Sebastian River Medical Center scored an “F” in the Leapfrog Group’s Safety Grade, the largest hospital safety survey in the nation. According to Leapfrog, of the 2,500 hospitals reporting nationally, only 1 percent got F ratings, and only two of those were in Florida.

Most of the data going into the score came from 2014 and 2015, when the hospital was owned by Community Health Systems, not its current owner, Steward Health Care, which took over in February 2017.

The failing grade, the lowest possible score, included the worst rate of patient falls among the 2,500 hospitals surveyed – 1.767 falls per 1,000 patients. The average hospital showed .37 falls per thousand.

It also showed a problem with dangerous bed sores, with a rate three times the average.

And in a category of errors known as “never” events – mistakes so horrible they should never be made – Sebastian scored in the red zone on its incidence of dangerous objects being left in a patient’s body. The worst-performing hospital in the nation had a rate of .397 per thousand patients discharged; pre-Steward Sebastian’s rate wasn’t much better: .320. The average rate was .022 per thousand.

Indian River Medical Center’s rate for the objects left in bodies post-surgery was also much higher than average:  .121 per thousand patients.

Indian River earned a C Leapfrog rating, down from a B last year.

“Disappointing scores for both, though terrible for SRMC,” said Allen Jones, an elected Hospital District trustee and a major proponent of metrics as a tool to improve health care. Looking at the data, he noticed that while Sebastian River had problems with patient outcomes, Indian River did significantly better in that arena. Both hospitals had problems with inadequate nursing staff, communication with patients and leadership to prevent errors.

Dr. Joseph Weinstein, Steward’s corporate-wide chief medical officer who is based at the company’s headquarters in Quincy, Massachusetts, was optimistic about improvements at Sebastian, based on the grades of the system’s nine Massachusetts hospitals: Three A’s, four B’s, one C, and one rural hospital that lacked the volume of data to be graded.

“I’ve been with Steward in this role for two years, and we have almost always been able to improve the quality of the hospitals we’ve acquired.”

The data for Sebastian River is “remarkably low,” he said. “[But] a lot of what Leapfrog looks at is in the rearview mirror. The data is important from three or four or five years ago, but really doesn’t reflect what the hospital looks like today.”

“I wish the data were more current,” said the Hospital District’s Jones.

Weinstein said all three hospitals Steward Health acquired in Florida last year – Sebastian River, Rockledge Regional and Melbourne Regional hospitals – are making “significant progress” in safety with new strategies implemented under Steward. Both Brevard hospitals saw their Leapfrog scores go down in the current ranking, from C’s to D’s, based mainly on data prior to Steward’s takeover.

“When we acquired these hospitals, we went through a lot of time and effort making sure these quality measures are in place. I don’t want to say it wasn’t in place, but we have re-invigorated all the efforts.”

Weinstein says Steward has already seen reductions in the incidence of injuries and infections occurring once a patient is admitted to the three hospitals. “We have reduced hospital acquired infections and hospital acquired conditions including falls,” he said. “We’ve implemented processes to increase the frequency of handwashing.”

Weinstein, a cardiologist who has worked in healthcare for 30 years, became Steward’s chief medical officer around the time Sebastian River and the two Brevard County hospitals were acquired. Since then, mergers expanded the system to the largest private hospital operator in the nation.

He said the current construction of a large patient tower with operating rooms and private rooms at Sebastian River will contribute to better safety scores in the years ahead.

Another “milestone,” according to Weinstein, is the pending implementation of Meditech medical records software, that includes computerized ordering of medications. The lack of that software earned Sebastian another worst-in-nation grade.

Prescribing with software can automatically check for dosage errors or conflicts with other medications. Sebastian scored a dismal 5 in the area of problems with prescription medicines; the best hospital surveyed scored 100. The average score was 80.8.

On the plus side, using more recent data collected mostly on Steward’s watch, Sebastian River got a perfect score – 100 – on efforts to track and reduce risks to patients.

That was just a few points higher than the average among responding hospitals – 97; the worst hospital score was 25.

The score measures hospital leaders’ efforts to learn from past mistakes, zeroing in on problem areas and taking steps to prevent issues from recurring including assessing risk zones and providing staff training.

Other nearby Florida hospitals also had less than stellar Leapfrog scores.

In Fort Pierce, Lawnwood Regional Medical Center scored a C. That hospital is owned by HCA.

Even Cleveland Clinic Florida, now in negotiations to take over IRMC, saw a dip on its safety report card. The Weston hospital scored a B, down from an A grade.

Two other hospitals looking to join Cleveland Clinic’s system, Martin Health and Boca Raton Regional Hospital, both scored C’s.

Holmes Regional Hospital, part of the Health First system, got a C in the latest assessment, the same safety score it received in fall of 2017. It earned a B in spring 2017. It last earned an A in 2015.

Two other smaller Health First hospitals in Brevard County earned A safety grades: Viera Hospital, which has 85 beds, and Palm Bay, which has 155 beds.

Taken together, Florida’s hospitals stayed about the same in the Leapfrog ratings, falling one notch in its state rankings, from 23rd to 24th, just below Pennsylvania. There was only a fractional decrease in the number of Grade A hospitals in Florida – just over 30 percent. The states with the largest number of hospitals scoring an A in safety were Hawaii, Idaho and Rhode Island.

The effort to grade hospitals on safety is not without controversy, and old data is not the only problem. Still, the issue of medical errors is an urgent one, and clearly difficult to wrangle. According to a widely cited 2016 Johns Hopkins study, medical error kills an estimated 250,000 people a year, making it third in adult causes of death after heart attacks and cancer. Johns Hopkins investigators have called the problem “an underrecognized epidemic” that goes beyond surgical errors and infections.

“It’s healthcare gone awry,” said Dr. Martin Makary, professor of surgery and health policy at Johns Hopkins University School of Medicine and a lead author of the study.

After decades of letting states try to curb the problem, the federal government stepped in around 2012 and built Medicare reimbursement penalties for bad safety scores into the Affordable Care Act.

This year, the Center for Medicare and Medicaid Services, known as CMS, cut the funding of 751 hospitals for having poor safety records. More than 3,300 were examined by CMS.

CMS penalized 47 Florida hospitals for fiscal year 2017, a more than 50 percent increase over 2016 and 2015.

As the focus on safety has intensified, the number of survey companies like Leapfrog has expanded, and inconsistencies in results have fueled complaints from hospitals questioning methodologies.

A 2015 academic study led by J. Matthew Austin of Johns Hopkins and published in Health Affairs looked at overlap among the top four consumer-targeted hospital rating services and found that out of 844 hospitals surveyed, no single hospital scored at the top level in all four national ratings.

Of those scored high-performing by one rating service, only 10 percent were scored high-performing by any of the other rating services. The lack of agreement was “likely explained by the fact that each system uses its own rating methods, has a different focus to its ratings, and stresses different measures of performance.”

While complaints about both safety and safety ratings continue, patient advocate groups laud changes that have taken place and say hospital executives are addressing safety issues with greater intensity.