South Shore emergency room faulted in two cases

After receiving numerous complaints about delays and problems in South Shore Hospital's emergency room, state health officials concluded the hospital erred in only two cases and should not be penalized.

The Department of Public Health report, released yesterday, ends review of a dozen complaints about the pace of care in South Shore's emergency room since last year. It found that emergency room staff at the Weymouth hospital wrongly delayed treatment for two patients with appendicitis earlier this year because they did not monitor the women's pain closely enough, and cited the hospital for one relatively minor violation, dispensing drugs without a written prescription.

Though state officials acknowledged that other patients have had long waits for care at the hospital, they said the responsibility for those delays lay not with the hospital, but the state's broader crisis in emergency room crowding than problems at South Shore.

''They've addressed their process problems," said Paul Dreyer, director of the department's Division of Health Care Quality. ''What no hospital can do on its own is address crowding."

Massachusetts has lost more than one-third of its hospitals with emergency rooms since 1981, leaving the remaining 67 to treat 2.7 million patients a year and causing serious backups during busy periods, such as winter flu season.

South Shore Hospital treats more than 200 patients a day in its emergency room, making it one of the busiest in the state. It is also one of the most complained-about hospitals, accounting for 15 percent of the state's emergency room complaints since January 2003.

Norma Jean Chiulli of Rockland, who waited more than six hours for treatment of what turned out to be a burst appendix, declined to comment on the investigation into her care, saying she had retained a lawyer for a possible lawsuit against the hospital. The other patient, Maura Richards of Milton, who also had appendicitis, could not be reached for comment.

South Shore officials declined to discuss the report but released a statement from Dr. Marvin Lipschutz, senior vice president for clinical affairs, reading, ''We take very seriously our obligation to meet the needs of the patients who make 75,000 visits to our emergency department each year. Our focus remains on providing each one of them with a quality experience."

However, South Shore officials have previously expressed regret over the treatment of Chiulli, who arrived June 1 just after 6 p.m. in an ambulance with a diagnosis of appendicitis.

She finally underwent emergency surgery after 4 the next morning, vomiting repeatedly while she waited.

The 30-page public health report, heavily redacted to protect patient privacy, portrays a hospital besieged by patients on the nights last spring when both Chiulli and Richards were treated.

South Shore medical staff told investigators that all emergency room beds were full on that night, forcing staff to divert ambulances to other hospitals shortly after Chiulli arrived. The triage nurse, whose job is to make sure the sickest patients are cared for promptly, said she was so busy that she was unable to circulate in the waiting room to check on patients.

However, her assistants reported that Chiulli's condition was stable when she was finally assigned a bed at 11:50 p.m.

The hospital made several changes in emergency room policy, based on an internal investigation into Chiulli's care, including increased monitoring of patients in the waiting area and ensuring that a doctor gets all calls about patients who will be arriving by ambulance.

In Richards's case, investigators found that medical staff made no record of how much pain she was in before concluding that she could wait as long as necessary for care when she arrived at 9:28 p.m. on May 18.

Richards was ''pale, clammy, and crying with pain," according to the investigation report, but she did not get pain medication for nearly two hours.

The public health report faulted the hospital for the delay in treating Richards and making her wait before she was transferred out of the post-anesthesia care unit to a less intensive setting.

Richards described her treatment as ''an absolute nightmare" to The Patriot Ledger.

However, just as in the Chiulli case, investigators found that South Shore immediately took steps to prevent similar problems, adopting what the report calls ''a customer service orientation to patient-family care."

As a result, investigators cited the hospital only for dispensing morphine and another drug to the two women without a written prescription.

Hospital officials said at least some of the treatment was based on verbal approval from a physician.

''It's not that we didn't find problems. It's just that the hospital had satisfactorily addressed them by the time we got there," Dreyer said.

Scott Allen can be reached by e-mail at allen@globe.com