and Gadomski said DPH officials have been on-site at the hospital on a regular basis.
Chris Boyle, a spokesperson for the DPH, said the agency “does not release any details regarding open investigations.”
‘These small hospitals can’t survive on their own’
Dr. David Hill, a pulmonary critical care physician on staff at Waterbury Hospital, who also serves as chair of the local leadership board for the hospital, attributed the hospital’s staffing challenges in part to cash flow problems, for which he said lawmakers bear responsibility.
“We have a high burden of Medicaid patients. The state has not increased reimbursement for Medicaid patients to hospitals in over fifteen years,” he said.
“The challenges we face, some of that may be put on Prospect, but a lot of this is on the state of Connecticut. We're a very wealthy state, and we're underfunding health care for the people who need it the most, and these small hospitals can't survive on their own.”
Waterbury’s median household income is $48,787, compared to $83,572 statewide, according to data from Data Haven.
Hospitals were reimbursed 62 cents for every dollar they spent on a patient insured by Medicaid in 2022, according to the Office of Health Strategy.
And then there’s the ongoing struggle of finding enough nurses.
It’s a crisis that has hit hospitals across America in the wake of the COVID-19 pandemic.
In a statement, Waterbury Hospital acknowledged the ongoing nursing shortages, but said, “despite this challenge, we continue to actively and successfully recruit nurses and staff, with new employees joining our team every month.”
Gadomski agreed. But said the problem is that they leave.
“Many of the nurses come in, unfortunately see what's going on and leave,” he said. “There's got to be a plan in place for retention, not just for drawing in nurses.”
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Pattern of alleged abuse emerges following state inspections at 2 Prospect-owned CT hospitals
