A Denver hospital is taking corrective action after a state report criticized its failure to effectively supervise the patient care and safety standards exercised by a specialty hospital to which it had referred surgeries, two of which resulted in injury or death.

One aspect of the state-mandated, hospital-developed correction plan is closer examination of contracted services through more frequent reviews of medical errors, infection rates and patient responses, say hospital executives.

"Historically, we have relied on the credentials of the partners that we work with," says Jeff Selberg, CEO of Exempla Healthcare, which owns St. Joseph Hospital, the facility cited in the report. "What we learned in this case is that is not enough."

"Our responsibility to patients extends even beyond our four walls, and we accept that responsibility with welcome," says Chief Medical Officer Lisa Kettering, MD. "We have a new standard to reach."

St. Joseph had contracted with the Colorado Orthopaedic and Surgical Hospital — a smaller facility founded in 2008 by 25 surgeons, funded in part by Exempla and the management firm National Surgical Hospitals, and operating out of a building owned by and adjacent to St. Joseph — to send surgeries to the specialty hospital.

In May, a 25-year-old woman undergoing brain shunt valve replacement surgery died at COSH after she was given an incorrect dose of Demerol. According to the state report, released on Sept. 24, the response to her cardiac arrest was hindered when an emergency team from St. Joseph found themselves locked out of the most immediate route to the situation.

In July, a 62-year-old woman who'd had her rotator cuff repaired spent a week ventilated in intensive care and suffered lasting neurological injuries after choking on vomit. While she'd complained of pain and difficulty breathing following surgery, the report says, nursing staff positioned her improperly and neglected to clear her mouth. Malpractice lawsuits have been filed by the families of both patients.

Later that month, the specialty hospital stopped performing surgeries in the wake of an investigation being conducted by the Colorado Department of Public Health and Environment since May. While it reopened for surgery in August, it is now permanently closed for economic reasons, according to published reports.

David Bernard