JOHNSON CITY, TN (WJHL) – When a Johnson City Medical Center patient fell during a routine procedure last year, it wasn’t the first time a patient fell inside a JCMC operating room.
At our request, Mountain States Health Alliance confirmed one other OR fall within the last five years. The health system would not release specifics of that fall.
“We’ve done hundreds of thousands of procedures in the last five years and yes, you had two situations where a patient fell,” CEO Alan Levine said. “In that case or in this case, the expectation should be the same. We did the investigation, we looked at the details, we tried to learn from it and we shared it.”
As we reported Tuesday, Melba Lowe fell off her stretcher during an endoscopy in July 2016. MSHA said the moderately sedated patient’s side bed rail was down at the time.
The health system said the woman shifted or moved at the end of her procedure and despite multiple people nearby who were “attentive and working appropriately,” the woman still fell. Levine later confirmed the fall coincided with one of the people in the OR taking his or her eyes off of the woman.
In the year since the fall, Levine said the health system has taken steps to make sure history doesn’t repeat itself.
“When a patient comes into a hospital, there’s always a risk,” he said. “We want to get better. We want to be the best.”
JCMC’s two OR falls are two more than Wellmont Health System reported to us in the last five years at any of its operating rooms or endoscopy suites.
“I could sit here all day and list off case after case where a patient came in and the doctor and the nurses performed absolute miracles for those patients and the patients left grateful and thankful for the care they got,” Levine said. “We want that to happen in every case. I wish it did, but it doesn’t.”
In Tennessee, the Tennessee Department of Health and hospitals aren’t required to release information about situations where patients experience an unexpected complication like a fall during a procedure.
While Lowe’s kids hope no other patient has to suffer what their mother went through, Levine said it’s cases like this one that keep him up at night.
“I wish we were perfect,” Levine said. “We’re just going to keep trying and I have enormous confidence in our nurses and our doctors. I believe they want to do the right thing every day.”
MSHA maintains what led to Lowe’s injuries was an “unfortunate accident,” not a mistake. The patient died less than three weeks after her fall. The health system said her death was not related to the fall.
Data collected before the woman’s fall show JCMC performs better than most hospitals across the country when it comes to preventing all types of falls. The Centers for Medicare and Medicaid Services collected the data between 2013 and 2015.
“According to the CMS claims data, JCMC was better than the US average for preventing patient falls,” MSHA Corporate Communications Director Teresa Hicks said. “The average was 0.39 falls per 1,000 patient discharges. JCMC had 0.194 falls per 1,000 patient discharges.”
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