Report: GMH Medicare status in danger - News: On Air. Online. On Demand.

Report: GMH Medicare status in danger

Posted: Jun 19, 2018 3:59 PM Updated:

The Guam Memorial Hospital will be kicked out of the Medicare program on October 3 if its response to a damning federal survey report is not deemed acceptable.

A survey report conducted by the Center for Medicare and Medicaid Services documents 80 pages of deficiencies that “adversely affect patient health and safety” – according to the report, which was the result of an April visit to GMH by CMS.

GMH administrator Peter John Camacho told senators in an oversight hearing the hospital had responded to CMS’s deficiency report last Friday. Camacho also told senators he did not inform the GMH board about the CMS survey report.

According to the survey report GMH “remains out of compliance with the requirements” necessary to be a part of the Medicare program.

‘Substantial compliance’ required

As a result of the April 27 CMS survey, deficiencies at GMH “substantially limit the hospital’s capacity to render adequate care” and CMS “intends on terminating GMHA’s Medicare provider agreement” at midnight on October 3 unless GMH corrects violations cited in the report and demonstrates “substantial compliance” with all federal Medicare requirements.

While the Calvo/Tenorio administration has pushed the narrative that problems at the island’s public hospital stem from a lack of funding, the CMS survey report highlights GMH has not met seven conditions of participating in the Medicare program – and these violations deal largely with a lack of proper procedures for patient care and the lack of a system of accountability for medical staff. Several doctors and one former GMH board member have testified before the Legislature that GMH problems are due to a lack of leadership, corruption and mismanagement.

7 Areas of non-compliance

The seven areas of Medicare program requirements GMH has not demonstrated full compliance in are:

Governing Body – There must be an effective governing body that is legally responsible for the conduct of the hospital. The governing body must set and oversee standards involving medical staff, the administrator of GMH, patient care, institution plan and budget, contracted services and emergency services. The CMS survey also held the Governing Body responsible for 80 pages of deficiencies included in the CMS survey.

Quality Assessment and Performance Improvement (QAPI) – GMH must use hospital-wide date to monitor the effectiveness and safety of services and quality of care, identify opportunities for improvement and changes that will lead to improvement. GMH failed to ensure the hospital-wide QAPI efforts addressed facility improvements directly impacting the quality of care and patient safety, and failed to ensure 12 out of 40 departments of the hospital provided reports related to QAPI activities and programs within their departments.

  • A patient with a kidney condition was mistakenly given iodine dye in an IV after he had already been given an oral contrast for a CT scan. The patient then had to have dialysis as a result of the medical error. A “patient safety form” was not submitted for this occurrence.
  • GMH failed to track adverse patient events and medical errors for at least 12 months prior to the CMS survey. An administrator could not explain why data is not collected for analysis and corrective action, but did cite “staff shortages” as a cause.
  • The report states the “failure to track, analyze and prevent adverse patient events has the potential to affect all patients receiving care” at GMH.
  • GMH did not ensure medical staff must examine credentials of eligible candidates for medical staff membership. Specifically, a doctor was granted privileges without “evaluation and determination to verify training and competency.”

Nursing Services – GMH must ensure it develops and keeps current a nursing plan for each patient and ensure proper standards and qualifications of nurses and the preparation and administration of drugs.

  • The CMS found that the facility failed to ensure a biological contrast of IV was administered in accordance with the orders of the practitioner and the accepted standards of practice for one of 30 patients who received care at GMH. In addition the hospital failed to ensure the staff followed the policy for reporting an error in the administration of the IV to one of 30 sampled patients.
  • GMH failed to ensure a nurse implemented a care plan for a patient who was receiving blood transfusions.
  • GMH failed to ensure drugs and biologicals were locked and secured. CMS found medication carts were left unlocked, leaving 140 medications “accessible and visible to everyone.”
  • GMH failed to ensure an agreement with an unspecified outside blood collection establishment included verbiage ensuring CMS compliance with requirements associated with potentially infectious blood products and blood (HIV and Hepatitis C virus).

Radiologic Services –GMH must maintain and ensure radiologic services are free from hazards for patients and personnel as detailed in the case of a patient with chronic renal failure being put in “immediate jeopardy” because he was mistakenly given an iodine-based dye in an IV.

Physical Environment – GMH was cited for numerous violations dealing with the safety and condition of facilities at the hospital.

  • Failure to maintain hospital building “immediately jeopardized” patient care on April 24. GMH then submitted an acceptable plan of correction that was validated by CMS on April 27.
  • GMH’s failure to maintain the overall hospital environment, kitchen equipment and Life Safety Code requirements results in the failure of GMH to comply with CMS standards regarding a hospital’s physical environment.

Discharge Planning – GMH must have in effect discharge plan process that applies to all patients and must identify at an early stage of hospitalization patients who are likely to suffer adverse health consequences upon discharge. Discharge plans must be evaluated and discharge plans and procedures must be specified in writing.

  • A patient who suffered from a ruptured appendix was not given any information about needs or preparations to be made for after leaving the hospital or wound care.
  • No assessment for discharge needs was completed after a patient’s left leg below the knee was amputated. The patient stated he had not received a wheelchair, was concerned about how he would drive or get up to two flights of stairs to his apartment. Review of medical records showed no documentation for patient to have smooth transition home.
  • An amputee patient with diabetes and dementia had been in GMH for 417 days and no plan had been developed for patient’s discharge.

Anesthesia Services – Anesthesia services must be provided in a well-organized manner and consistent with patient needs and services pre, intra and post anesthesia evaluations must be completed and documented.

  • Anesthesia data is not being analyzed for opportunities to improve care. Failure to have analysis or data collected by the department results in a failure to find opportunities to improve care and services.

Millions of dollars at risk

Medicare is a federal insurance program for people who are 65 or older, younger persons with disabilities and persons with kidney failure requiring dialysis or transplants. If GMH’s participation in Medicare is revoked, the hospital stands to lose up anywhere from $11 to $15 million in matching funds per fiscal year, according to the latest GovGuam budget.

The CMS conducted its survey of the Guam Memorial Hospital from April 23rd – 27th, 2018.

A special investigative committee has been formed by the Guam Legislature to look into problems plaguing GMH.

Powered by Frankly