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Deadline suspended for Missouri hospital facing second ‘immediate jeopardy’ finding this year

A hospital in Missouri had been given until September 22 to bring its operation into compliance with the CMS Conditions of Participation (CoP) after surveyors last month found significant problems pertaining to nursing services and patient rights. That deadline has been suspended, however, as federal regulators review the findings of a follow-up visit.

State surveyors returned last week to Mercy Hospital Springfield to determine whether the facility has fixed the problems that led to the “immediate jeopardy” findings in August, a spokesperson for the CMS regional office in Kansas City said this week. Suspending the deadline gives CMS time to review what the follow-up surveyors found, the spokesperson said.

In early September, the hospital announced that it had recently fired 12 employees after determining that their behavior in “highly tense situations” had been inadequate. Remaining staff members would receive additional training on de-escalation techniques and preventing patient abuse and neglect, the hospital said. The following week, an interim leadership team [1] stepped in.

“Everything we’re doing is to ensure the well-being and safety of everyone, including our co-workers,” hospital spokesperson Sonya Kullmann said.

Details from the August inspection are not yet publicly available, but records obtained via the Missouri Sunshine Law and the federal Freedom of Information Act indicate that Mercy Hospital Springfield has struggled recently to recognize incidents of possible abuse and neglect. The Missouri Department of Health and Senior Services and CMS each released the findings of a complaint investigation conducted in early January and the hospital’s subsequent plan of correction. (To review the 219 pages of records released by the state, download the PDF [2].)

In January, surveyors faulted the hospital’s Behavioral Health Unit (BHU) for failing to properly handle certain tense situations, including one incident that involved a scuffle between a nurse and a patient diagnosed with schizoaffective disorder, as previously reported by HCPro’s OSHA Healthcare Advisor [1]. The newly released documents reveal that the nurse, who “slammed the patient to the floor,” was placed on administrative leave before the survey concluded. The nurse returned two weeks later to review video footage of the encounter, and he acknowledged that he had contributed to the escalation with the patient, the records state.

Prior to returning to patient care, the nurse was to complete required training on de-escalation, preventing abuse and neglect, and other topics; meet with his manager weekly for four months to discuss opportunities for improvement; and satisfy other requirements. After returning to work, he was to lead two educational in-services with his peers concerning proper ways to interact with volatile patients. As of February 16, however, the worker was terminated, the records state.

An entry on February 24 indicates that the behavioral health nursing director and nursing manager would be required to undergo additional education on recognizing and reporting potential abuse and neglect with BHU patients.

A follow-up visit in April determined that the hospital was once again compliant with the CoPs pertaining to patient rights, quality assessment and performance improvement programs, and nursing services. Although the condition-level deficiencies had been corrected, the April survey issued standard-level citations pertaining to patient rights. Three patients held in seclusion in the emergency trauma center were secluded without adequate supervision and without being separated from equipment and supplies in the room that the patients could use to harm themselves, such as suction tubing, phone cords, and similar items, according to the records.

The CMS spokesperson said the investigations in January and August were each in response to separate complaints. Other than the follow-up visits in April and September, there were no other CMS-directed investigations at Mercy Hospital Springfield in 2017.

It’s not uncommon for a hospital to have multiple complaint investigations in a single year, the spokesperson noted.