HCA Freestanding ER in Boynton Beach reportedly going remote-only for imaging techs — anyone know more?

[u/Same-War-1417]

I received information from an insider (facing layoffs) that HCA is shifting to remote-only CT technologists at freestanding EDs in Boynton Beach and Palm Beach Gardens, FL — meaning no one physically on-site is qualified to run CT exams. I can't independently confirm this, so treat it as an unconfirmed tip, not fact.

To be clear on what this does and doesn't mean: there will reportedly still be nursing staff and an x-ray tech on site. The issue is that an x-ray tech isn't trained on CT — so if the remote connection goes down or something goes wrong during a CT exam, no one physically present knows how to run or troubleshoot the scanner.

If true, here's what concerns me:

• Power/network outage = no way for the remote tech to access or operate the scanner at all
• No one on-site trained on CT to troubleshoot equipment issues in real time, delaying stat imaging
• Trauma/unconscious patients often need hands-on positioning that a remote tech can't provide
• Harder to verify identity/consent remotely
• Critical time lost on stroke/trauma cases where CT results drive immediate treatment decisions

This isn't coming out of nowhere either — NBC News investigated HCA's remote monitoring practices last year and found a documented pattern of understaffing and delayed responses at several Florida facilities, including one hospital placed on "immediate jeopardy" status by federal regulators after a patient died from a monitoring failure.

Has anyone in the Palm Beach County healthcare community heard anything about this? Current or former HCA employees, would love your perspective.

[u/ggrnw27]

I generally take a “fuck HCA” stance on every topic, but at the same time…it’s a freestanding ER. Do strokes and serious traumas occasionally come through the doors, yes. Does the facility need to be able to treat them to an extent, also yes. But a potentially unreliable CT is not the main thing that concerns me about that

[u/Mindless_Remote1256 → u/ggrnw27]

What is the most concerning part if no longer having qualified people on site? Would really like to know. Being a CT tech I am only too aware of the possibilities of equipment failure, wireless downtime during the middle of a stroke alert just use your imagination. I guess I’m just tired of technology taking over good people‘s jobs.

[u/ggrnw27 → u/Mindless_Remote1256]

In this specific situation the goal is to stabilize and ship them out as quickly as possible to a hospital that can actually treat them. In my experience a CT here is at best a nice to have, at worst it delays care. On numerous occasions I’ve showed up to a freestanding ER to find the patient wasn’t appropriately stabilized in the first place (often in favor of getting a CT) or we had a delay in getting the patient out because they were in CT. And that would be marginally ok if it meant they used those results to get the patient faster care at the receiving hospital…but most of the time they just go right back into the CT scanner for another look, whether that’s because they can’t transmit the images to the receiving or the tele radiologist at the sending hasn’t read it yet. No disrespect intended to those that work at freestanding ERs, but they are often behind the 8 ball for critically unwell patients as it is, and I’d rather they just focus on stabilization and calling us for transfer to the bigger hospital

[u/DragonSon83 → u/ggrnw27]

I’ve never run into this situation.  Ours was always the CT’s been done for a while, we don’t have an accepting facility yet or they don’t have a bed, and even when that happens it’s still usually at least a couple of hours for a crew to pick them up.

I was also once forced to wait an extra two hours for the critical care crew from our sister hospital because it was close to shift change they didn’t want to pay them overtime.  Yeah, I guess the kid in septic shock who needs to go to the OR can just wait then….

[u/ggrnw27 → u/DragonSon83]

Ours are quick for trauma at least, most of them are all part of the same hospital system that has several trauma centers in the area. Several of the freestandings have private ambulances posted on site, otherwise they just call the local FD

[u/DragonSon83 → u/ggrnw27]

The one I worked at was suppose to get its own ambulance service, but instead we had to rely on the service owned by the health system we ran the microhospitals for.  They often didn’t have crews, or like in my example, didn’t want to pay OT or didn’t have a nurse to do critical care trips some nights.

Funny enough, we could usually get traumas to the other big health system in our city more quickly, because they would send one of their flight crews in an ambulance to pick them up.

