Today, the Department of Health released its findings and issued a $300,000 fine to Rhode Island Hospital in connection with an incident that occurred in August, when a small piece of a drill bit was inadvertently left in a patient's wound after surgery. In addition, we recently reported another incident that occurred in July, when a foreign object was retained in a patient's wound following a surgical procedure. That case is currently being investigated. We also learned today that the Center for Medicare and Medicaid Services has asked Health to conduct a full survey of our hospital to ensure that we are in full compliance with Medicare rules and regulations.
We take these findings extremely seriously. As president and CEO of this hospital, and as a surgeon myself, I have made patient safety central to my personal and institutional vision for Rhode Island Hospital since I arrived two years ago.
There is absolutely nothing more important to us, and no issue we consider more critical, than the safety and well being of our patients. We have made aggressive efforts to put the strongest, most effective policies in place to eliminate medical errors. But if we fail to adhere to these policies 100 percent of the time - we are falling short. And that is unacceptable and frustrating.
It is unacceptable and frustrating precisely because we have a team of highly skilled, highly dedicated surgeons, peri-operative staff, medical leaders and management teams that are profoundly committed to quality and patient safety. Therefore, any error is not only disheartening and harmful to the patient, but extremely damaging to the morale of an excellent hospital staff and detrimental to the public's perception of our hospital. Thankfully, none of the incidents we have reported at Rhode Island Hospital over the past few years have been life threatening, or resulted in lasting harm to a patient.
In its investigation, Health cited "numerous staff reports" of incorrect surgical counts or other deviations from our stated policies and procedures. It's important to realize that we have been actively encouraging, indeed urging staff members to speak up about any safety issue, no matter how small - even those that have no consequences for patients. The number of staff who feel free to speak up and report any deviation from standard safety procedure is a good sign - a step toward the kind of transparency and collective accountability that we are seeking.
In the meantime: in the wake of today's findings, we have assigned a team of people to understand all of the issues they have raised and provide a detailed assessment of how we can address those issues.
Everything is on the table in our review: how surgical teams are structured, lines of communication and accountability, leadership, frequency and type of training, ramifications for not following procedures, etc.
The bottom line is that mistakes like this should never happen. Even though we know that medical errors occur at all hospitals across this country, each one contributes to an erosion of the essential trust between a patient and their hospital. We have apologized to the patients in question, but I extend my personal and profound apologies to those patients and their families. As President and CEO, I take full and personal responsibility for directing a team of senior leaders and charging them with identifying and resolving the challenges that still exist, creating a plan of action aimed at rebuilding trust, eliminating all medical errors, and ensuring that our patients receive the highest quality and safest care available anywhere.
I have been a surgeon and an executive at several, nationally prominent hospitals over my 25 year career and the quality of care we deliver to our community here at Rhode Island Hospital is as good, if not better, than any place that I have ever worked.
Learn more: Patient Safety Efforts at Rhode Island Hospital