A report from the state Department of Health says Pocono Medical Center repeatedly failed to provide enough nurses to adequately care for patients in two of its units.

The deficiencies occurred in the cardiovascular telemetry unit and the emergency room, according to the department's report.The report came about after unannounced inspections at the hospital in August and November 2014. After the second visit on Nov. 13, regulators determined that understaffing in the emergency department presented "immediate jeopardy" to patients' health.Working on the understaffed unit was so overwhelming for employees that "staff members were in tears" and that they had to skip lunch and even bathroom breaks to complete their duties, according to the report.Department officials said the emergency room has gotten back in compliance after a recent inspection, but that report is still not available. The reports become public information only after 41 days. That means immediate jeopardy wasn't lifted until after Dec. 17, more than a month after it was first initiated.PMC also paid the state a civil penalty, but regulators were unable to disclose the amount Wednesday.DOH spokesman Holly Senior confirmed that the understaffing in the department did represent "immediate jeopardy" to patients' health."Facilities are responsible for ensuring adequate staffing. It's a plan that they develop," Senior said.Staffing levels were a big part of recent contract negotiations between PMC and JNESO Local 1, the union that represents about 500 registered nurses at PMC. Both sides reached a tentative agreement Wednesday.JNESO representatives said the reports confirm what they have heard from members about short-staffing at Pocono Medical Center."Our nurses documented 545 times in the last two years that the whole hospital experienced shortages," said Barbara Conklin, JNESO labor rep.Hospital spokesman Geoffrey Roche said he believed the shortages in question were the result of vacant positions that have since been filled. He said PMC is not currently under immediate jeopardy.Staffing matrix not followedIn August, the state observed that the hospital was not abiding by its staffing matrix a formula created by the hospital and approved by DOH that determines how many nurses and aides work on a unit based on the number of patients.That came after complaints from employees on both units. In their report, DOH regulators said that on nine occasions between June 19 and July 19, 2014, emergency room employees reported that staffing levels were affecting care.One employee told regulators "there were many days that the staff was crying."Regulators, citing the hospital's own files, said the CVT unit was short-staffed all but 11 days during a month-long period between July 7 and Aug. 7."We require a staffing matrix, and we expect that they are going to meet that matrix," Senior said.The state and PMC agreed that the hospital would increase the amount of manpower in both departments. PMC would add three nurse managers to the CVT unit. In the emergency department, PMC would increase the workforce by about 8 percent. The hospital agreed to put the changes in place by Oct. 28.But on Nov. 13, regulators found that despite the changes, the emergency department was still short-staffed. Regulators made the decision to invoke "immediate jeopardy."Immediate jeopardy is defined as "a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death ...," according to the Federal Center for Medicare and Medicaid Services. If a hospital remains in immediate jeopardy, it could lose its ability to receive Medicare and Medicaid funds.During that inspection, employees who were interviewed again told regulators they were stressed and overwhelmed. One employee said nurses were assigned to cover six patients, and had to cover an additional six any time another nurse had to transport a patient to another area of the hospital.Another said staff morale was very low, and that nurses were resigning at an "alarming" rate.The immediate jeopardy condition was eventually lifted, but regulators said they can't disclose the date when that happened. However department officials confirmed that immediate jeopardy was in place at least through Dec. 17.Distributed by Tribune Content Agency LLC