State regulators informed AdventHealth Porter on Oct. 12 that one of the Denver hospital’s two 50-year-old boilers was in such disrepair that it was no longer safe to operate and gave the health system 60 days to fix it or risk civil and criminal penalties.
The hospital ordered a backup boiler from Texas and planned to run its heat and hot water systems off the second 50-year-old unit in the meantime. But 18 days later, on the morning of Oct. 30, that second boiler failed — and the backup was not yet in Denver.
The broken boilers forced Porter officials to evacuate more than 100 patients and to close the entire hospital for 10 days, state officials said. But in their public communication about the hospital shutdown, AdventHealth Porter officials never disclosed that one of the facility’s boilers had been taken offline because it failed an inspection weeks before the second unit broke.
The Denver Post discovered the report detailing the Porter boiler’s inspection during a review of records in Colorado’s state boiler database.
Hospital closures can complicate the care of sick people and they’re costly to hospitals’ bottom lines. They are a rare occurrence and lead to involvement from multiple local, state and federal agencies, including the federal Centers for Medicare and Medicaid Services and the state Department of Fire Prevention and Control.
Rachel Robinson, an AdventHealth spokeswoman, said in a written statement that the hospital’s operations team diligently administers regular maintenance checks of the building’s boiler operating system, but the string of boiler breaks was “a confluence of events” that led to the need to close the facility.
“We are now operating with triple boiler redundancy,” she said in a statement.
Colorado’s chief boiler inspector Bob Becker said the crisis likely was “a run of real bad luck.”
However, one health care economist told The Post that it would be fair to question AdventHealth Porter’s risk-management strategy and its financial well-being after the closure.
Hospital closures due to failed equipment are rare and avoidable, said Ge Bai, a professor of health and policy management at Johns Hopkins University in Baltimore.
“As hospital management, it’s your job to make sure risks are mitigated,” Bai said. “It’s fair to blame management.”
Porter is a private, nonprofit hospital and is not required to disclose its financial statements. Robinson declined to share them when asked by The Post.
“Not safe to operate”
On Oct. 12, a boiler inspector working for a company that insures the hospital discovered serious problems with one of Porter’s boilers during a routine inspection.
“This boiler is not safe to operate,” the inspector wrote in a report on file in the online boiler database maintained by the Colorado Department of Labor and Employment’s Division of Oil and Public Safety.
The state issued a deficiency notice to Porter the day after the Oct. 12 inspection that said the boiler was in violation of state regulatory laws and the hospital had 60 days to fix it. Failure to repair boilers can carry criminal charges or result in fines of up to $1,000 for every day the boiler remains broken.
Tubes on Porter’s boiler had failed and those broken tubes were clogged with cement, according to the inspector’s report. Another part that provides insulation for the boiler had broken and had not been properly repaired, causing a hot spot to develop on a piece that insulates the boiler, the report said.
The boiler also had undergone three major repairs between June 2016 and August 2022 that would have involved welding, the inspection report said. Welding work on a boiler requires workers to have a special certification and those repairs must be signed off on by state inspectors, Becker said. The report did not specify what those prior repairs entailed and further information was not immediately available online.
The new problems discovered in the Oct. 12 inspection would not have required the state to approve any repair work because welding would not have been involved, Becker said. Once Porter made the repairs, hospital staff could turn the boiler back on and the hospital would be in compliance with state law.
At no point was the damaged boiler a public safety hazard, Becker said.
“From what I understand, these conditions were found during the internal inspection and that’s the purpose of the internal inspection: to identify anything that needs correction,” he said.
The second boiler broke on the morning of Oct. 30.
Robinson’s statement said the unit “unexpectedly failed due to extreme temperatures.” Becker said a tube split, causing a leak.
Required boiler inspections
The 45,000 boilers registered in Colorado are inspected twice a year — once for external problems and once for internal problems. Internal inspections require facilities to shut off the boiler so inspectors can look inside, Becker said.
About 40% of the inspections are performed by state employees and the rest are conducted by insurance companies. But those insurance inspectors have the same credentials as the state inspectors and are approved to work within the state’s system, Becker said.
Porter’s second boiler had been inspected on Sept. 19 and no deficiencies were found. A certificate to operate was granted, according to Colorado’s boiler database.
Both boilers were built in 1973, according to state records. It’s not unusual for 50-year-old boilers to still be in operation because they are built to operate for a long time, provided they are properly maintained, Becker said.
When Porter officials realized one of the hospital’s boilers would be out of commission for repairs, they ordered a rental boiler to serve as a backup, Becker said. But it did not arrive before the second boiler broke.
“In order to retain redundancy, they had ordered the temporary boiler,” Becker said. “It just hadn’t made it there yet.”
Porter officials ordered an emergency backup from American Steam Incorporated in Wylie, Texas. That company loaded a boiler onto a flatbed trailer and drove it to Denver.
It arrived by 4 a.m. Nov. 1, and engineers from American Steam flew into town to start it, according to a news release from the company. By Nov. 3, the hospital had the heat, hot water, steam and sterilization capabilities that are necessary for its operations, the news release said.
Porter plans to permanently operate with three boilers, Robinson said. A third permanent boiler eventually will replace the temporary unit.
Porter had to undergo inspections from multiple state agencies before the hospital could reopen. The facility resumed clinical services on Nov. 9 and elective surgeries restarted Nov. 13, according to an email from Gabi Johnston, a spokesperson for the Colorado Department of Public Health and Environment.
Hospital closures are very rare
It is exceedingly rare for a hospital to evacuate patients and temporarily close, said Scott Bookman, the state health department’s senior director for public health readiness and response.
The last time a Colorado hospital evacuated all of its patients was Dec. 30, 2021, when Centura-Avista Adventist Hospital in Louisville was threatened by the raging Marshall fire. But that was an external crisis.
In 2010, Rose Medical Center in Denver evacuated patients after its backup generator failed during a power outage caused by a transformer blowout in the neighborhood.
“These happen a couple of times a decade at the most because of an issue internal at the facility,” Bookman said.
The patient evacuation went smoothly, said Elaine McManus, director of the state health department’s Health Facilities and Emergency Medical Services Division. State records show 125 patients were at the hospital for various services at the time.
Porter needed to transfer 77 patients to other facilities and found space for 70% of those patients at other AdventHealth hospitals in the region, Robinson said. Another 74 were discharged.
At no point were any lives at risk, McManus said.
“We had an awful lot of lessons learned over COVID and we set up systems that enhanced what our emergency response would have been prior to the pandemic,” McManus said. “I’ll sort of brag that we’ve gotten pretty darn efficient.”
Porter also was inspected by the Colorado Department of Fire Prevention and Control before it reopened, said Chris Brunette, chief of the agency’s fire and life safety section.
In 2018, Porter suspended surgeries for nearly a week after state inspectors learned it was not properly sterilizing surgical equipment, increasing the risk of infections for thousands of patients. The investigation was launched after a doctor found a bone fragment on an instrument during spinal surgery. That incident resulted in a lawsuit filed by more than 60 former patients.
The controversy surrounding the dirty surgical instruments followed by the broken boilers was alarming to Bai, the Johns Hopkins health policy and management professor.
Risk management at hospitals is imperative, she said. Executives need to run scenarios of what can go wrong and address problems before they emerge.
“It’s a wake-up call for them to improve risk management. It’s a warning for other hospitals,” Bai said. “It can blow up into a big event and you can have a big financial hit.”
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