Springfield Hospital’s CMS certification endangered by violations

Springfield Hospital could lose its ability to participate in Medicare and Medicaid because of incidents in which health care professionals violated patients’ rights, according to an investigation.

The hospital received a termination letter from the federal Centers for Medicare and Medicaid Services in February, and an April investigation by the Division of Licensing and Protection found the hospital and its off-site psychiatric facility had violated patients’ rights.

A follow-up visit from investigators in June found the hospital to be in compliance with state and federal law, but officials were unaware of an incident just two weeks earlier where a patient’s rights were again violated.

A subsequent investigation conducted July 8 again found the hospital was not in compliance with state and federal law. A correction plan was accepted by state regulators Aug. 19, but there is a 45-day window before CMS will decide whether to issue another termination letter.

The Brattleboro Retreat, the state’s largest psychiatric facility, is also in danger of losing its CMS certification. 

The combined impact of two hospitals simultaneously losing federal funding would significantly weaken Vermont’s mental health system of care, which already has limited inpatient capacity.

Losing its provider agreement with CMS would also hurt Springfield Hospital and the patients it serves.

Springfield Hospital ignored repeated requests for an interview with hospital officials.

Anna Smith, chief of marketing and corporate communications for the hospital, said via email only that “The Plan of Correction was approved August 19th and is being implemented.”

The fact that a plan has been initially accepted by the federal government doesn’t preclude another letter of termination or a follow-up investigation to ensure the correction plan is working.

The fact that a plan has been initially accepted by the federal government doesn’t preclude another letter of termination or a follow-up investigation to ensure the correction plan is working.

Hospital officials say in a budget narrative submitted to state regulators that “Cash flow has not been adequate to support operations,” and that “Springfield Hospital has a horrible payer mix.”

A hospital’s payer mix is the distribution of payments from government programs, commercial insurers and the uninsured. Government programs, Medicare and Medicaid, reimburse hospitals at lower rates than commercial insurance and the uninsured are often given a discount.

A bad payer mix would suggest a larger percentage of people who utilize Springfield Hospital are covered by government programs or are uninsured.

In the same budget document, Springfield Hospital describes the demographics of its patients as “challenging” noting their “comparatively poor health status” and high rates of poverty, crime, drug use and low educational attainment.

The hospital describes itself as the “poster-child” for how the social determinants of health impact a small rural medical delivery system.

Springfield is designated a “Critical Access Hospital,” which means it is particularly reliant on government support and must follow a set of specific regulations to keep its federal funding. The investigation reports show the Windham Center incidents violate those rules.

The hospital will be seeking a 5.1 percent increase in net patient revenue, or $2.7 million for a total budget of $54.6 million, when it goes before the Green Mountain Care Board next week.

That would give the hospital an operating margin of 2 percent, which officials say is necessary to continue serving area residents.

The board will hear from the state’s 14 hospitals at a set of hearings Aug. 26-28.

A pattern of disregard for the rights of mentally ill patients

On Dec. 10, 2013, a patient with schizoaffective disorder and post traumatic stress disorder was involuntarily admitted to the Windham Center.

The patient had been involved in an “assaultive incident” four days earlier at an outpatient mental health facility with police involvement, records show. The outpatient agency had provided care to the individual for a decade “without incident prior to the assault.”

When the assault occurred, the patient had been off prescribed medication for nine days, the patient later confirmed. In the emergency department, prior to being admitted, the patient agreed to begin taking meds again.

The day after being admitted, the patient told staff that he/she was having trouble controlling sexual urges. But the patient continued to comply with staff and is quoted in the record saying, “…the danger has passed, I’m OK, the medication and music helped.”

The next day the patient asked to be transferred to a different psychiatric facility because he/she was having sexual thoughts about a staff member.

“During this time no additional therapeutic support was provided,” the investigation report says.

Shortly after that, the Windham Center staff decided to transfer the patient to Springfield Hospital’s emergency department. The decision was made so that sheriff’s deputies could provide additional security for the patient, who, per the investigation report, had not demonstrated violent behavior since being admitted.

The Windham Center didn’t assign additional staff to monitor the patient or use seclusion to try and avoid the transfer, the report says.

Local and state police took the person, who was still considered a patient, and without charging him or her with a crime, placed the patient in handcuffs and took the patient to the police station.

Without any clinical oversight, the patient spent more than two hours in the police station before being taken to the hospital’s emergency department.

Once there, the patient remained for eight days in a “small exam room” or ambulatory care unit, without “the therapeutic milieu of a psychiatric facility,” and under constant surveillance by mental health workers and sheriff’s deputies.

Six months later, the psychiatric facility again violated a patient’s rights when they left a patient in restraints for 12 hours and coerced him/her into taking medication.

Springfield Hosital’s budget narrative talks about the unanticipated costs of housing mentally ill patients in its emergency department as a financial burden.

In a similar incident in February 2013, a mentally ill patient who was “…whispering lying on the floor…agitated and crying” was transferred to Springfield Hospital’s emergency department without displaying any violent behavior.

The investigation concluded that both events violated state or federal regulations, and were due, in part, to understaffing at the Windham Center.

Springfield Hospital is “budgeting for a fairly significant decline” in the Windham Center’s occupancy, according to its budget narrative, which is “consistent with current utilization.”

The hospital is currently designated to take involuntary psychiatric patients in state custody, though it rarely does, said Frank Reed, deputy commissioner for the Department of Mental Health.

He did not say what it would take for Springfield Hospital to lose its designated status with the department. The hospital failed to report any of the incidents to the state as required, Reed said.

The department is working with the hospital to help bring it back in compliance with state and federal regulations, Reed has said.

Morgan True

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