Patients at Hawaii Medical Centers East and West could face a serious risk of injury to their health if patient care continues to significantly decline or to be materially compromised, a court-appointed watchdog has warned.

Questionable sterilization practices in surgery, waits of up to an hour for nurses to respond to calls for help, and insufficient nurse and staff backup for recovering post-surgical patients were among the problems reported.

Also cited was the hospitals' turning away dialysis patients who show up at the emergency department because they fail to receive adequate reimbursements, but the practice of having a cap on the number of dialysis patients ceased as of Oct. 30.

Patient care ombudsman Dianne Okumura, who reports to a judge about the quality of care, filed the report Friday with the U.S. Bankruptcy Court in Honolulu.

Hawaii Medical Center LLC filed for Chapter 11 bankruptcy reorganization on Aug. 29 to prevent closure of its two hospitals. The hospitals are owned by CHA Hawaii/Hawaii Physician Group.

The ombudsman made several unannounced visits at various times of day to the facilities in October and November.

She found that nurses take 30 minutes to an hour to respond to patients' call bells or when relatives ask for a nurse's assistance.

The report said that on occasion, the staff in specialty units lacked the required qualifications or experience in their settings.

A lack of a sufficient supply of equipment was the cause of questionable sterilization of instruments, the report alleges.

Post-surgical patients in recovery after hours were put in the Intensive Care Unit with one recovery nurse and ICU staff backup, which the staff indicated was not up to national standards, the report said.

Salim Hasham, chief implementation officer of Hawaii Medical Center, responded with a written statement: “;We are fully cooperating with the ombudsman and, once we have fully evaluated the concerns identified in her report, we will file an appropriate response in court. At this point, we can say we are confident that our patients have not experienced undue risk.”;

Hasham added these specifics:

» When dialysis patients have been treated in the emergency rooms, they have consistently received full and appropriate treatment.

» Long waits by patients after calling a nurse are not typical, and their frequency is similar to conditions at other hospitals. “;Nonetheless, we are improving the experience of our patients in this regard,”; he said.

» Patients consistently receive appropriate specialty services based on their need, and staff members are appropriately oriented to the units in which they work.

» HMC consistently takes measures to ensure patient safety in light of the complexity of care they require and to meet all national standards.

“;We follow strict infection-control practices in all our operations, including surgery,”; Hasham said. “;HMC recognizes the need to increase our equipment purchases and has taken measures to do so.”;