Complaint about patient safety, staffing at Erlanger NICU sparks review

Officials blame backlash on contract change

File photo by John Rawlston/Chattanooga Times Free Press - A nurse checks on an infant in the NICU unit at Erlanger Medical Center in this file photo.

An anonymous complaint alleging patient safety, staffing and other facility problems at the Children's Hospital at Erlanger's Neonatal Intensive Care Unit has prompted reviews by the state and a national regulatory agency that oversees hospital accreditation.

The complaint accused hospital administration of ignoring NICU staff concerns that ranged from medication and lab errors to missed feedings and infection control, attributing most of the problems to an overworked nursing staff.

Erlanger officials said both agencies found the allegations "unsubstantiated." However, they cannot release the accreditation and state survey documents because they are protected by the Tennessee Patient Safety & Quality Improvement Act.

Currently, the NICU nursing staff is employed by Erlanger, while Pediatrix Medical Group supplies eight neonatologists, 20 neonatal nurse practitioners and two administrative staff. But Pediatrix's nearly 20-year contract with Erlanger expires Dec. 3.

Don Mueller, CEO of Children's Hospital at Erlanger, said he "expected backlash" when the contract wasn't renewed, and the complaint was likely filed out of spite.

"The basis for this letter, first of all, isn't true, and none of these allegations are true," Mueller said. "It hurts me to know that someone is acting out because they weren't chosen to stay as the vendor. They are choosing to create this big issue."

He emphasized that the change hasn't affected quality of care within the hospital.

Jennifer Gutierrez, a spokeswoman for Pediatrix's parent company MEDNAX, said the company had no knowledge of the complaint.

"We have clearly directed our employees not to disparage Erlanger or comment to anyone concerning their decision to end the relationship," Gutierrez said in an email.

On June 11, Erlanger announced the Children's Hospital at Vanderbilt will take over management of the main campus and Erlanger East NICUs starting Dec. 4. Pediatrix and one other group also vied for the contract.

"It is good business practice to every once in awhile look around to see what your other opportunities may be," Mueller said, adding that Vanderbilt was chosen after careful consideration by a multidisciplinary team.

Vanderbilt will provide the medical director and director of nursing, and Erlanger will employ the physicians and nurse practitioners.

"The Vanderbilt opportunity is much more aligned with the way we want to practice in the future - they're an educational institution, we have a clinical affiliation agreement with them, they have teaching models," he said. "The change will be very positive for the kids of this community."

Erlanger officials did not provide details of the new contract, but said it cost "substantially less" than the one with Pediatrix.

Complicating the matter, Mueller said, is that noncompete clauses prevent Erlanger from hiring the employees who work under the current contract - meaning all of the doctors and nurse practitioners currently working in the unit will no longer be allowed to practice in Chattanooga.

"These people are mad. They're upset they have to move. Their lives are changed, and it's not because of us," Mueller said. "We would hire them tomorrow, if they wanted to stay, if they could get out of their noncompetes, and I've told them that."

Gutierrez said that although no financial terms were offered, allowing Erlanger to buy out the noncompetes was "not in the best interest of the providers or the National Medical Group." The company is making "every effort" to place providers within its other practices across the United States, she said.

At last week's board meeting, Erlanger CFO Britt Tabor informed trustees that the period from July to September 2018 was "one of the highest level of NICU days that we've had in a long time and we're still seeing that actually roll into the October month."

He said staffing a full NICU can get "very complicated, because those are specialty nurses."

Contact staff writer Elizabeth Fite at or 423-757-6673.