Surveyors from the Centers for Medicare & Medicaid Services are expected to finish their inspection of Dallas-based Parkland Memorial Hospital later this summer. A civil suit stemming from the death of a patient has been approved to proceed by a federal judge.
The patient death that sparked a federal investigation into Dallas–based Parkland Memorial Hospital could continue to shape the hospital's safety policies long after surveyors from the Centers for Medicare & Medicaid Services finish their inspection of facility later this summer.
U.S. District Judge David Godbey issued a 36-page ruling last week that the federal civil suit brought against Parkland by the deceased patient's mother, Jane Pena, may proceed, based on her claims that her son's civil rights were violated.
Pena's son, 49-year old George Cornell, died in a seclusion room at Parkland in February 2011. Cornell had schizophrenia and arrived at the hospital complaining of chest pains. After being admitted, three psychiatric technicians allegedly held Cornell down on the ground of the seclusion room for 15 minutes to administer anti-psychotic drugs, then left him there without being monitored. He later died.
Pena's suit names the three technicians as well as hospital leadership who were ousted after the incident, including former CEO Ron Anderson, MD; former CMO John Jay Shannon, MD; and former nursing director for psychiatric services, Nancy Schierding, RN, MSN.
An investigation of Cornell's death by the Dallas Morning News caught the attention of CMS, which found numerous patient safety violations upon inspection and led to Parkland's systems improvement agreement, an action CMS reserves for hospitals with the most egregious errors.
The SIA required a third party to be onsite while Parkland's corrective action plan was being implemented. It's the only way the hospital was able to continue receiving Medicare reimbursements, which is still at stake until CMS agrees that Parkland has sufficiently improved.
The hospital has been preparing for the CMS inspection for 18 months. By April, the hospital proclaimed it was ready for CMS surveyors. They had said they'd be onsite by April 30, but then changed course. Instead, CMS inspectors showed up June 17, but left after only five days on June 21, without finishing their inspection.
David Wright, deputy regional administrator for CMS, did not say why surveyors left mid-inspection, only that they will return.
"The survey is still ongoing," says Wright. "Surveys always include both onsite and offsite reviews of information, and we can go back at any time, which allows us to have a more comprehensive sample in terms of both time and findings."
Wright says at least 14 CMS surveyors were at Parkland for a top-to-bottom inspection of changes. The date of their return remains unknown to hospital officials, just as the initial visit was.
"They will not tell us when they are going to return," says Mike Malaise, interim senior vice president of external affairs for Parkland. "That's part of the surprise element."
To get ready for the CMS survey that determines whether Parkland will continue to receive federal funding, the consulting firm that oversaw the hospital's CAP surprised Parkland staff with two mock surveys. The results of those surveys are confidential, though Malaise says the hospital has improved significantly from 2011 when an analysis found that patients were in imminent danger.
"Everything we have done has steadily made this a safer place for patients," says Malaise.
It's not clear what parts of the hospital CMS surveyors spent time in while they were onsite in mid-June, though Malaise says they looked throughout the system. Parkland's offsite locations are also covered under the SIA, so surveyors can inspect clinics, physician offices, and the Dallas County jail, where Parkland oversees the healthcare of inmates.
While Cornell's death sparked a massive investigation into the hospital, its patient safety practices, and culture as a whole, it is not the first time Parkland has faced federal review for treatment of psychiatric patients.
The Joint Commission reviewed two other cases in which psychiatric patients died in 2010. The Texas Department of Health also hit Parkland with a $1 million fine in 2012 for patient safety errors and other issues that included the sexual abuse of a patient by a nurse.
In addition to the nearly 500 action items in Parkland's CAP that address CMS concerns, the hospital is attempting to drive change by tying compensation to performance. It's a practice that Parkland previous engaged in but abandoned the same year CMS began its oversight. The Dallas County Commissioners Court has final say over approving a bonus plan; the hospital's board also has not approved the measure.
Parkland officials are under tremendous pressure to regain their footing with CMS and the public. The findings from CMS are expected to be issued before the end of August.
"We did complete the action items that were within the corrective action plan," says Malaise. "Clearly the hospital is higher quality and a safer place than it was two years ago. We're hopeful that the results come back and reflect that.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.