Advocate BroMenn Medical Center in Normal will pay a $55,000 fine for not having adequate staff on call at its emergency room last year and failing to follow state rules.
According to notice of violation, settlement agreement, and plan of correction documents from the Illinois Department of Public Health, Advocate BroMenn's emergency room lacked one-hour access to a cardiovascular surgeon for at least 26 days last year.
That 60-minute access window is a requirement of BroMenn's Level II Trauma Center status, according to the IDPH.
In July 2016 a patient requiring heart surgery came to the ER when timely heart surgeon coverage was not available.
"The patient exhibited obvious signs of rapid life-threatening exsanguination into the chest. Despite being seen by a general surgeon with chest surgical privileges, the chest trauma patient was not taken to Respondent's operating room for emergency surgery," according to state documents.
BroMenn sent the patient to a Level I Trauma Center 40 minutes away and the man died from blood loss and shock.
"Secondary transfer by respondent delayed emergency surgery by more than one hour," said the complaint.
The complaint indicates BroMenn could have let emergency responders know it did not have the right kind of doctor available. BroMenn could have asked that the man be taken to another Level II Trauma center with a cardiovascular surgeon available only two miles away. BroMenn was required to tell the IDPH it did not have adequate specialist coverage. Advocate could have also made emergency arrangements for on-call qualified surgeons in the Chicago area to be transported speedily by air to Normal.
Documents indicate none of these things happened.
The original proposed fine from the state was $90,000, but after Advocate BroMenn admitted the allegations and agreed to a corrective action plan, the fine went down to $55,000.
A spokesperson for Advocate BroMenn declined to grant an interview or answer questions such as whether this was an aberration caused by the unexpected unavailability of a qualified surgeon for that period, a purely local institutional policy failure, or corporate common policy to rely on Chicago-area specialists in the absence of a local heart surgeon?
Advocate Vice President of Public Affairs Lisa Lesniak issued this statement via email.
"When this was first brought to our attention, we worked closely with the Department of Public Health to respond to their concerns, which dated back to mid-2016. We resolved the matter, and continue to maintain our Level II Trauma Center designation. The safety of our patients is our top priority and we continue to ensure our emergency department is appropriately staffed to provide the highest quality care in the safest environment," said Lesniak.
The settlement agreement details increased reporting requirements to the state for at least a year, and provides that the firm Cardiothoracic and Vascular Surgical Associates (CTVSA) is contracted with BroMenn to provide 24/7/365 coverage from within the Bloomington-Normal area. It lists the primary doctor and five qualified backups. The agreement also requires that when the covering doctor is in surgery another be designated as on-call. The Emergency Department will also have real time notification when that doctor is performing surgery.
CTVSA is also providing BroMenn a schedule of who will be on call on an annual basis.
BroMenn has also agreed to document all diversions of patients to other trauma centers for the next year and provide those records to the state. And the medical center has agreed to training of all staff on the new on-call schedule management process.
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