Corrective steps being taken to protect patients and workers alike, hospital says

This article first appeared September 13, 2017 on OSHA Healthcare Advisor.

By Steven Porter

A hospital in Missouri at risk of losing its Medicare funding within the month installed an interim leadership team this week as it seeks to appease federal inspectors.

Mercy Hospital Springfield was placed in “immediate jeopardy” by CMS after an inspection last month found significant violations of the regulations pertaining to nursing services and patient rights. The hospital announced last week that it had fired 12 employees whose behavior in “highly tense situations” was deemed inadequate. That news was followed Tuesday by an announcement that the interim leaders would step in to right the ship.

“They bring a fresh perspective and will help bolster local resources,” said Jon Swope, interim president of Mercy Springfield Communities, in a statement announcing six temporary leaders.

“I want our community to know that we will do whatever it takes to provide the care they deserve and expect,” Swope added. “We want to meet and exceed federal standards.”

Following an inspection August 25, the hospital was notified that its Medicare agreement would be terminated on September 22 if it didn’t bring its operations into compliance, said Julie Brookhart, spokesperson for the CMS regional office in Kansas City. That immediate jeopardy status was based on violations under the regulations pertaining to nursing services and patient rights.

“It is important to note that most facilities take the necessary steps to correct deficiencies prior to termination,” Brookhart said in an email, noting that the hospital had yet to submit an adequate plan of correction as of Tuesday.

Sara O’Connor, spokesperson for the Missouri Department of Health and Senior Services, said the state agency is “aware of the incidents at Mercy Hospital” and conducting an investigation.

Hospital spokesperson Sonya Kullmann noted that the firings were part of an effort to better address problems that stem from rising rates of drug addiction and mental health issues. The hospital has also implemented additional staff training that includes modules on de-escalation techniques, she said. Kullmann declined to comment, however, on the precise misdeeds that led to the terminations and related actions.

“Due to privacy concerns, we will not speak about specific incidents,” Kullmann wrote in an email. “Our expanded training continues as we help our co-workers gain additional skills for providing dignity and compassion to our patients. We continue to work with regulators to secure their input and support for our plan of action. Everything we’re doing is to ensure the well-being and safety of everyone, including our co-workers.”

 

‘Everything we’re doing is to ensure the well-being and safety of everyone, including our co-workers.’

 

While details of the August inspection remain murky, there’s more information available about an inspection that took place at the facility about eight months earlier. The early-January inspection and the one in August were each conducted as part of separate complaint investigations, but both found noncompliance in the area of patient rights, Brookhart said.

The violations noted in January resulted in the hospital being placed in immediate jeopardy, but that status was removed after the hospital provided an immediate action plan that included additional training on recognizing and reporting abuse and neglect, policies and processes for restraint and seclusion, and proper de-escalation techniques for dealing with aggressive patients. The hospital also agreed to hold simulations and require patient care staff to demonstrate their competencies in these areas, according to an inspection summary report obtained from CMS by the Association of Health Care Journalists, which published the redacted record online: www.hospitalinspections.org/report/13758.

Some of the violations were based on a confrontation between a nurse and a patient admitted to the Behavioral Health Unit (BHU) shortly before 5 a.m. on January 3, 2017. The patient screamed and spat on the nurse’s chest, according to the inspection report, which cited an audiovisual recording of the encounter.

“Don’t ever spit on me again,” the nurse said, moving forward toward the patient.

When the patient raised his right arm, the nurse pushed it back down. The patient used his other hand to punch the nurse in the face, then the nurse “charged forward and struck the patient in the face/neck area,” pushing him up against a wall as the patient continued to strike the nurse’s head and neck. The nurse then “slammed the patient to the floor,” the report states.

“That was a major mistake, I will press charges, guaranteed,” the nurse said.

The nurse—who held the patient on the ground for several minutes, until three security officers moved the patient to the Acute Care Area (ACA)—continued to document the patient’s care until the end of his shift two hours later. That meant the facility failed to remove the staff member as it should have, according to the inspector.

“The altercation between [the nurse] and [the patient] was never identified as a potential abuse situation by the facility, so the staff member was not removed from patient care, which resulted in an unsafe patient care environment,” the inspector noted.

Similarly, the inspector faulted the facility for failing to recognize use of the ACA—which contained four small lockable rooms, none with exterior windows—as a form of restraint and seclusion.

“I have been here for over ten years and we have never considered patients that were placed into the ACA as being in seclusion,” a BHU nurse manager told the inspector in an interview January 4, according to the report, which cites three incidents in which patients were held in restraint or seclusion without a physician’s orders to do so, sometimes for more than two weeks at a time.

If it were to fail to implement adequate changes, Mercy Hospital Springfield (which is a component of Mercy Health based in Chesterfield, Missouri) would be the second hospital in the city to lose CMS funding in recent years, the Springfield News-Leader reported. Ozarks Community Hospital in Springfield (which was operated by OCH Health System based in Springfield) closed last year after CMS determined the facility did not meet the definition of a hospital and terminated its Medicare agreement.