Patient's death shows hospital lapses

After a man's heart stops following knee surgery, investigators find many violations

LOUISBURG -- William Bobbitt Paschall was a bad candidate for surgery, particularly given the poor care that investigators say awaited him at Franklin Regional Medical Center.

On the morning in December when he was admitted for elective knee surgery, Paschall, 76, had more pressing health problems: chest pain, shortness of breath and numbness in his left arm.

Paschall's symptoms suggested a severe heart condition, but doctors went ahead with the knee replacement anyway, according to his medical records and a federal investigation. The doctor who assumed care of Paschall after the operation said the surgical team did not inform him of Paschall's chest pains. The next day, the lab and nurses acted slowly to report a critical blood test showing he was on the verge of heart failure.

Paschall's heart stopped before doctors got the test results.

His death has led to three federal investigations at Franklin Regional. Beyond Paschall's case, investigators found that the hospital violated dozens of federal standards designed to keep patients safe.

According to two federal investigations, nurses and doctors failed to record critical medical information. The hospital allowed nurse anesthetists to work without required supervision. The third, as yet unpublished, investigation has found problems with the hospital's pharmaceutical and respiratory services, according to the Centers for Medicare and Medicaid Services in Atlanta.

Last week, federal regulators said they plan to take the rare action of cutting off the hospital's Medicaid and Medicare funding June 22.

The first investigation in March found an immediate and serious threat to patients' safety, said Jeff Horton, the acting director of the N.C. Division of Health Service Regulation. Conditions at the hospital posed a high risk of hurting patients, Horton said.

"That's very serious," he said.

The first two investigations and interviews show a hospital that kept poor track of patients' conditions and, in Paschall's case, allowed serious complications to go unreported and unnoticed.

Al Sayles, a Louisburg doctor and critic of the hospital, resigned his privileges in 2006 after citing what he described as a decline in patients' care.

"I got to the point I was constantly angry with the hospital, and how it was run," said Sayles, who first practiced at Franklin Regional in 1989. "Administration attempts to increase profit margins often resulted in short staffing, and it became a real effort to manage patients in the hospital."

The investigations have hurt Franklin Regional's attempt to relocate closer to Wake County.

Franklin Regional is a for-profit hospital owned since 1986 by Health Management Associates of Naples, Fla. Over a two-month period, Mike McNair, Franklin Regional's chief executive officer, declined requests for interviews to discuss the federal findings.

McNair issued a three-paragraph statement that said, in part:

"The committed staff of Franklin Regional Medical Center continues to work with CMS on our corrective action plans for quality service here at FRMC. We will continue to work diligently to satisfy their requirements. ... The hard work of our staff and physicians in addressing these concerns will assure that Franklin Regional continues to maintain the best care for our patients."

This report is based on interviews, medical records and federal reports.

Pills for chest pain

Except for a stint in the Army, William Paschall lived his entire life in Henderson, working as an electrician and maintenance man. On Dec. 4, he went to Franklin Regional for a pre-surgery evaluation that noted significant heart and lung problems. His surgeon obtained clearance for surgery from two of Paschall's doctors, including his cardiologist.