St. Christopher’s Hospital CEO departs as hospital faces ongoing license problems

The CEO of St. Christopher’s Hospital for Children is resigning as state regulators demand improvement from the troubled Philadelphia hospital.

St. Christopher’s has been operating under a temporary license since July, after failing two inspections to secure a permanent, three-year license.

Only five other hospitals in the state, including Temple University Hospital, have been unable to pass a license inspection and ordered to fix safety problems under a temporary license in the last five years.

The state issued a six-month license for St. Christopher’s in July, after inspectors found a litany of safety, sanitation, and patient privacy issues. Among the privacy violations, children in the emergency department were being required to wear lime green scrubs so that staff could easily identify them as patients with serious mental health issues.

On their return visit in November, inspectors found that the scrubs issue and most of the problems had been fixed, but identified new violations. The state issued the hospital a second temporary license in January.

Now, the hospital must fix a new list of problems during a time of leadership transition. Tower Health, which owns St. Christopher’s, announced Wednesday that CEO Donald Mueller is resigning for a job in Tennessee, located closer to his family.

Mueller took the job at St. Christopher’s in 2020, but did not permanently move to Philadelphia.

State inspectors have repeatedly blamed safety lapses at the hospital on Mueller’s absence. He was ordered to be in Philadelphia five days a week after the parent of a patient evaded security officers to take the infant from the neonatal intensive care unit against state child protection service orders.

Robert Brooks, who lives in Philadelphia and has worked as St. Christopher’s chief operating officer since September, will take over as CEO after a transition period of at least two months, Tower said.

Administrators will continue working with the state to resolve safety violations, a spokesperson said.

“St. Christopher’s is always making improvements to ensure that we continue to provide the highest quality services to a diverse community, working collaboratively with the Department of Health,” Paul Healy, a hospital spokesperson, said in an e-mailed statement responding to The Inquirer’s questions about its recent inspections.

St. Christopher’s is a critical resource in the North Philadelphia neighborhoods it serves. Families there experience high rates of childhood asthma, obesity, and behavioral health issues, and often have few other places to turn for care. The hospital in October opened a community fridge to provide free food to families in need.

About 80% of its patients are covered by Medicaid, the state and federally funded health insurance program for low-income families, which has contributed to financial strain at the safety-net hospital. St. Christopher’s has struggled for years to make enough money to cover its expenses because Medicaid pays less than private insurance for health services.

Tower brought in Mueller, a Tennessee hospital executive with a reputation for financial success, after acquiring the children’s hospital in a 2019 deal with Drexel University.

Tower, a health system based in Reading, praised Mueller’s performance on Wednesday, saying that the hospital broke even last year, up from a $97 million loss three years earlier.

But even as the hospital’s financial position improved, safety problems persisted under Mueller.

St. Christopher’s received an “immediate jeopardy” citation in January, one of the state’s most serious warnings that indicates severe safety problems that could put patients’ lives at risk. Mueller began working in Philadelphia five days a week after inspectors blamed his absence for contributing to safety oversights, the hospital said.

» READ MORE: 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 hospital’s license problems began months later, in May.

Inspectors cited the hospital for having dirty patient rooms and food preparation areas, and for failing to properly oversee housekeeping staff.

Inspectors noted “a mound of a layered black sticky thick substance resembling dirt and grime” in the back of a refrigerator, and a “thick layer of dust” on windowsills and lamp coverings in patient rooms.

They faulted department heads for not monitoring cleaning logs. Inspectors said Mueller had failed to properly review maintenance contracts, to ensure workers were meeting expectations.

The hospital was also cited for failing to monitor the temperature of warming units for blankets, breast milk, and infant formula. During the May inspection, staff scrambled to find a maintenance worker when regulators pointed out an error message on the temperature gauge of a warming unit containing breast milk and formula, according to the inspection report.

Inspectors also found that doctors in the infusion and dialysis departments were improperly ordering medications orally, instead of through the written protocol that is designed to reduce medication errors.

Medications can be ordered orally in an emergency, but a staffer told inspectors that many of the oral orders “are not urgent orders but are for convenience.”

In the emergency department, inspectors found that children believed to be at risk of suicide or fleeing the hospital were required to wear lime green scrubs so they would stand out from other patients.

“That’s how we know what’s wrong with them and to watch them with a closer eye,” one staffer told inspectors.

But inspectors said that the bright outfits violated patient privacy rights and that the hospital should instead provide one-on-one observation for patients who they believed were at risk of harming themselves or others.

Administrators also agreed to deep-clean the kitchen and patient rooms, update contract policies, and improve their oversight of housekeeping staff.

The hospital received a temporary license in July, after the state accepted its plan for correcting the problems.

Most problems had been resolved when inspectors returned in November. But inspectors identified new issues, and denied the hospital a full, three-year license, according to inspection reports.

Inspectors found medications that had expired days before their visit, unsecured oxygen tanks, and sterile supplies stored without protective covering.

In at least two cases, they found that staff had failed to notify patient families in writing when a scan found a significant abnormality.

Staff also neglected to document an “unusual incident” in which a nurse found a patient left with a tourniquet wrapped around a left biceps, causing swelling in the arm and hand. A blood pressure cuff was hanging from the patient’s arm.

The state issued a second temporary license in January. This gives administrators time to address the new violations.

St. Christopher’s is among the few hospitals to fail a license inspection in recent years. The Pennsylvania Department of Health has issued temporary licenses to just five hospitals over the last five years.

It is even more uncommon for hospitals to need a second temporary license after failing their initial inspection. Just three hospitals have needed a second temporary license in the last five years, according to the health department.

In one of those instances, Temple University Hospital Inc., which operates its main, Episcopal and Jeannes campuses under one license, was issued a temporary license in 2021. Temple then received two extensions before passing its inspection to obtain a full operating license.

After receiving an initial temporary license, the health department can issue three additional temporary licenses before regulators must determine whether the hospital’s problems are serious enough to decertify it, according to state law. That means St. Christopher’s could receive a temporary license two more times before it is at risk of losing its license to operate.