Report reveals why rural KY hospital lost critical federal funding

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PINEVILLE, Ky. (WATE) – A report by the Centers for Medicare and Medicaid Services (CMS) highlights why critical federal dollars were stripped from a rural Kentucky hospital.

A letter sent to leaders of the Pineville Community Health Center notified them effective May 25, 2019, the Pineville Community Health Center would no longer receive Medicare and Medicaid reimbursements.

This blow to the community hospital came after WTVQ reported the hospital’s previous owner filed bankruptcy in 2018. Next, the City of Pineville made strides and picked up the mantle, financially, to keep the hospital afloat. Once they were no longer able to pick up the tab, a notice was placed on the front door that they were closed.

We reported the closure on August 7. The next day it reopened.

Bell County, Kentucky, Judge Executive Albey Brock told WATE 6 On Your Side that “the city has been given the opportunity to reopen.” He said after the hospital reopened, “the situation is still volatile and fluid, but we’re in a much better position that we were yesterday.”

We don’t know the arrangement that’s keeping the hospital open today, but we have confirmed CMS funding has not been restored at this time.

The report, based on a site visit by CMS inspectors in January, says the hospital “failed to protect the rights of six patients of neglect.”

Inspectors found the hospital out of compliance with many standards set by CMS including: Conditions of participation, governing body, patient rights, quality assurance and performance improvement, nursing services, pharmaceutical services, discharge planning, surgical services, and emergency services.

Report reveals details, accounts of failures

A few other takeaways from the 135-page report include interviews revealed the hospital did not provide intensive or critical care services and had no policy or procedure in place regarding the scope of the services that the medical surgical unit could provide.

A registered dietitian informed inspectors they only consulted with one patient since he had been contracted with the hospital in eight months.

The hospital failed to have a pharmacy distributor because of outstanding debt.

It failed to have required medicine, including antibiotics, intravenous fluids and medicine required for emergencies, including:

  • Verapamil (for high blood pressure, chest main, and heart arrhythmia)
  • Epinephrine (for life-threatening allergic reactions and cardiac arrest)
  • sodium bicarbonate (for cardiac arrest and metabolic acidosis)
  • only had one Activase (for blood clots in patients having heart attacks and strokes)

The hospital didn’t have an overall plan that included annual operating budget to ensure they had enough supplies, equipment, and medication for patients failed to have effective governing body responsible for conduct of hospital.

The CEO was aware the hospital didn’t have enough supplies and medicine, but didn’t form a plan.

The hospital failed to have a required institutional plan that had annual operating budget, all anticipated income, expenses and capital expenditures for a three-year period and failed to have enough supplies and medicine because of budget constraints.

Its inability to obtain cash flow left a debt with a pharmacy distributor of roughly $500,000. More debt was reported with a electronic medical records vendor of $600,000.

One physician left in October 2018 because, “continuing care at the hospital was endangering lives of his patients.” They also said, “there were times instruments could not be sterilized and staff would have to leave in the middle of a procedure to search hospital for supplies.”

The Chief Nursing Officer (CNO) and ACNO said hospital was unable to consistently meet payroll since a new CEO took over in May 2018.

That CNO said employees had their health insurance premiums withheld from their paychecks, but the hospital had not been paying premiums and staff were without coverage.

Staff planned to walk out next time they didn’t receive a timely paycheck, according to CNO.

The CEO told CMS he believed at that time the financial state of the hospital was “not that bad.”

The CEO said they changed billing companies in October 2018, and they did a terrible job and hospital’s collections had fallen off a cliff.

The hospital projected a loss of $644,748 between July 2018-June 2019.
Linen delivery was being cut back to once a month. Physicians told patients to bring medicine from home to be given while they were at the hospital.

CMS Tours the hospital

Inspectors found no functioning telemetry monitor in the emergency department nurses station (shows electrical activity of the heart).

They found zero bio-hazard sharps containers in emergency department patient rooms and found functioning pulse oximeters in eight or nine emergency department rooms.

There were not enough adequate supplies to perform casting on fractured bones due to the entire supply of casting tape expired and appropriate sizes not available to treat various injuries.

In the surgical department, inspectors found disinfectant solutions currently being used to clean and disinfect surgical rooms and instruments, expired in 2018.

The Patient Stories

Patient 1:

  • Admitted for abdominal pain
  • Signed a consent form for a EGD, which looks at stomach and upper portion of small intestine
  • Hospital, according to report, attempted to perform colonoscopy, without patient’s consent

Patient 2:

  • Admitted for chest pain
  • Hospital did not have cardiology services available or intensive care unit to monitor patient
  • Facility didn’t conduct heart testing, blood pressure monitoring, or lab testing to monitor their heart status, which was ordered by doctor
  • On second day, patient developed heart arrhythmia, but the hospital failed to notify patient’s physician
  • Not transferred to acute care facility until 34 hours after initially coming to emergency room

Patient 3:

  • Came to emergency room with severe left foot pain in December 2018, both feet and little toe were blue and cold
  • Emergency Department physician ordered lovenox (to prevent and treat blood clots) and zosyn (antibiotic)
  • Staff did not give medicine until 24 hours after it was ordered
  • Staff found a blood clot in a leg artery that was blocking blood flow
  • Hospital admitted patient although resources were unavailable to care for patient,
  • Staff didn’t transfer them to a hospital with ability to treat blood clot for nearly two days

Patient 4:

  • Admitted for congestive heart failure and diabetes in January 2019
  • Hospital didn’t give the patient needed insulin because it was unavailable
  • Physician ordered to be notified when patient’s blood glucose was above 200
  • Report shows two documented instances the patient’s sugar was above 200, without physician being notified

Patient 5:

  • Came to emergency room with fractured hip
  • Staff found a blood clot
  • Staff failed to assess and treat wounds to patient’s leg and burns on their fingers
  • Staff failed to feed patient for two days
  • Patient weight: 95 pounds
  • Patient also found to have critically low potassium level
  • Physician ordered STAT (immediate) medication for potassium, blood clots, and pain
  • Patient wasn’t given medication for another hour and half
  • Nurse told CMS inspectors she was late giving the patient medication because the hospital didn’t have the appropriate equipment needed to access their catheter

Patient 8:

  • Admitted to medical surgical unit in January 2019, with signs of stroke
  • Hospital did not have a neurologist or speech/occupation/physical therapy services
  • Physician failed to transfer patient to another hospital for neurological assessment until the day after admission
  • Nurse says doctor told her, “don’t call me back anymore…we’ll sit on it tonight and transfer him/her out tomorrow.”
  • Nurse said the patient “should have never been admitted here and the Doctor put his/her life in jeopardy.”

Patient 10:

  • Came to emergency room with very high blood pressure with signs of stroke
  • Did not receive medical imaging, including a non-contrast head computed tomography scan, until after being admitted to the medical/surgical floor for five hours after arriving

Patient 11:

  • Admitted to surgical services in September 2018 for treatment of gall stones with pain, nausea, vomiting
  • Emergency department’s physician was uncertain if anesthesia was available
  • The next day, a gastrointestinal specialist recommended to transfer patient “where they can do surgery.”
  • Hospital didn’t transfer patient for three additional days
  • Physician admitted to CMS the patient should have never been admitted to the hospital, they were unable to meet their needs

Patient 12:

  • Came to hospital in December 2018 with full cardiac arrest
  • On two occasions, patient required multiple doses of epinephrine to keep the patient alive
  • Hospital failed to have enough to treat the patient, so medicine came from emergency medical services

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