PA Hospital's Deficiencies Detailed in CAP

Beleaguered Saint Catherine Medical Center, which filed for Chapter 11 bankruptcy earlier this week, owes 76 vendors an estimated $2.3 million according to a document released by the Philadelphia office of the Centers for Medicare & Medicaid Services.

draft of corrective action plan for SCMC

The document also notes that syringes and saline solutions are in short supply and that preventive maintenance is behind schedule for critical pieces of medical equipment such as an EKG, ventilators, and a defibrillator.

The debts, supply shortages, and equipment problems were discovered during a complaint survey conducted at the Ashland, PA facility on March 27 on behalf of CMS by the Pennsylvania Department of Health. According to state and federal officials the deficiencies and violations placed patient health and safety in immediate jeopardy.

As a result, the state placed a ban on new admissions to Saint Catherine, as well as surgical services, emergency, and outpatient procedures at the 67-bed hospital. Although the medical center is still licensed, there are no patients at the facility.

In an April 3 letter to Merlyn Knapp, the medical center's CEO, CMS officials said the medical center's Medicare agreement "will be terminated by April 19 if the immediate jeopardy has not been removed."

The CMS document released to HealthLeaders Media includes the findings of the original survey as well as Saint Catherine's corrective action plan (CAP) to address the deficiencies.

Typically, CAPs address each deficiency and provide a timeframe for resolution. In its April 3 letter CMS specifies that "to forestall termination of your facility's Medicare provider agreement, it must be determined that the hospital has removed the immediate jeopardy prior to April 19."

The completion date stated in the CAP for resolving each deficiency, however, is May 10.

According to a CMS official "the plan of correction would not constitute a credible allegation of compliance for federal purposes for the simple reason that the correction date is 16 days after the (Medicare) termination date."

Figures from the Pennsylvania Health Care Cost Containment Council indicate that in 2010 Medicare accounted for 49% of Saint Catherine's $22 million in net patient revenue.

The deficiencies indentified in the 51-page survey fall into five broad categories: radiologic services, physical environment, surgical services, compliance with laws, and governing body. Extensive shortages of medical supplies are noted, including a lack of syringes and needles in the intensive care unit and the lack of catheter kits used in the ER to measure blood flow pressure in the heart.

In addition a review of the medical supply room revealed no surgical gloves available, no medicated soap, no disposable bed pans, no paper or durapore tape, only 1 safety glide 22 gauge syringe (101 were supposed to be in stock), and 22 bags of one-half normal saline (64 were supposed to be in stock).

The medical supply shortages were directly related to vendors refusing to provide supplies until the medical center settles its debts. The blood supply vendor requires cash on delivery for any orders. An operating room orthopedic equipment supply vendor placed the facility on hold until its almost $20,000 outstanding balance is paid in full.

Delays in preventive maintenance and equipment repairs are also related to vendor debts. The facility's preventive maintenance vendor placed the medical center on hold until an $18,118 is settled. The diagnostic scope service vendor has taken a similar step over an almost $6,000 debt.

Day in and day out operations of the investor-owned, acute-care facility are also affected by the outstanding debt situation as vendors for coal heating, water company, electricity, phone service, the computer system, carpet cleaning, elevator inspection and repair, answering service, office equipment, and food supply take steps to recoup money owed to them.

Other deficiencies and violations identified in the survey include:

• Failure to transfer emergency room patients to other facilities in a timely manner
• Failure to ensure that the x-ray equipment is properly calibrated
• Failure to dispose of expired medications
• The continued use of expired lab testing supplies
• Excessive humidity levels in operating rooms
• Failure to conduct preventive maintenance on operating room anesthesia machines
• Failure to prepare and for the board to accept an annual operating budget for 2012
• Consistent delays in the payment of employee federal tax withholdings, and Social Security and Medicare payroll deductions as required by law.
• Continuing to deduct from employee paychecks the payments for long-term disability insurance although the policy was terminated in August 2011 due to nonpayment.
• Suspending payments to the employees' 401K vendor without notifying employees.

The survey identifies several instances when the deficiencies or violations may have directly compromised patient care:

• The ER staff was unable to monitor the heart rate or blood oxygen levels of an 18-day old infant because there were no pediatric/infant electrodes or a pulse oximetry machine available in the ER.
• A ER patient requiring advanced cardiac life support waited two hours for a transfer to another hospital
• The fire alarm system vendor cancelled the service for nonpayment. For four months Saint Catherine didn't have central station fire alarm monitoring however staff was never informed that they would need to call the fire department to report a fire at the hospital.

Medical center officials addressed the steps they plan to take to correct the problems, including:

• Present a monthly progress report to the board
• Correct all state and federal deposits in arrears by May 10
• Develop an annual operating budget
• Set up payment plans with each vendor until outstanding balances are met or alternatives in place.
• Monitor patient transfer times with a goal of less than one hour for a transfer
• Schedule preventive maintenance and repair; remove any equipment not meeting the schedule from daily use
• Institute a daily monitor for all blood bank reagents
• Repair the ventilation system and air handlers in the surgical services department

Holli Senior, a spokesperson for the DOH, told HealthLeaders Media in an e-mail exchange that before Saint Catherine can reopen "it must address all of the deficiencies cited on the 2567 (survey)."
According to the Office of General Counsel at CMS, Saint Catherine's Chapter 11 filing will not "have any effect on CMS's termination action."

Saint Catherine officials have not responded to repeated requests for comment.

See also: PA Hospital's Financial Woes Trigger Harsh Repercussions