Judging by state Department of Health surveys, it's been a rough few years at Carlisle Regional Medical Center.

Those surveys can all be found on the department's website, and CRMC did not respond when asked for comment on them for this story.

Between 2005 and 2008, the Department of Health didn't often find something to report about at the hospital. Its team investigated complaints, but there were only a few times where the hospital was not in compliance with standard practices.

The hospital was called out on State Licensure Surveys when it wasn't in compliance with every detail of a state or federal policy - often regarding failures to ensure the Plan of Correction for past problems was actually taken - averaging about one complaint a year for not being in compliance with policies.

Visits rise

That changed in 2009, when the Department of Health visited the site 14 times, eight of which in response to complaints or past complaints.

The hospital was found to not be in compliance on four complaints and two State Licensure Surveys - failure to enact a Plan of Correction and failure to obtain required Department of Public Welfare and federal criminal history clearance for employees working closely with children.

The following year, the department would visit CRMC six times, investigating four complaints, in three of which the hospital was found to be non-compliant.

Just this year, the department has made nine visits to the hospital, seven of which regarded complaints.

It found in four complaints that CRMC was not in compliance, and the hospital was not in compliance with a State Licensure Survey, because it did not follow a number of procedures properly.

The non-compliance issues have increased since 2005 and are at a much higher number than at some of the other area hospitals.

Other hospitals

The Department of Health regularly visits hospitals for a various number of reasons - sometimes for occupancy surveys to make sure the facilities follow requirements and at other times to investigate complaints or past complaints filed with the department against a hospital.

However, most area hospitals seldom are found to be in non-compliance with their policies.

According to the Department of Health's reports for 2011, Holy Spirit Hospital was visited nine times, five of which regarded complaints or past complaints. Holy Spirit was found to be in compliance on all of the visits.

Chambersburg Hospital was also found to be in compliance after each of its visits, only receiving attention from the department three times in 2011. One was for a mental health survey and the other two were for complaints.

Of seven investigated complaints at PinnacleHealth, one was found to be not in compliance, though the department noted that the error occurred once. It regarded a sample specimen that was not handled correctly with the right chemicals or procedure.

The department had conducted 18 visits overall at PinnacleHealth.

Hershey Medical Center

Penn State Milton S. Hershey Medical Center is the only other hospital that received a higher number of non-compliance issues, though it was also visited by the department on 24 occasions, 13 of which regarded complaints or past complaints.

Of those complaint investigations, five resulted in non-compliance findings.

Smaller instances made up those complaints - some documents weren't signed in the case of one patient and employees had cut the hair of another patient without permission, though the patient was unable to give permission at the time.

However, the other times the hospital was found to not be in compliance with policies involved some larger issues.

In a Jan. 12 review, a patient came to Hershey's Emergency Department on Dec. 13 with high blood pressure - higher than the normal in the systolic range. The patient was discharged a few hours later without anyone having retaken his blood pressure within one hour.

In a May 6 review, the DOH reported, a patient in the hospital on Jan. 25 had signs of bacterial meningitis. Staff completed a lumbar puncture around 5 p.m., and the physician ordered antibiotics at 7 p.m. when the result was consistent with bacterial meningitis.

However, there was no documentation that droplet precautions (an infection control method) were initiated until after midnight the next day - a delay of more than four hours after antibiotics were started.

The last non-compliant complaint was in a July 6 review, where a patient with shortness of breath arrived at the walk-in clinic but was not registered, checked in or had anything documented before the patient was told to go to the Emergency Department.

CRMC reports

CRMC was also on the receiving end of five non-compliant reports this year, including the one conducted from June 9 to June 22 that detailed multiple instances in which patients weren't getting timely treatment, including two instances where patients died in the care of the hospital while staffing was short.

CRMC CEO John Kristel has disputed that finding, saying in a statement, "We take great exception to the notion that the regrettable deaths of two patients may have been related to staffing issues at the hospital. We look at our staffing levels on a continuous basis and at this juncture we have no reason to believe that these deaths were in any way connected to staffing levels."

While the deaths and staffing were the focus points of the June report, the Department of Health has listed other instances of non-compliance due to other reports this year.

The department recently released its July 7 report indicating that the hospital failed to correct its deficient practices based on the Plan of Correction it submitted regarding problems with patients not receiving prompt triage examinations when they first arrive.

A May 18 report from the department says that the hospital failed to ensure that patients' monitors were constantly observed by appropriate personnel.

In this case, the department talks about the role of the monitor tech, the staff member who should perform cardiac monitoring on clinical areas and notify personnel of abnormalities.

Through interviews with employees, it was learned that sometimes nurses expected the monitor tech to also be the certified nurse assistant and secretary when either of those people was pulled to another area and sometimes nurses were asked to watch the monitor when the tech left - which wasn't always covered when the nurse had to respond to a critical patient.

Policy issues

A March 10 report was one of the largest of the year - second to the June report - and detailed problems from a full State Licensure survey the department conducted March 8 through March 10. The department detailed a number of instances in which the hospital did not conform to all state and federal laws and regulations.

One review listed CRMC's failure with its policy on restraining patients.

Of 10 restraint records reviewed, one did not have a reason for restraint listed on the order sheet. In five of those cases, the facility failed to obtain orders from a physician for the use of restraint.

The March report also noted that CRMC failed to report deaths to the Organ Procurement Organization for three of three medical records reviewed. The hospital's policy is contact "Gift of Life at or near the time of each death, ideally within an hour, to determine a person's suitability for (organ) donation," according to CRMC's policy.

Treatment issues

Another review showed that a member of the medical staff failed to provide timely treatment to a patient, taking more than an hour to respond to a page, and that the facility failed to follow policy and state pharmacy regulations in dispensing sample medication.

In another policy review in that report, the department found that CRMC employees failed to follow physician dialysis orders three times.

In one instance of hemodialysis on Nov. 5, a patient was dialyzed for two-and-a-half hours, even though documentation said the patient should have been dialyzed for three hours.

Another was dialyzed on Feb. 23 for three-and-a-half hours even though the document said three hours.

Documentation also indicated the patient should have been given Heparin, but none was given.

In a Dec. 28 case, the blood flow rate for the hemodialysis was incorrectly set for the patient.

The last issue the department noted in the March report was that CRMC performed high-risk cardiac catheterization, even though it did not have an open heart surgical program onsite.

According to policy, only a high risk cath lab can perform certain cardiac catheterizations.

CRMC's cath lab is listed as a low-risk laboratory, but in 2010, it operated on a patient who had other co-morbidity conditions, including kidney failure and insulin-dependent diabetes.

Plans

The only other report in 2011 that found the facility to not be in compliance was a Jan. 10 report that said a Plan of Correction was not followed in regard to an earlier report that employees failed to turn patients with a Braden score (which analyzes the risk for sores) of 15 or less every two hours as stated in the facility's policy.

Each time the Department of Health finds something with which a hospital is not in compliance, the hospital must file a Plan of Correction, and each hospital has done so for their respective reports.

The Department of Health has yet to release the Plan of Correction for CRMC's June report.