MACHIAS, Maine — In the latest of a series of incidents, Down East Community Hospital has been disciplined by state and federal agencies for a number of serious violations within the last year.
The Maine Department of Health and Human Services recently ordered the hospital to operate on a conditional state license, an action deemed “necessary to protect the interests of the general public,” said Catherine Cobb in DHHS’s Licensing and Regulatory Services division.
Additionally, the Center for Medicare and Medicaid Services, a federal agency that oversees health care coverage at U.S. hospitals and ensures compliance with certain federal regulations, has threatened to sever ties between Down East Community Hospital and Medicare. The hospital can avoid that action if it corrects certain deficiencies within a set period of time.
Both sanctions are related to a series of complaint investigations conducted by state officials that began after the death of Reid Emery in early January 2008 and continued throughout the calendar year.
According to Cobb, in a Dec. 24, 2008, report addressed to hospital CEO Wayne Dodwell, the four areas that showed what she referred to as serious violations were pharmacy, clinical records, standards of care and quality, and patient safety.
In a telephone interview this week, Dodwell addressed the recent decisions by DHHS and the Center for Medicare and Medicaid Services.
“In the end, it’s part of doing business,” he said. “Despite what’s been reported elsewhere, this is really routine business for most hospitals. Every year, there are usually four or five hospitals on the state’s list of [facilities] that need to improve in certain areas.”
In fact, the hospital chief said, DECH recently submitted a proposed plan of correction to DHHS, which was accepted. The next step is for state officials to survey the hospital again at an unannounced later date to see if it’s in compliance.
The issue with the Center for Medicare and Medicaid Services involves the same observed violations, although they deal with federal guidelines. Roseanne Pawelec, a regional spokeswoman for the Center, said that when state officials survey hospitals they often wear federal hats as well.
“The state goes in on our behalf to conduct surveys for compliance,” Pawelec said. “Many times the deficiencies overlap.”
The state’s report identified four issues confirmed by Dodwell:
ä Pharmacy — The report indicated that over the period of a couple years, some hospital employees were overriding a computer system in order to steal prescription medications. Dodwell said the correction plan involves more oversight and review of the system.
ä Clinical records — In November 2008, the hospital discovered that numerous confidential patient files had washed up in a nearby waterway. The documents had been stolen from the hospital, which the state determined was a breach in confidentiality. All hospital documents now must be kept in a more secure location. Dodwell said an investigation is still continuing to determine who stole the files and why.
ä Standards of care — This deficiency deals with policies and procedures around sedation of patients. DECH, when issuing moderate sedation, did not have an anesthesiologist present, which is a state requirement. Dodwell said this particular area represents a difference of opinion between hospital personnel and the state. The hospital CEO said his staff believed it was administering minor sedation, which does not require an anesthesiologist in the room.
ä Quality and patient safety — The final area identified as deficient is the hospital administration and its board of trustees for failing to meet their own quality indicators. Dodwell said more responsibility will be put on his staff to ensure that policies are administered in a way that provides quality health care in a safe environment.
While Dodwell downplayed the recent sanctions as part of doing business, Cobb said issuing conditional licenses to Maine hospitals is relatively rare. The last case was in 2005, she said.
It’s the second time in about a year that DECH has been found out of compliance by the Center for Medicare and Medicaid Services. In February 2008, after the death of Emery, the hospital was forced to address a number of deficiencies surrounding the man’s care. Emery was a former patient who checked out of the hospital against doctor’s wishes and turned up dead the next day from a combination of hypothermia and accidental drug overdose.
According to Pawelec at the Center for Medicare and Medicaid Services, the hospital came into compliance regarding the Emery case later in the year.
“It almost never happens that a hospital wouldn’t correct those deficiencies because the penalty would be a loss of agreement with Medicare reimbursement. That would likely cause a hospital to shut down,” she said.
Still, the man’s death on Jan. 2, 2008, also set in motion a series of public perception problems the hospital still faces. Later in the year, a number of physicians protested over what they felt was unfair treatment and, in some cases, wrongful termination. The Committee to Save Our Hospital formed to challenge DECH on its policies.
Annie Dickinson, one of the founding members of the Committee to Save Our Hospital, said she was not surprised by the recent actions of the state.
“They need to get their act together, and so far I haven’t seen any signs of that,” she said. “It’s a sad thing.”
Committee members have tried on several occasions to meet with hospital officials to address concerns. So far, they have been unsuccessful.
“We can’t get it through to them that we are not trying to close the hospital,” Dickinson said. “But it seems like they don’t want to work with us; they just want to make this go away.”
“From our perspective, it starts with new management and apparently new board members,” she said.
Dodwell said, from his perspective, the community concerns have nothing to do with what goes on inside the hospital.
“The fact is, there are a lot of things we are doing well,” he said. “We can always do a little better, and that’s often where these outside reviews come in.”
Cobb also stressed that while the state and federal surveys were prompted by patient complaints, they weren’t driven by any political arm wrestling Down East.
“I think one of the things [DHHS] brings is an objective approach,” Cobb said. “We’re not embedded in local politics. We can go in and take an objective look. Certainly in the last year, some complaints were valid, but there were others we could not substantiate.
The state’s conditional license is good for one year, at which point DECH can reapply for a full license, but Cobb said there is no official timeline for monitoring progress.
“The point is to monitor compliance over a longer period of time,” Cobb said. “[Down East Community Hospital’s] compliance is geared to long term viability as opposed to a quick fix.”