The CEO of St. Christopher’s Hospital lives in Tennessee. After inspectors found serious safety lapses, he must be in Philadelphia five days a week.

The CEO of St. Christopher’s Hospital for Children has pledged to show up five days a week at the North Philadelphia hospital after state inspectors said poor leadership was contributing to a litany of potential threats to patients’ safety.

CEO Donald Mueller was hired in July 2020 to lead the financially challenged hospital serving some of Philadelphia’s most impoverished children. Until recently, he worked much of the week from his home outside Chattanooga, Tenn., where he lives with his wife and school-age children.

A spokesperson for St. Christopher’s said Mueller now works at the hospital five days a week, but declined to provide details or make him available for an interview in person or by phone.

The hospital declined to answer any questions from The Inquirer, such as whether Mueller plans to move to Philadelphia permanently or how often he visited before the state’s inspection in January.

The Inquirer’s public records search found that Mueller bought a house in Tennessee in December 2020, just months after starting his job in Philadelphia. As of late June, his profile on LinkedIn listed his job location as hybrid, though it’s since been updated to Philadelphia.

St. Christopher’s needs on-the-ground leadership, its administrators and inspectors decided, after the hospital was put in “immediate jeopardy” — the highest warning inspectors can give — over safety lapses that could have compromised the hospital’s ability to serve patients. That red flag has since been removed.

Mueller is now expected to meet weekly with the chief operating officer for the hospital’s owner, Tower Health, and submit regular reports on quality and safety to Tower’s leadership, according to the plan established in January to address the inspection report.

“St. Christopher’s Hospital for Children’s top priority is always the safety of its patients, their families and its employees,” Paul Healy, a spokesperson for St. Christopher’s, said in an emailed statement.

Whether a hospital CEO’s residency matters is an evolving debate coming out of a pandemic that made remote work routine for people with desk jobs, but required health-care workers to show up on the front lines. Some health-care analysts argue that it shouldn’t matter where a CEO lives, if they’re meeting financial and operational expectations. Others say hospital leaders must be close to their patients to fully deliver in the business of caring for people.

Even St. Christopher’s staff and patients are divided. Some families interviewed by The Inquirer were upset to learn that Mueller lived 750 miles away, while others didn’t care, so long as St. Christopher’s remained a part of the community.

The hospital is a vital part of the neighborhoods it serves, where families experience high rates of childhood asthma, obesity and behavioral health issues, and often have few other places to turn for care. Many parents who bring their kids to St. Christopher’s went there themselves as children and count on it for safe, high-quality care.

“The leader of St. Chris should be someone who knows the area, knows the struggles that people of different income levels may go through,” said Melinda Cleveland, a retired city dispatcher who has lived in North Philadelphia for decades and brings her foster son to St. Christopher’s.

Questions about Mueller’s whereabouts and leadership came to light after the hospital reported a child abduction at the beginning of January.

A 2-month-old was admitted to the neonatal intensive care unit for a head injury. Hospitals are required to report such events to the state Department of Human Services and keep the child on site until DHS can investigate for potential abuse.

Days later, a parent picked up the baby and walked out of the hospital, though medical staff and security guards tried to stop them. Staff should have called a “code pink,” a child abduction alert, according to hospital protocol. This would have locked the hospital doors and prevented anyone from leaving.

Police told The Inquirer they found the child safe at home, and do not consider the case an abduction.

Still, the episode triggered a visit from state inspectors, who found that the hospital had not conducted a “code pink” drill for a child abduction since 2020, though it should be performed annually.

The inspection also noted that the hospital had left the position of director of emergency management vacant since 2021.

Nor did the CEO ensure that staff were properly trained and that patients were cared for in a safe environment, inspectors found. For example, Mueller did not review the surveillance footage of the alleged abduction that triggered the inspection, according to the report.

The inspector’s report noted discussions with hospital leadership about “the day-to-day oversight of hospital operations by the president and chief executive officer,” his accessibility to other staff leaders, and his communication with board members.

In response, the hospital decided that Mueller would be on site five days a week, unless away on company business or paid time off.

What’s more, Tower’s chief operating officer would visit the hospital “to ensure the duties of the president and chief executive officer are being executed.”

The hospital further required all 1,800 employees to complete training that included in-person drills and online education.

