An ongoing federal investigation and construction delays have held up the opening of San Joaquin Community Hospital's much-anticipated cancer center.
The revelations come three months after the hospital hosted a gala and open house complete with an outdoor light show to show off The AIS Cancer Center at San Joaquin Community Hospital.
Hospital officials have previously said the cancer center would begin seeing patients in early 2013, but no one has been treated at the center yet and the facility is now estimated to open mid-year.
Hospital spokesman Jimmy Phillips and a news release cited various impedients including licensing, construction delays and "extensive staff training for the sophisticated equipment and systems" as the reason for the delay.
"Due to the nature of licensing new health care facilities, it is often difficult to project an exact opening date," said the hospital news release.
But the hospital must also right itself with the Centers for Medicare & Medicaid Services, also known as CMS, before the state can license the cancer center.
Not only is the cancer center at stake but, also importantly, San Joaquin's ability to contract with Medicare to treat beneficiaries.
San Joaquin "is currently noncompliant with federal regulations" and the California Department of Public Health will not approve the center until the hospital is in line with state and federal requirements, according to Pam Dickfoss, assistant deputy director for the department's Center for Health Care Quality.
Documents provided by the hospital listed myriad measures the hospital has taken to correct the "deficiencies" identified by inspectors, including greater oversight of the facility by corporate leadership.
One action noted is the corporate chief operating officer taking over as interim hospital CEO until a new leader is hired.
The hospital announced last month that then-CEO Robert J. Beehler would be leaving the hospital for a corporate position with Adventist Health. Hospital board member Scott Reiner stepped in as interim president and CEO.
A complaint triggered the CMS investigation and led to several "surveys" of San Joaquin last year, according to documents provided by CMS and the hospital.
After receiving a complaint, CMS can conduct an inspection of the hospital called a survey. CMS contracts with the California Department of Public Health to conduct surveys.
The surveys of San Joaquin Community Hospital turned up different issues. On their December 2012 visit, which stemmed from the earlier complaint, inspectors dinged the hospital for failing to follow its policy for labeling medication, not ensuring positive air pressure in two catheterization lab rooms and not following policies to keep the proper temperature and humidity levels, among other things.
The survey report said a nurse drew medications into a syringe then left it without a label in an operating room. The report also found fault with open doors in cath lab rooms and inspectors' observation of a doctor leaving an endoscopy room that had just been used wearing clothes meant to be worn once during surgery and going to speak to a patient in a holding area.
"The cumulative effects of these systemic failures resulted in the hospital's inability to ensure a sanitary environment placing patients at risk of being exposed to infectious and communicable diseases," a report from the survey said.
Phillips said the hospital has been diligently working to correct the issues. The plan the hospital submitted to CMS in response to those deficiencies lists the measures the hospital has taken to right itself, ranging from administrators having conversations with the individual staff members referred to in the inspection report to a monthly newsletter called "Bug Bytes" from the hospital's infection control department.
The plan also says the hospital has tapped consultants and hired a director of infection prevention and a vice president of organizational excellence.
Phillips said the hospital is committed to cooperating with CMS.
"We welcome this process because really their job is to ensure patient safety," Phillips said.
On Jan. 31, CMS sent San Joaquin a letter warning that the hospital still was not in compliance with its "Conditions of Participation." The letter cautioned that the hospital's Medicare provider agreement could be terminated by May 3, 2013, if it did not provide "credible documentation" showing that the problems witnessed in a December inspection had been fixed.
On Friday, Rufus Arther, the director of hospital operations for CMS region nine, which includes California, said his San Francisco staff have received San Joaquin's latest plan of correction and accepted it. The next step will be an unannounced "revisit survey" to see if the hospital is following through.
"I think everyone's hopeful that those things that were cited will be corrected," Arther said.
Phillips pointed out that other local hospitals have had survey deficiencies as well. He said San Joaquin has received other accreditations and high marks for care.
"There's a lot of really high quality work being done here," he said.
Phillips said the hospital has not submitted a request to be licensed for the cancer center and wouldn't be ready to even without the hospital's ongoing CMS issues.
"What I know from our team is that today, aside from the CMS issues, we would not be ready to have the state come in and license the cancer center," Phillips said.
Construction snags have added up, Phillips said, citing the most significant building setback as an incident where crews leveling the cancer center's parking lot cut through phone lines and Internet wiring.
The center was also waiting for state authorization to deliver radiation therapy, Phillips said, adding that the hospital secured that approval a little later than anticipated in early February.
Dorsey Griffith, a spokesperson for the UC Davis Comprehensive Cancer Center, said the hold-up hasn't impacted the cancer center's partnership with the academic center's cancer care network.
"We understand that these kinds of delays unfortunately are fairly common," she said. "We're ready to go when they are."