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Lab closure forces shutdown of Gouverneur hospital

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GOUVERNEUR — The closure of E.J. Noble Hospital’s lab Friday also prompted the facility to shut down other services, sending its 18 patients to neighboring hospitals.

The decision came after multiple lab deficiencies, which resulted in problems including “a recent blood transfusion error that resulted in a patient receiving the wrong blood type,” according to a state Department of Health order. The incorrect blood transfusion occurred when the lab switched samples while performing testing, an investigation showed.

“I don’t blame a bit the commissioner of health for making the decision he did,” said Dr. Timothy J. Monroe, veterinarian and E.J. Noble Hospital board president. “Most deficiencies that occurred are in supervision and oversight of lab techs, as to their competency and training and continuing education and safety instruction.”

Department of Health spokesman Bill Schwarz said the hospital had been cited in August for severe deficiencies in its lab, including lack of critical supplies and personnel needed to carry out testing, insufficient quality control measures, a number of expired or unsafe supplies and materials, and significant safety concerns, including potential contamination of blood supply.

He said there is not a definitive number of deficiencies a hospital lab can have before it closes; rather, closure decisions are based on the “imminent risk for patients’ health and safety.”

Dr. Monroe said that when the Department of Health became aware on Friday that lab-tested proficiency samples’ results were reported incorrectly, it was “the straw that broke the camel’s back.”

Until Friday, the hospital was working with the department on a plan of correction to address its list of August lab deficiencies. Now, with the lab closed, an additional correction plan will be in place. Medical staff and board members met Saturday to discuss such plans.

E.J. Noble Administrator Charles P. Conole said it’s now the hospital’s top priority to work with state Health Commissioner Dr. Nirav R. Shah on correcting all deficiencies immediately.

“That’s absolutely critical,” Mr. Conole said.

Without a functioning lab, Dr. Monroe said, E.J. Noble cannot provide acute-care or emergency services. People were turned away from the emergency department Friday night. Dr. Monroe said the nursing home component remains open, but lab work for those residents is sent elsewhere.

Dr. Monroe said he met Saturday afternoon with Canton-Potsdam Hospital CEO David B. Acker about the Potsdam hospital possibly managing E.J. Noble’s lab services; E.J. Noble administrators would need to meet with Commissioner Shah regarding reinstating the lab, then get permission from the state Department of Health if they wanted to proceed.

Mr. Conole said he was unaware of any such meeting Saturday with Mr. Acker.

The 18 patients who were uprooted from their E.J. Noble beds were transferred to a nearby facility of their choice. Samaritan Medical Center in Watertown received six of them, according to Samaritan spokeswoman Krista A. Kittle. Two of those patients went to the medical/surgical unit, one to the progressive care unit and three to the alternative level of care unit. The latter three are awaiting nursing home placement somewhere in the north country, Ms. Kittle said.

“These patients are ours now and will be discharged when ready to go,” she said.

River Hospital, Alexandria Bay, received one swing-bed patient, according to CEO Ben Moore III. That person didn’t quite fit into an acute care or nursing home setting, he said.

Claxton-Hepburn Medical Center, Ogdensburg, received two patients, and the remaining nine were sent to Canton-Potsdam, according to Mr. Conole.

A few obstetrician patients were transferred from E.J. Noble to Carthage Area Hospital.

All area hospital CEOs have been understanding and accommodating, Mr. Conole said. Since August’s deficiencies were announced, he said, he has been keeping regular communication with north country hospital administrators, particularly at Canton-Potsdam, Claxton-Hepburn and Samaritan.

Ms. Kittle said Samaritan recently assisted E.J. Noble Hospital with its lab policies and procedures.

E.J. Noble is entitled to a hearing to contest the state’s order outlining deficiencies, which was issued Friday. A hearing is to be held within 30 days of the order at the Department of Health’s Syracuse location.

Another order, also was issued Friday, stated that the state health commissioner ordered the hospital’s operating certificate to be suspended for 30 days; that it had to notify 911 emergency medical services to divert ambulances to other facilities; that it can’t admit new patients through its emergency room or from community physicians; that the hospital must develop and implement a transfer plan for the patients it had, and that all surgeries and procedures were to be canceled.

The hospital may request a hearing within 10 days of that order to see whether the operation of a hospital without clinical lab services poses a danger to the health of current and future E.J. Noble patients.

E.J. Noble also may request that the state perform another inspection to determine whether a specific condition or practice continues to exist. Requests will be met within 10 days. According to the order, “in the event that the previously found condition or practice has been eliminated the suspension shall be withdrawn.”

Mr. Schwarz said that a Department of Health investigation about lab deficiencies is proceeding, and that the department has not yet levied fines on the hospital.

E.J. Noble closed the books on 2011 with a $690,000 loss, primarily because it had to absorb an $800,000 adjustment through Blue Cross/Blue Shield based on an outpatient program that was formatted incorrectly. In 2011, there also was a 9 percent drop in patient admissions.

Dr. Monroe said the lab closure and subsequent loss of revenue from those 18 patients being transferred elsewhere will hurt the hospital. He said he doesn’t expect to see a loss of revenue until about 60 days, after Medicaid and Medicare billing would be finalized.

“I don’t think we’d make up that loss of revenue from patients,” he said.

When the hospital’s financial team returns to work Monday, Mr. Conole said, the administrative staff should at least have a better idea of what the projected loss will be.

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