LEWISTON — Central Maine Medical Center leaders say they are correcting problems recently cited by federal investigators and are implementing, among other things, staff training, protocols for when a patient has chest pain or spine problems and changes to when and how emergency patients are seen.
The hospital has until June 30 to fix its issues to the satisfaction of the Centers for Medicare & Medicaid Services or lose payments for Medicare and Medicaid patients.
“We feel that if CMS was to come in today, they would find we are fully in compliance,” said John Alexander, chief quality officer for Central Maine Healthcare, CMMC’s parent organization.
The hospital turned in its required correction plan last month. CMS released it to the Sun Journal on Monday.
The 10-page plan calls for the hiring of Massachusetts-based consultant, The Greeley Co., to help the hospital correct its problems.
It also calls for clarifying and enhancing emergency department processes, including promptly evaluating anyone with cardiac chest pain, adding a triage nurse from 10 a.m. to 10 p.m. and deploying nurses or doctors to the emergency department’s waiting room during busy times to help with triage, patient monitoring and getting patients to beds.
The plan also entails changing the way medical orders are issued for patients with spine problems, requires training reviews for medical staff and requires emergency nurses to show they understand spinal precautions, particularly the danger of raising the head of a spinal patient’s bed.
“This deficiency reflects variation in the understanding of spinal precautions, since multiple staff members did not seem to recognize that elevating the head of a spinal injury patient’s bed is usually contraindicated,” the correction plan read.
A January investigation by CMS found a number of problems at CMMC, including: The failure of hospital leaders to ensure that a life-changing medical error was thoroughly reviewed; the failure of hospital leaders to prevent that error from happening in the first place; the failure of the hospital to identify and address documentation disparities in that patient’s medical record; and multiple failures by the hospital to stick to its own policy on patient grievances.
Much of the January report centered on a patient who had fallen and was brought to CMMC’s emergency department by ambulance on the morning of Oct. 4, 2018. At CMMC, according to the report, the patient complained of neck pain, back pain and numbness to the right half of his abdomen and down his right leg. A CT scan showed a skull fracture and a small fracture with fragments to one of the bones in his neck.
A trauma surgeon had the patient move his head and neck “in every possible way” to determine range of motion, “contrary to the standard of care for a patient with a known cervical fracture,” according to the report. Later, a nurse raised the head of the patient’s bed, forcing him to sit up at a 45-degree angle, while a family member protested that a doctor had ordered the patient to remain flat.
As the nurse raised the bed, the patient screamed in pain. He was left paralyzed.
Additional investigations in March and April found more or continuing problems at CMMC, including failure to ensure medical records were accurate and failure to document whether patients had an advance directive to guide their treatment.
The March investigation also found CMMC, which includes a nationally accredited heart center, failed to care for a patient who arrived in the emergency department at 5:13 p.m. on Jan. 22 with chest pain, dizziness, shortness of breath and blood pressure so high it met the American Heart Association‘s criteria for a “hypertensive crisis.”
The patient received an EKG within seven minutes, and that test came back normal. However, according to the report, nothing else happened for almost two hours. The patient never saw a medical provider and left.
If CMMC does not fix its problems to the satisfaction of CMS, it stands to lose tens of millions of dollars a year, a sizable portion of its revenue. It would also force MaineCare patients who use any of the 50 clinics and medical practices associated with CMMC to find new places to get their health care.
Hospital officials remain adamant that will not happen. Alexander said many of the changes listed in the correction plan are already done.
Investigators will make another unannounced visit to the hospital to help determine whether CMMC is moving in the right direction.
CMMC is the flagship hospital of Central Maine Healthcare, one of the largest health systems in the state. The system has been in turmoil for months, including votes of no confidence in system CEO Jeff Brickman, the resignation of the president of the Bridgton and Rumford hospitals, the exodus of medical professionals across the system, a call from a citizens’ group for the system to pull out of Bridgton and the April resignation of board member Phil Libby.
CMHC also recently lost two top officials, however hospital leaders say neither loss was due to the recent turmoil. Ryan McKeown, vice president for strategy and managed care, resigned last month. Chief Financial Officer David Thompson resigned last week.
Michelle Talka, head of human resources, said McKeown left because his wife recently had a baby and he wanted a better work-life balance. She said Thompson is returning to Colorado “for the sake of his own career, business interests and family interests.”
Both men started in 2017. Talka said that length of employment is not unusual.
“In organizations this size, people come and they go,” she said. “These days, three years is about your average tenure in any organization.”
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