On Feb. 6, 2018, Travis Claussen had his right hip replaced at Blue Valley Hospital in Overland Park.

The 40-year-old resident of Lawson, Missouri, had been experiencing severe back pain for years. Before then, he’d been a physical fitness buff who was into off-road motorcycle racing.

His back pain got so bad that, other than helping out his mother with her small T-shirt and sign business, he’d been unable to work for the previous five years.

Claussen was considered a poor candidate for back surgery because, at six-feet-one-inches tall and 240 pounds, he was considered obese. But one of the doctors at Blue Valley thought he was sufficiently young and healthy to undergo hip replacement surgery.

Claussen went ahead with the procedure, but following his discharge from the hospital he developed a surgical site infection. He returned to the hospital 13 days after his discharge and was treated with pain medications, intravenous antibiotics and a wound dressing to promote healing.

He was discharged again a week later but readmitted several more times over the following weeks when it became clear the infection wasn’t clearing up. On April 9, 2018, the surgeon removed Claussen’s hip implants. During the procedure, Claussen’s right femur fractured.

Claussen family

Medical records show that over the next 24 or so hours, he was given large quantities of narcotics, including fentanyl and oxycodone, and sedatives, including Valium and Ativan. At 3:50 a.m. on April 11, a nurse found him unresponsive. He was transported about 50 minutes later just down the road to Saint Luke’s South Hospital but it was too late. Claussen was dead.

He wasn’t the first patient at privately owned Blue Valley Hospital, which was renamed Pinnacle Regional Hospital in 2018 and on Wednesday filed for Chapter 11 bankruptcy, to die following surgery there.

Joseph Metz, who had endured back pain for years, underwent spinal fusion surgery at Blue Valley on Dec. 22, 2017. He was discharged four days later, although his temperature was elevated and an autopsy subsequently showed he had pneumonia. The following day he was discovered unresponsive in bed at home. He was pronounced dead at 4:43 that morning. Metz was 36 years old.

The two men’s deaths came during a time when the hospital was in peril of losing its Medicare certification because it didn’t have a sufficient number of inpatients. In fact, a hospital staffer told CMS inspectors in 2017 that it was performing “a lot of extra surgeries to get the numbers we needed.”

Andrea Carabetta, the pharmacy director at Blue Valley Hospital for nearly three years before she left in the fall of 2018, told KCUR that Claussen should have been transferred to another hospital with a higher level of care.

“I feel like they killed him,” she said.

Families sue

In October, Metz’s two minor children and the personal representative of his estate sued the hospital and two of its physicians for medical malpractice, alleging they were negligent in their treatment of Metz. The defendants have denied the allegations, claiming the plaintiffs’ injuries “were the direct and unavoidable consequence of Joseph Metz’s pre-existing condition.”

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Claussen’s family filed their own lawsuit against the hospital, two of its physicians, a nurse practitioner on Thursday. They amended it later in the day to name the hospital's owner, Douglas Palzer, as well. Like the Metz family's lawsuit, the Claussen suit alleges the defendants were negligent in their treatment of their son and seeks unspecified damages.

Leland Dempsey, the Claussens' attorney, said he named Palzer because “he's directing a malfeasance on the part of the corporation, which directly resulted in our client's death.”

“He's holding these hospitals out as being a full-service facilities when they're not, and they're not properly equipped to handle patients, including a seriously infected young man, which should not have been managed at that hospital. ... And you know, he lost his life.”

Palzer, who lives part-time in Las Vegas, could not be reached for comment.

A ‘more intimate hospital experience’

Palzer, a businessman, opened the hospital, which is located at 128th Street and Metcalf Avenue, in 2010 as a seven-bed facility with two operating rooms. Palzer had previously owned a nearby ambulatory surgical center specializing in weight loss surgery.

A news release announcing the hospital’s opening said that while it was designed with weight-loss surgery in mind, “it is expanding its range of specialties and procedures.”

“We offer a more intimate hospital experience than what many people expect,” Palzer was quoted in the release as saying. “With only three outpatient and four inpatient beds, our patients get a lot of personal attention.”

Federal records obtained by KCUR, however, show they may not have gotten enough. In June 2018, regulators issued a statement of deficiencies report about the hospital containing an “immediate jeopardy” finding – or a situation where patients could be at risk of injury or even death.

‘Screamed of overdose’

The report by inspectors for the Centers for Medicare and Medicaid Services (CMS) found that both Claussen’s and Metz’s deaths resulted from multiple failures by hospital staff to comply with conditions for getting Medicare and Medicaid funding.

As part of their investigation, the inspectors interviewed members of the hospital’s staff, including physicians and nurses. The report, as is customary with statements of deficiencies, does not identify the staff members by name, but some of their statements are damning.

One said that after Claussen (who is identified in the report as Patient 10) was found unresponsive, they reviewed the crash cart and discovered that no Narcan, epinephrine or any emergency drugs were used.

“We gave Patient 10 a lot of narcotics and I believe anyone with experience would have recognized a potential for narcotic overdose and would have tried at least one dose of Narcan,” the staff member said, referring to a drug used to treat narcotic overdoses.

