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Parkland Hospital Submits Plan to Remedy Deficiencies, Protect Funding

 |  By Margaret@example.com  
   August 22, 2011

At a specially called board of managers meeting Friday, officials at Parkland Health and Hospital System in Dallas, TX unveiled a corrective action plan to address deficiencies that federal officials said represent “an immediate and serious threat to patient health and safety.”

The plan addresses deficiencies discovered during an eight-day review conducted by the Centers for Medicare & Medicaid Services and the Texas Department of Health Services.  If unresolved, the problems at Parkland Hospital could cost the system some $417 million in Medicare and Medicaid funds out of its annual budget.

Problems with infection control and emergency room care were among nine broad categories of deficiencies discovered in July at the safety-net hospital during the review. State health officials requested the review following the death of a patient in Parkland’s psychiatric emergency department. The hospital had failed to report the death to federal and state regulators as required by law.


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In an August 9th letter to the health system’s CEO, Ron Anderson, MD, officials at CMS identified deficiencies and gave the health system until August 24to develop a corrective plan.

The letter said that because of the deficiencies, the health system “no longer meets the requirements for participation in the Medicare program,” and it warned that failure to submit acceptable plans of correction would result “in your termination from the Medicare program effective Sept. 2.”

Because the Medicare and Medicaid programs have similar requirements,  Medicaid funding also was in jeopardy, the letter noted.

According to media reports, this year Parkland expects to receive about 50% of its patient revenue or $226 million from Medicare and Medicaid payments. It also receives about $191 million in Medicaid disproportionate share subsidies. The total from both programs – $417 million – represents about 35 percent of Parkland’s total annual budget.

With the letter, CMS and Texas officials released to the hospital more than 600 combined pages detailing their findings. The reports, annotated by Parkland to indicate corrective measures, were made available to the public Friday evening.

The CMS report may be viewed here
The Texas report may be viewed here.

Among the deficiencies:

  • Failure to dispose of soiled gloves and gowns and wash hands after treating patients
  • Failure to properly dispose of infectious waste, including used syringes, body fluids, used respiratory equipment and used suction equipment
  • Lack of stabilizing treatment in emergency department before a transfer to another acute care facility
  • Lack of ER screening by a qualified medical professional
  • Failure to identify or assess emergency severity index
  • Medical residents unsupervised during clinical care by either an attending physician or faculty member
  • ER patients in a high level of pain provided with maps and directed to go to other parts of the hospital for treatment without benefit of any other assistance
  • Failure to provide 24-hour nursing services
  • Failure to change bed linens between emergency room patients
  • Failure to dispose of expired medications

Hospital officials separately addressed each deficiency and identified the steps Parkland Hospital will take or has already taken to correct the problems, including:

  • Requiring medical screening for every patient entering the ER
  • Revising medical staff rules to require medical screening to be performed by a qualified medical professional
  • Requiring transfer certification and consent and a memorandum of transfer be completed for any ER patient transferred to another facility
  • Assigning escorts to help patients move from one section of the hospital to another
  • Implementing a medical management bar coding system to managing supplies and drugs
  • Hiring at least 10 additional nurses
  • Enforcing infection control procedures to reduce contamination
  • Setting up preventive maintenance program to keep equipment in working order

In statement posted on Parkland’s website on Friday night, CEO Ron Anderson provided some additional insight into the steps the hospital is taking to rectify the issues cited by CMS and the state. “Mandatory training and re-education is under way for all employees and medical personnel. Monitoring of employee practices for compliance has begun. For instance, infection prevention education sessions are being held every hour, on the hour for six days to reiterate the proper disposal of personal protective equipment and hand hygiene.”

CMS will review the corrective action plan this week. If approved, another review will be conducted before Sept. 2. In an interview with the Dallas Morning News, David R. Wright, acting deputy regional administrator for CMS explained that after the second review “If the immediate jeopardy continues or there is identification of new immediate jeopardy, the hospital will be terminated on September 2. If inspectors determine there is no longer any immediate jeopardy to patients but that some problems still exist, CMS would issue Parkland another plan of correction deadline.”

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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