St. Christopher’s is jointly owned by Tower Health, a nonprofit health system headquartered in West Reading, and Drexel University.

Mueller came to St. Chris after a tumultuous period, when the hospital needed a leader who could set it on a path toward financial stability. When he was hired, his new bosses highlighted his track record of physical and financial growth at Children’s Hospital at Erlanger in Chattanooga.

St. Christopher’s had numerous owners and leaders: A for-profit national hospital chain, Tenet Healthcare Corp, bought the 189-bed hospital out of bankruptcy in 1998 and owned it for 20 years. In 2018, Tenet sold it, along with Hahnemann University Hospital in Center City, to a California businessman for a combined $170 million.

Over the next several years, St. Chris had at least three different CEOs, then again ended up in bankruptcy, before the Drexel-Tower joint venture bought the hospital for $58 million.

It has continued to lose money, leading the new owners last year to seek a financial lifeline.

A group of prominent Philadelphia health-care institutions agreed last spring to contribute $50 million over two years to help stabilize St. Chris. They include Children’s Hospital of Philadelphia, Thomas Jefferson University (owner of Jefferson Health and Einstein Healthcare Network), Temple Health, Philadelphia College of Osteopathic Medicine, Independence Health Group, and private donors.

A financial update has not been publicly disclosed. Tower this year stopped breaking out financial results for St. Chris, making it impossible for the public to know its current financial situation.

The families who flow in and out of St. Chris’ doors often know little about the hospital’s finances and management issues.

“The hospital runs great and has been good to me and my kids. That’s all that matters,” said Stacey Marks, who said she brings her three kids to St. Chris because the doctors are kind, appointment coordinators answer the phone, and support staff are helpful.

When her 16-year-old daughter tore her anterior cruciate ligament (ACL) at a trampoline park last year, St. Chris doctors operated and staff helped Marks to complete a medical leave application, so she could take time off from her job as a surgical coordinator at Temple University Hospital.

“The people are amazing. The services are amazing. We don’t even ask who is behind the scene that is doing all that,” said Glinka Nelson, a 39-year-old mother of four from Northeast Philadelphia, whose son had a speech therapy appointment on a recent day.

Doctors and nurses care deeply about their patients, said Sue Swift, who has worked as a nurse at St. Christopher’s for 36 years and is president of the nurses’ union there.

But what patients don’t see, she said, is the sometimes strained relationship between staff and leadership, which affects morale, workplace culture and, ultimately, patient care.

Swift said she was optimistic that Mueller would help rejuvenate St. Christopher’s.

“I would never work at a hospital where I wouldn’t bring my own children,” she recalled him saying at a staff town hall meeting shortly after he was hired.

“But he never came,” with his family to Philadelphia she said.

The residency status of executives who lead key community institutions, such as hospitals, has long been debated.

National health-care experts said it’s not unheard of for an executive such as Mueller to commute. “It happens more than you’d expect,” and it’s almost always for a personal reason such as kids in school, said Josh Nemzoff, chief executive of StoneBridge Healthcare LLC, a Bucks County firm that acquires financially distressed hospitals.

But even if executives live nearby, that may not guarantee familiarity with how their patients live.

A 2022 study published in the medical journal Health Equity found that just 10% of hospital leaders from the 68 largest (by bed count) hospitals in the country — including Thomas Jefferson University Hospital and Penn Presbyterian Medical Center in Philadelphia — lived in the same zip code as their hospital.

Rather, researchers found hospital executives more often live in wealthier, less racially diverse communities that are “fundamentally different” than those in which their hospitals are based.

Those CEOs who do live in the community they serve are more attuned to their patients’ needs. Living among patients and their families offers critical context for their decisions and approach to leading staff, said Charles Sanky, an emergency medicine physician and population health researcher in New York, who was the study’s lead author.

That’s how Cleveland, the 60-year-old foster parent who frequents St. Christopher’s, feels. She spent 33 years working for the city’s central dispatch center, a job that required her to become deeply familiar with the communities she served.

She’d like the same from the leaders of institutions her neighbors depend on.

“You might want to step out into the community and see what’s going on and how people are living,” she said. “And then you have a better understanding of what’s needed to support those people.”

Staff writer Harold Brubaker and staff researcher Ryan W. Briggs contributed to this article.