By Tonya Fennell: CNJ Staff Writer
Plains Regional Medical Center has received 26 citations for violating federal regulations, according to a federal report issued after a May investigation.
The extensive investigation was performed by the Centers for Medicaid and Medicare Services, a division of the U.S. Health and Human Services Department whose mission is to improve quality of care and health outcomes for individuals with Medicaid or Medicare benefits.
The Clovis News Journal previously reported the results of a February survey in which the Clovis hospital was found to be deficient in 13 federal requirements. The February survey found deficiencies in improper disposal of infectious waste and inadequate training for contracted service providers. Registered nurses at the hospital were also found to be administering sedatives without proper training, and restraint of patients was not properly documented. Patient meals and discharge procedures were also found to be insufficient.
According to CMS spokesman Dodjie Guioa, the February investigation was a “for cause” survey fueled by a complaint against PRMC. Guioa said CMS initiates “for cause” surveys when a patient, news source or relative issues a complaint against a health care facility. “If we (CMS) pick up something that concerns to patient care,” Guioa said, “then we conduct a survey.”
Since the February “for cause” survey found the Clovis hospital to be deficient, the May “full” survey was launched, Guioa said.
New hospital administrator Hoyt Skabelund said many of the infractions found in the May inspection were due to paperwork.
“We (PRMC) were providing good care,” Skabelund said, “but the written policies were not updated.”
According to the CMS report, after randomly reviewing 38 patient records, the hospital was cited for two incidents involving patient care.
The first incident involved a patient with a terminal prognosis. The patient was admitted to the hospital in severe respiratory distress with physician’s orders for “comfort care only.” According to the report, the pain medication dispensed was not sufficient to relieve the patient’s distress.
Guioa called the incident serious and said it indicates PRMC is not meeting patient needs. “This (citation) deals with patient’s rights,” Guioa said.
Skabelund said the incident surprised the hospital administration. “Hopefully it was an isolated incident.” Skabelund said the hospital plans to have the medical staff review pain management protocol with classes or online training in the next 60 days.
The second patient incident involved a child, also terminally ill, who arrived at PRMC’s Emergency Department with airway problems. According to the CMS report, the hospital ED physician allowed the ambulance company to provide care for the child. Three attempts were made by ambulance personnel to create a clear airway via intubation.
Skabelund said he is concerned about the incidents and said hospitals are a life or death business. “Was there anything else we could have done (in these cases)?” Skabelund asked. “Who knows?”
According to the administrator, corrective action is being taken to resolve the issues by conducting thorough in-house audits and by providing additional training to medical personnel. Skabelund added the airway patient has become a case to study and learn from.
According to the CMS report, the hospital was also cited for failing to appoint the interim administrator as chief executive officer. PRMC Board of Trustees Chairman Gayla Brumfield said the task was performed but the board meeting minutes failed to document the appointment.
“There will be much more thorough minutes now,” Brumfield said. “We (Board of Trustees) will be taking a more stringent approach to things.”
Guioa said PRMC has 90 days to come into compliance or face termination from Medicaid and Medicare eligibility. “The likelihood of a hospital not meeting compliance is very low,” Guioa said.
Skabelund said the hospital is diligently working to correct the deficiencies.
“Clinically we are competent,” Skabelund said, “but we want to improve our patient’s perspective (of PRMC).”
Brumfield said she considers the PRMC staff to be fantastic. “There is always room for improvement,” she said, “but we are on top of it and addressing it.”
Skabelund said many of the citations were issues already being addressed by the hospital. The administrator said his future goal for the facility is to retain employees and provide good quality health care.
“Health care is a journey,” Skabelund, “not a destination.”