MACHIAS, Maine — A recent probe into complaints at Down East Community Hospital uncovered procedural failures in emergency room treatment, once again putting the health care facility under heightened scrutiny by federal and state agencies.
A nine-page document prepared recently by the Center for Medicare and Medicaid Services, or CMS, showed that on Oct. 3, 2008, the hospital staff failed to recognize the life-threatening severity of a patient’s condition when he arrived.
The document further showed that DECH failed to adequately stabilize and transfer the same patient and failed to have an adequate system in place to identify problems within the emergency department.
The unidentified patient died a week later after being transferred to a hospital in Bangor. There was no way to conclude that the patient’s death was a result of treatment, or a lack thereof, at DECH, according to federal officials.Perhaps the most damning revelation in the CMS report came from an unidentified but high-ranking DECH staff member.
Asked by federal authorities about ensuring a uniform quality standard, the hospital official said, “No, I can’t guarantee that each patient gets the quality of care that they need here in the emergency department.”
The hospital official further stated, “If you are finding that many patient concerns then I agree, our systems don’t work.”Robin Popp, spokeswoman for the Machias hospital, declined to comment Tuesday on the report because officials are still conducting a full federal survey of the hospital. The survey is expected to be concluded by the end of this month.
“Out of respect for that process, we’re going to wait to comment,” she said.The Center for Medicare and Medicaid Services is a federal agency responsible for administering Medicare, Medicaid and other health-related programs to ensure compliance with certain federal regulations.
In most cases, Maine Department of Health and Human Services officials are sent to conduct investigations on behalf of CMS, but those officials investigate on behalf of the state agency as well.
According to the most recent statement of deficiencies, a patient was taken by ambulance to DECH’s emergency room on Oct. 3. The patient had been drinking and fell down a flight of stairs. He was unresponsive and exhibiting spasmlike contractions. Based on the report, which referenced records at the hospital, the patient was classified as “urgent” rather than “emergent,” categories that determine how soon a patient is seen by a physician. If the patient had been classified appropriately as emergent, he likely would have been seen sooner.
When he was seen, a neurological exam was conducted and a determination made to transfer the patient to Eastern Maine Medical Center in Bangor. The patient was transferred by LifeFlight helicopter and the LifeFlight crew installed a breathing tube. A hospital official later admitted, according to the CMS report, that a tube should have been installed right away.
There was no information in the report about the patient’s care from the time he was transferred to EMMC until his death on Oct. 11. It’s also not clear whether the patient’s death was the impetus for the state and federal investigations, which were conducted jointly in March.
However, because of investigations of the Oct. 3 incident and the subsequent statement of deficiencies, DECH was required to submit a plan of correction.
“As a result of an investigation that identified an immediate jeopardy, we worked closely with the hospital to develop a plan to address this,” explained Catherine Cobb, director of the Maine Department of Licensing and Regulatory Services, a division of DHHS.
“One thing I would say is that I heard the right things from the hospital about a new quality plan. We hope they can show us a willingness to sustain that quality effort.”
The plan of correction totals nearly 200 pages and features a comprehensive review of the hospital’s emergency room policies and procedures.
Cobb said the most important facets of the plan are the creation of a task force on emergency services and the hiring of an additional emergency room physician to take pressure off the emergency room director.
There may be additional sanctions or restrictions on the hospital once the full federal survey is completed.
“The most important thing that has to happen is, the hospital has to prove that they have altered operations so as not to put patients in jeopardy,” said Roseanne Pawelec, a regional spokeswoman for CMS.
Since authorities were still conducting their survey on Tuesday, it is not certain whether the hospital has complied. Pawelec said full federal surveys are relatively rare but are required when a hospital is cited as being out of compliance with CMS. This is the third survey involving DECH within the last 15 months.
While all hospitals face state and federal probes from time to time, concerns have ramped up in Machias since an incident in January 2008.
Reid Emery, a former patient who checked out of the hospital one snowy night, was found dead in a snowbank near the hospital the next day from a combination of hypothermia and an accidental drug overdose. Emery’s death prompted an investigation by both the state and CMS, which found several deficiencies in regard to the Eastport man’s care.
DECH spent several weeks instituting changes in policies to come into compliance.
In February, after a lengthy investigation into numerous complaints, DHHS ordered the hospital to operate on a conditional state license, an action it said was necessary to protect the interests of the general public.
At the time, Cobb said investigations found serious violations in the areas of pharmacy, clinical records, standards of care and quality, and patient safety. CMS threatened to sever ties between DECH and the Medicare reimbursement process.
The hospital responded by working quickly to address those deficiencies, but it remains on a conditional license and will be monitored regularly for the next year.Amid the many concerns and investigations, DECH also has had problems with retaining and recruiting physicians.
A community group, the Committee to Save Our Hospital, has formed in response to what it feels has been unfair treatment of doctors and staff at DECH. Its members have picketed outside the hospital on multiple occasions and held a forum last month hosted by a national expert on the phenomenon of “sham peer review.”
Some physicians who have been fired or dismissed believe they were the targets of sham or bad-faith peer review and at least two have filed lawsuits against the hospital. Several other physicians have resigned amid the internal turmoil.
“Clearly, our department has been concerned about the hospital since we put them on conditional license [in February],” Cobb said. “We’ll continue to monitor their progress closely.”
Cobb also said that during the last visit to investigate the Oct. 3 incident, the state investigated additional complaints. Results of those investigations are pending.