Another staff member said that Claussen’s symptoms “screamed of overdose to me. Patient 10 should have gotten Narcan. We do stock Narcan here, so it was available.”

The CMS report said Claussen’s autopsy report indicated the cause of death as coronary artery disease with fentanyl intoxication as a contributing factor.

The report said that “oxycodone intoxication,” along with underlying medical conditions, likewise contributed to Metz’s death. Citing the autopsy report, it said the concentration of oxycodone found in Metz, who is identified as Patient 3, was “above the expected therapeutic range and within the potentially fatal range.”

‘Blame game’

A hospital staff member told the CMS inspectors that following Metz’s death, hospital staff fought over having the reason for his death changed. The staff member said “there is a lot of the blame game going on …”

At the time, Blue Valley was trying to boost the number of surgeries it performed.

CMS had concluded the hospital did not “primarily engage” in providing services to inpatients – a requirement for participation in Medicare – and said it was going to end Blue Valley’s eligibility for Medicare reimbursements. Hospitals that don’t average at least two inpatients per day and at least two night average length of stay are considered same-day surgical centers, which are reimbursed differently.

Carabetta, the pharmacy director who left in the fall of 2018, told KCUR she believed Claussen had been kept at the hospital instead of being transferred “to keep the patient census up to meet CMS requirements.”

“I took my oath to provide good quality care and I didn’t feel I was living that oath,” she said.

A spokeswoman for the hospital did not return phone calls seeking comment.

‘No one expressed any sympathy’

Still grieving over their loss, the Claussens are angry and upset over what they describe as the hospital’s cavalier response to their son’s death.

“The doctor never acted like he was sorry this happened. He sure never said he was sorry this happened. The hospitalist never said he was sorry. The director of nursing never said she was sorry this happened,” says Debra Claussen, Travis’ mother.

“Even after he died, nobody in management expressed any sympathy or regret. And I know that’s because they’re expecting a lawsuit and they’ve got to be careful what they say.”

Money was clearly on the minds of the hospital’s administrators over the last few years.

Before it lost its Medicare certification, Blue Valley claimed to perform 35% of all Missouri Medicaid bariatric surgeries, a procedure performed on obese patients. Seeking to restore its Medicare funding, Blue Valley filed a lawsuit in which it claimed that its termination from the program would likely result in the loss of Medicaid and commercial coverage as well, which would financially cripple it.

‘Extra surgeries’

In an April 2018 statement of deficiencies finding Blue Valley did not qualify for participation in Medicare, CMS inspectors said a hospital staff member – from the context, it appears to be one of the hospital’s executives – told them the hospital performed “a lot of extra surgeries to get the numbers we needed.”

“So, I offered a new benefit to all employees and their families,” the staff member told the inspectors, according to the report. “I told them for those that medically qualify for a gastric sleeve, we would pay what insurance didn’t. Our staff has requested it for years because the insurance we have won’t cover the costs for the surgery here. Unfortunately, I have a lot of obese employees and they wanted this surgery. So it was something that could help us both. We have done about 50-60 employee/family surgeries to date with about 70 more that want it.”

Although a federal judge dismissed Blue Valley’s lawsuit on procedural grounds – a decision upheld by a federal appeals court – Palzer, the hospital’s owner, managed to get around CMS’ termination of its participation in Medicare by buying Cooper County Memorial Hospital in Boonville, Missouri, in 2018.

After the purchase, he renamed the Boonville and Overland Park facilities Pinnacle Regional Hospital.

Sebastian Martinez Valdivia / Side Effects Public Media

But last month, about two years after he purchased it, Palzer closed down the Boonville hospital. In a statement, Pinnacle CEO Joseph Conigliaro said that Missouri regulators’ demand that the hospital upgrade its sterile processing procedures would have proved too costly.

By then Pinnacle was already in serious financial trouble. Vendors were suing for nonpayment and Pinnacle’s lender, Great Western Bank, claimed it was owed more than $24 million in unpaid loans, interest, late fees and other charges.

In a lawsuit filed last month, Great Western said that both the Boonville and Overland Park businesses were “collapsing” and asked the court to appoint a receiver to oversee them and assess whether a sale would maximize their value.

Seeking to restructure their debts, Pinnacle and its parent company, Pinnacle Healthcare System Inc., filed for Chapter 11 bankruptcy reorganization on Wednesday. The companies said they hope to emerge from the proceeding as more stable, viable businesses.

In astatement Thursday announcing the filing, Pinnacle CEO Joe Conigliaro said the Overland Park hospital would remain open and the Boonville hospital would be reopened.

The Chapter 11 filing, Conigliaro said, will allow the companies “to restructure our debts and ensure stable, stronger, and viable business operations now and when we emerge from Chapter 11”

“The reorganization proceedings will enable our companies to continue our mission of providing high quality and cost effective medical and surgical services in our communities,” Conigliaro said.

This story has been updated to include the comments of the Claussens' attorney.

Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.