Eastern State Geriatric Center Loses Certification

By Amber Lester Wednesday, September 15, 2010

The Hancock Geriatric Treatment Center has lost its Medicaid and Medicare certification.

CMS decertified the facility Sunday after a series of inspections beginning in March identified 15 health care deficiencies, nine of which have not yet been corrected. The 150-bed Hancock Center has 30 days to come into compliance with federal regulations, or it will lose its federal Medicaid matching funds.

Virginia Secretary of Health and Human Resources Bill Hazel sent a letter to state legislators notifying them of the decertification on Sunday. In his letter, he said the state has already reached out to families to let them know they have the option to transfer their family members to another facility.

Hazel learned of CMS’s decision on Friday and made an unannounced visit to the facility on Saturday morning. With Acting Director Olivia Garland and several other state personnel, Hazel inspected the facility, spoke with patients and staff, and questioned Acting Medical Director Guillermo Schrader. He also reviewed the CMS website’s ratings of the facility, and read an inspection report completed in June 2010 by the Virginia Office of the Inspector General.

Hazel is also planning to have a geriatric psychiatry expert review the standard of care at Hancock in the next week. The goal is to identify areas for improvement and correct them as soon as possible in order to pass a re-certification inspection. Staff will also go through several weeks of training before re-inspection, he said.

He noted some of the facility’s problems have been corrected. A new nursing director started work Monday; the position had been eliminated due to budget cuts. Two internal abuse investigator positions were also eliminated last year, but Hazel said another investigator has been hired and additional staff are being trained to do the work. Having only one was a problem when the remaining investigator contracted pneumonia and did not complete an abuse investigation within the required five days.

Despite Hancock’s previous problems, Hazel is convinced patient care at the facility is very good and there is no unusual risk of harm to patients. “I would be comfortable having a family member placed there,” he wrote. “The issues that we are dealing with now are not insignificant, but are largely procedural and solvable. The items cited in the report from the last inspection are largely technical.”

When it opened, the Hancock Center was praised as an innovative facility, receiving an award in 2008 from the National Council for Public-Private Partnerships. But life safety has been a concern since a patient committed suicide shortly after the facility opened. At the time, the Office of the Inspector General identified several areas of risk and made recommendations. Since then, many changes were not implemented, according to the last OIG report.

The CMS’s ratings for the facility identify 15 health deficiencies for the nursing home. The CMS investigators determined on March 12 and May 19 that Hancock failed to report and investigate acts of abuse, neglect or mistreatment; protect each resident from all abuse and physical punishment; give professional services that meet a standard of quality; immediately report a resident’s injury or change in health; or be administered in a way that leads to the highest level of well-being for each resident. For its health inspections, Hancock was rated one out of five stars by the CMS.

Inspector General for Behavioral Health and Human Services G. Douglas Bevelacqua conducted an unannounced inspection of Eastern State Hospital from June 1 to June 3. In preparation, OIG reviewed critical incidents that occurred on the hospital’s campus between Jan. 1 and May 15, finding that 80 percent of the incidents involved Hancock patients. The majority of incidents included minor injuries such as scratches or skin lacerations, but 10 of the incidents were classified as serious or potentially serious. Five events involved potential head injury and five were unexplained fractures.

In his report, Bevelacqua wrote that the hospital does not have a risk management plan that emphasizes “the importance of an integrated approach.” For example, the facility’s risk manager did not have consistent access to abuse and neglect investigations, and there was not a structured process to reduce risk or take corrective actions. In addition, OIG staff noted Hancock’s incident reports varied greatly in thoroughness, often failing to provide information about the patient’s treatment.

On several occasions, a registered nurse reported witnessing the physical abuse of a resident by a certified nurse’s aide. In each case, the abuse investigator determined the allegation was unsubstantiated because several witnesses denied the abuse. OIG could not find any evidence the circumstances were reviewed to determine whether the staff could be conspiring against unit nurses.

After interviewing staff at all levels, Bevelacqua found the previous facility director John Favret “created an environment that suppressed the active monitoring of areas of risk to the detriment of both the staff and the patients.” Staff further reported that communicating about areas of risk in an open manner was “routinely discouraged.”

In his letter, Hazel told legislators “we had to remove the director of Eastern State Hospital early this year” and have been aggressively searching for a new director. He also noted Schrader has been the “acting” medical leader for five years.

In their interviews with Bevelacqua, staff praised acting director Garland for her “more open and integrated approach” to identifying and correcting areas of risk. Staff also said they had little interaction with Favret, but that Garland is easy to approach with issues or concerns.

Staff also complained of being overworked due to staff shortages, and receiving a “threatening e-mail” from supervisors a week prior to the OIG inspection. The staff members were unwilling to share the e-mail with Bevelacqua, citing fear of retaliation. In his report, Bevelacqua wrote, “All the staff interviewed stated that staff morale was low.”

In the coming weeks, the Virginia Department of Health will have to petition CMS for permission to conduct another inspection in the near future. CMS was notified of the request Monday. Hazel said his department is working with the Office of the Attorney General to determine whether to appeal survey findings from the last CMS inspection, which could restore certification. That process could take more than a month, he said.

To read the full OIG report, click here. To see Medicare’s review of the facility, click here.