Lots of money, lots of problems

Public documents show JPS' wealth is growing, while a not-so-public consultant's report depicts a chintzy and blighted public hospital system.

Healthy finances

Net income at JPS Hospital has quadrupled since 2001, and the hospital's investment funds have more than doubled. The nonprofit hospital in 2006 achieved a healthy 16 percent return on equity, the common measure of a hospital's profitability. In comparison, Harris Methodist Fort Worth earned a return on equity in 2006 of 7 percent.

	FY 2001	FY 2002	FY 2003	FY 2004	FY 2005	FY 2006
Net income (in millions)	$17.4	$25.0	$25.0	$45.1	$54.1	$77.7
Investments (in millions)	$112.2	$132.6	$159.5	$111.4	$118.0	$255.0

Source: Medicare cost report information from Cost Report Data Resources and American Hospital Directory

Broken, worn and missing equipment

For a wealthy public hospital, JPS Health Network had a tough time keeping supplies stocked, equipment in one piece and essential services up and running.

Departments ran out of fundamental goods like thermometers, couldn't offer pillows to patients and even struggled to keep enough surgical instruments in circulation, according to reports by Houston-based InSight Advantage last year. JPS administrators say many such problems are resolved as soon as employees bring them to their attention.

These were among the troubles spotted by InSight:

A centrifuge -- equipment that separates blood into its components -- was broken for months.

Washers to sterilize equipment regularly broke down so it had to be carted elsewhere at the hospital.

Some surgical instruments were missing or in disrepair. Nurses sometimes cannibalized parts to make do.

Blankets and sheets in the Short Stay Unit were torn and worn.

Endoscopy equipment to clean scopes broke down up to eight days a month.

Patient beds were broken and mattresses torn in the Correctional Unit for patients from the county jail.

The bone-density scanner at the Family Health Center wasn't properly maintained.

What the documents say

JPS paid more than $650,000 for Houston-based consultant InSight Advantage to assess operations of various facets of the public healthcare system. The nearly 600-page report, recently obtained by the Star-Telegram, details staffing issues, systemic delays and barriers to access, management bunglings, and critical shortcomings in equipment and processes.

During observations, the Rapid Assessment room was over-crowded with patients waiting hours in uncomfortable chairs for their turn to be moved to a treatment area. The environment was less than humane -- uncomfortable, hot and reeking. Patient privacy was not even remotely possible due to the close nature of the patients. The working conditions for the staff are difficult to say the least.

4. Inadequate Supplies in OR's

Finding: In preparing for cases, CST [certified scrub technicians] and CRN [circulating registered nurses] are constantly in and out of OR room running to retrieve necessary supplies and equipment. During cases the RN is frequently leaving the room to obtain items the NA's [nursing assistants] are either unavailable or not familiar with what is needed. This is an unsafe practice.

14. EVS Issues

Finding: On more than one occasion the CST and RN Staff were opening packs for the next case and have found blood, bone and fat globules on the floor, walls, under carts, under the table and stuck to the wheels of the carts. The cost of having to close, re-clean and sterilize unused opened packs and clean the room again is high. If the cleaning problems go unnoticed and the surgery proceeds the risk of infection is greater. Some CST's believe that the EVS [Environmental Services] Staff is so poor that they should be fired and the OR Staff should be cleaning the room. Environmental Services has no ownership in the OR cleaning process, nor do they understand the need to complete this process quickly.

13. Finding: Where is the Caring and Compassion?

Most staff interviewed explained they work at JPS ED [emergency department] because they like working with the patient population; however, during visits to the ED, staff appeared robotic almost hardened to the patients needs. In general, staff seemed accepting of the long wait times, lack of communication and uncomfortable physical environment such as the Rapid Assessment area. A walk through the halls at any point in time revealed patients lacking basic necessities such as pillows or coverings, and complaining about the lack of information from staff and providers. There appears to be an overall lack of caring and compassion and, at times, outright rudeness to patients.