Doctors, advocates slam Mission's plan to correct deficiencies; doesn't address staffing
ASHEVILLE – A coalition of local doctors, former Mission Hospital employees and advocates sent a memo to the state health department, criticizing the federally approved plan to correct serious deficiencies at the hospital.
The group sent the memo Feb. 20 to North Carolina Department of Health and Human Services Chief Deputy Secretary Mark Benton.
"While we cannot comment on ongoing investigations, staff from CMS and DHSR are onsite at HCA-Mission to determine if the hospital’s federally-approved plan of correction is in effect," an NCDHHS spokesperson told the Citizen Times in a Feb. 23 statement.
The federal Centers for Medicare and Medicaid Services declared that conditions at the hospital created an “immediate jeopardy” situation on Feb. 1. According to the CMS definition, the hospital’s noncompliance with federal Medicare regulations created put patients in danger of serious injury, harm, or death.
Mission submitted a plan to correct noncompliance with federal Medicare and Medicaid participation requirements. This plan must place Mission back in “substantial compliance” with these regulations, per federal guidelines. CMS said they found the plan acceptable in a Feb. 15 letter to Mission Hospital Chief Executive Officer Chad Patrick.
“We are pleased that CMS accepted our Plan of Correction and we will continue to collaborate with the surveyors through this process,” Mission Health spokesperson Nancy Lindell told the Citizen Times in a Feb. 23 statement.
But the group of doctors, former employees and advocates was not pleased with the plan of correction. In their memo to Benton, they argued that the hospital’s plan to correct deficiencies did not sufficiently address the fundamental source of the problem — inadequate staffing.
“HCA’s response offers only bureaucratic solutions to what is fundamentally a workforce issue,” the memo said.
The report detailing those deficiencies found that four patients who endured care that did not meet federal staffing standards ultimately died.
Comments to DHHS Re Mission Hospital POC by Mitchell Black on Scribd
“The hospital's emergency department staff failed to ensure adequate nursing staff was available to provide and monitor the delivery of assessments, care, and treatments in the Emergency Department,” the report read.
Staffing additions are small pieces of the hospital’s corrective action plan, which frequently relied on educating employees and restructuring internal processes. The hospital made some changes to the patient intake process in the Emergency Department, which has been a longstanding issue at the hospital past Citizen Times reporting shows.
More: State and federal government survey Mission Hospital after Immediate Jeopardy designation
More: Federal judge denies HCA's motion to dismiss county and city antitrust lawsuit
Mission said that the hospital added a second triage nurse during peak times, a second charge nurse for the waiting room or internal processing area. The hospital also said they would assemble two intake teams to help with “patient care implementation” and in the waiting room.
Throughout its plan of correction, Mission deploys audits that track compliance with administration of various procedures. The hospital aims for 90% compliance with complete remediation of issues sustained for three months, proceeded by quarterly monitoring for a year. These audits are tracked and reported to various internal committee and the board of trustees. The memo took issue with the target compliance levels, calling them “completely inadequate.”
Lindell did not answer a Citizen Times question about making remediation reports public.
“I do not think it builds community trust if that is an internal process,” state Sen. Julie Mayfield said at a Feb. 22 news conference, referring to the internal reports. “HCA has never sought and has affirmatively rejected outside help to address the problems in the hospital.”
The memo signers:
Dr. Clay Ballantine
Dr. Brian England
Dr. Scott Joslin
Dr. Bruce Kelly
Dr. Robert Kline
Dr. Allen Lalor
Dr. Mike Messino
Missy Harris, Pastor and former Mission Hospital chaplain
Victoria Hicks, Health Equity Coalition
Karen Sanders, RN Patient Advocate
Miriam Schwarz, former executive director of the Western Carolina Medical Society
More: Mission Hospital CMO Spensieri says he'll 'step away' after CMS cites Immediate Jeopardy
Mitchell Black covers Buncombe County and health care for the Citizen Times. Email him at mblack@citizentimes.com or follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.
This article originally appeared on Asheville Citizen Times: Asheville's Mission Hospital deficiency correction plan criticized
