Enloe watch

Mike Wiltermood expected his second week on the job as Enloe Medical Center’s chief operating officer to be another get-acquainted session, he was in for a big surprise.

First, the new second-in-command learned that his boss, CEO Debi Yancer, had been injured in an accident in San Diego and was laid up in a San Diego hospital. She was reachable by phone, but moment-to-moment he—the brand-new guy—was in charge of the place.

Then, as the week began on Monday, Aug. 6, a team of 10 state inspectors descended on the hospital to do a four-day top-to-bottom exam, looking for problems. This was the second time the Department of Public Health (formerly Health Services) had surveyed the hospital. In April, two inspectors (a doctor and a nurse) examined six of the 23 conditions of participation in the Medicare program; this time around the team examined all 23 of the conditions—that is, just about every aspect of the hospital’s functioning.

At stake was nothing less than the hospital’s continued participation in Medicare, which accounts for half the hospital’s income. When a hospital loses its Medicare privileges, it ceases to be able to operate. And the earlier visit had left Enloe—already battered because of some recent, unexplained operating-table deaths—with a badly blackened eye.

Wiltermood can smile about it now. Unlike the earlier inspection, this one found—at least in its preliminary, verbal report— no problems that jeopardized patients. While it found shortcomings in seven areas, they were “largely administrative issues that we can fix very quickly—a good sign,” he said. One involved medical certification for dieticians, another a contract with the company that harvests organs for donation. Some of the problems have already been corrected, he said.

In addition, the inspectors found that all of the problems noted during the April survey had been rectified.

While the inspection was taking place, Wiltermood was busy making sure that everyone in the hospital was responding appropriately to the team’s presence. Yancer has stressed that such inspections are helpful to the hospital and should be welcomed, and Wiltermood said he did his best to make sure everybody remembered her instruction.

After the April inspection, Yancer put a comprehensive correction plan in place, so by the time this inspection began, “people were very well prepared,” Wiltermood explained.

Perhaps the most serious problem concerned some pediatric nurses. Four of five interviewed were not able to calculate quickly enough the correct medicine dosage called for in a certain potentially fatal emergency, or “code,” situation.

Pediatric codes are extremely rare at Enloe, Wiltermood said, which may explain why the nurses didn’t know or remember the dosage. That said, they need to remember such things, and the hospital immediately introduced increased training for them, he added.

It is also planning to increase the number of nurses who have received pediatric advanced-life-support certification.

Wiltermood said he expects the hospital to get a written report this week or next. Enloe will develop a correction plan in response to the report, and another DPH team will make an unannounced visit sometime in the future to check up on it. In the meantime, the hospital will remain on its probationary status.

Yancer has returned from San Diego and is staying at Enloe’s Rehabilitation Center, though efforts are being made to enable her to move back into her home. She’s in close touch by phone—and in fact made regular calls from San Diego while the inspection was going on. “The fact that she wasn’t letting being in the hospital deter her sent a strong message [to the staff],” Wiltermood said.

For his part, the inspection was definitely a challenge, but it had the side benefit of enabling him to work closely and intensely with his management team, having what he called a “bonding experience.”

Wiltermood previously worked at Fremont-Rideout Hospital in Yuba City. He, his wife and 12-year-old daughter are living in an apartment here until their home sells (they also have two adult children), but they’re happy to be in Chico, he said.