Greenville Memorial Hospital may lose Medicare coverage – Greenville News
Greenville Memorial Hospital’s Medicare contract is in jeopardy after a federal review into the death of an emergency room patient turned up a variety of problems that hospital officials say they’re working to correct before an April 16 deadline.
An audit by a federal regulator who oversees patient safety under Medicare found that security officers improperly restrained a 48-year-old patient who died because he couldn’t breathe.
Auditors with the Centers for Medicare and Medicaid Services investigated after they received a complaint about the death of Donald Keith Smith, who died March 6 after security officers strapped him to a gurney during an altercation, said April Washington, spokeswoman with the CMS regional office in Atlanta.
The audit found deficiencies in multiple areas of hospital care that could cause Greenville Memorial to lose its Medicare contract next month if it doesn’t correct its deficiencies, which would put payment for the medical care of an untold number of patients at the hospital at risk.
Any potential loss of Medicare coverage would affect all Medicare patients at Greenville Memorial but wouldn’t affect any other GHS affiliated hospitals, practices or doctor’s offices, according to Scott Sasser, chair of emergency medicine for the Greenville Health System.
The move by the federal Medicare regulators is meant to show the public that the hospital failed to protect the health and safety of its patients, Washington said.
Smith died as a result of traumatic asphyxiation, meaning he was unable to breathe, due to the position he was placed in on a gurney, said Coroner Parks Evans.
The State Law Enforcement Division is continuing to conduct a criminal investigation into Smith’s death and the hospital system has removed the security officers involved from the hospital.
The audit was conducted by The Centers for Medicare and Medicaid Services beginning on March 13 and found deficiencies in three areas of emergency services – its governing board, patient rights and nursing services, Sasser said.
The site survey and each of the three areas of deficiencies were related to a review of the incident that led to Smith’s death, Washington said.
Sasser said he couldn’t comment on the specifics of the site visit due to patient privacy laws. He said he couldn’t comment on its relation to Smith’s death because the incident is still under investigation.
He also wouldn’t speak in general about the deficiencies found, again citing the Health Insurance Portability and Accountability Act.
“I can’t really comment on that any further because they involve individual patients,” Sasser said.
Auditors reviewed a video recording of the incident, conducted interviews, and reviewed the hospital’s policies and determined that “the hospital failed to ensure that the nursing personnel and the contracted security staff followed hospital policies and procedures for aggression management and physician orders related to restraints and holds,” Washington said.
“The security officers failed to perform a safe takedown hold in that the patient’s upper body was positioned face down on the bed and there was no clinical assessment of the restrained patient throughout the incident to ensure the patient’s safety,” she said.
Smith was put into a four-point restraint on a gurney and received an injection without any clinical assessment, she said.
As a result, Greenville Memorial could have its Medicare contract involuntarily terminated by CMS if it doesn’t correct its deficiencies, she said. The announcement was first posted as a legal notice that ran in The Greenville News on Tuesday.
The notice said the agreement between Greenville Memorial Hospital and the Secretary of Health and Human Services, would end April 16 due to compliance issues at the hospital.
Medicare would stop making payments for patient care on April 16, Washington said.
The hospital is making changes to its processes in an effort to keep its Medicare coverage and show the regulators it has a plan in place to correct deficiencies, Sasser said.
Sasser said he couldn’t discuss details of the deficiencies found in his department due to patient privacy laws. The GMH action plan for the emergency department includes strengthening clinical documentation processes around patient care, increasing staffing and providing more intensive training.
The hospital is still accepting Medicare and is confident its action plan will satisfy regulators, Sasser said.
In order for a hospital to participate in Medicare, it must meet certain conditions. Auditors can show up for a site visit at any time to examine conditions. Greenville Memorial officials said the site survey came after the hospital notified CMS that it had identified potential areas for improvement in the emergency department. Sasser said he didn’t know exactly how many total violations auditors found or how many patient cases CMS audited.
“We are committed to implementing our action plan that ensures that we meet all requirements and that there is no interruption in Medicare funding and patient care,” Sasser said.