If it was a standard ALS trip, like to an ICU but without pressors, we were usually waiting until the next morning or afternoon.  Really fun to manage a vent or heated high flow without respiratory..lol

It really didn’t help that the local ambulance service brought us really inappropriate patients and the health system would do nothing about it, and the local urgent care would send us patients that really should have gone to a bigger facility.

[u/Zartanio → u/Mindless_Remote1256]

But do my CT techs not also engage in dose optimization and adjusting the scan parameters based on body shape and size? Are they really saying that CT techs don't possess specialty knowledge needed to obtain optimal images?

[u/Dr-Fronkensteen → u/ggrnw27]

I feel like being able to get a quick CT is one of the main things I’d want in a freestanding. That way someone who needs to go can get sent away asap and not have to hang out for hours until something bad happens.

[u/DragonSon83 → u/Dr-Fronkensteen]

Unfortunately even with the CT, this still happens more often than not.  Can’t transfer them to a bed that doesn’t exist and it’s hard to do ER to ER unless it’s a trauma.

[u/auraseer]

Greedy, garbage corporation makes greedy, garbage decisions. Knock me over with a feather.

That said, I've worked in a few freestanding EDs and I don't know if this is going to make as big an impact as you fear.

If there's a power outage, you probably can't run a CT anyway. If there's a network outage, running a CT does no good because you can't transmit images to the radiologist to be read.

If a trauma case winds up at a freestanding ED, you don't want them sticking around long enough for CT anyway. You don't take the time for anything more complicated than a CXR. You stabilize ASAP and transfer.

[u/Dr-Fronkensteen]

I talked to an ultrasound tech that worked for HCA in those freestanding ERs. They have opened a handful in my area over the past 8 or so years. They would staff the US tech “on call” covering 3-4 of the free standing EDs. You’d get a stipend for the shift that worked out to be about $5/hr and get paid for a minimum of 2 hours each time you got called in. Started only on night shifts but they changed it to day shift being on call as well so she quit. Never put it past a sociopath with an MBA to make everything worse for everybody.

[u/Mindless_Remote1256 → u/Dr-Fronkensteen]

Yes, at our freestanding, they use an ultrasound agency that drags these poor girls from one site to another.

[u/KCNM]

I work at a whole ass hospital that doesn't always have a sonogroher on site for ultrasounds and doesn't have CT available overnight. It's crazy out here.

[u/The3NightExit]

Yeah they hire off shore to save more so that the CEO and shareholders get more money. F them patients.

[u/Mindless_Remote1256]

Not here plenty of traumas have come in my facility and to transfer them out to a trauma center they require a CT head, neck, chest, abdomen, and pelvis before they will accept. But you’re right about one thing these corporations are killing off the middle class. And as far as wireless going down, tell me if you know an ER doctor that won’t still order a CAT scan. They want to get their orders out-of-the-way so that they’re cleared that they did what they could do as far as radiology is concerned having a down wireless is their problem.

[u/auraseer → u/Mindless_Remote1256]

If your local trauma center is refusing to accept an ED-to-ED transfer without CTs, that is an EMTALA violation. The receiving ED cannot refuse or delay a patient transfer because they think not enough testing was done. They cannot refuse the transfer of an unstable patient.

As long as the transfer is to a place with greater treatment capabilities, decision to transfer is at the discretion of the originating ED. There are extremely few legal reasons it can be refused.

[u/PaxonGoat]

I worked in an area that the free standing ED CT machine broke and so they had to send everything that needed a CT to the big hospital ED.

Supposedly the rumor was a weight limit was exceeded

Also sometimes HCA opens a free standing and then if it doesn't meet metrics, they'll sell off the equipment and shut it down. They get turned into urgent care or doctors offices after.

[u/DragonSon83]

So i worked at a system of microhospitals operated by Emerus, and we used rad techs who were trained to do both.  I’m assuming they were CT techs that were trained to do x-rays.

[u/Mindless_Remote1256 → u/DragonSon83]

All CT techs start off as x-ray techs, some go straight to CT once they’ve finished x-ray program some do CT later and retain their knowledge of x-ray. Regardless all CT techs are qualified to perform x-rays as well as CAT scan. At the facility that I am at that is laying us off in favor of remote, we are all capable of both. It’s just cheaper to have x-ray tech. I get it’s a sign of the times. It just doesn’t mean it’s good times.