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HomeMy WebLinkAboutMINUTES - 12052006 - D.2 sE L Contra TO: BOARD OF SUPERVISORS Costa FROM: William Walker, M.D. , Health Services Director County W�M STA COUK� DATE: December 5, 2006 SUBJECT: Citation at Contra Costa Regional Medical Center SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ACCEPT report from Health Services Director. FISCAL IMPACT: None BACKGROUND: Summary: On November 3, 2006, Contra Costa Regional Medical Center (CCRMC) received a citation from the Centers for Medicare and Medicaid Services (CMS) regarding the transfer of three patients out of the Psychiatric Emergency Services (PES). The citations resulted from a complaint from a receiving hospital that proper procedure was not followed when a patient was transferred from PES to the other emergency room. When CMS investigated this complaint, they found two other cases in the PES that did not have proper documentation for a patient transfer. No patients were injured, and no bad outcomes occurred because of the process mistakes that were identified. CONTINUED ON ATTACHMENT: NO X YES SIGNATURE: —,,�R COMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER r SIGNATURE(S). ACTION OF BO D N �(Q � / saLQPPROVE AS RECOMMENDED I� OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAII : ATTESTED I NJie-/� ✓ l �t JOHN CULLEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Patrick Godley,7-5405 CC: Health Services Admin.,50 Douglas Dr.#310-A,Mtz. BY: ,DEPUTY Citation at Contra Costa Regional Medical Center December 5, 2006 Page 2 What happened? There were three patients transferred from CCRMC Psychiatric Emergency Services (PES) to other facilities without following all the appropriate transfer policies and procedures. One patient was transferred by an unlicensed provider. Because the proper procedures were not followed, and because there was an unlicensed provider involved in the assessment of one of the patients, the Centers for Medicare and Medicaid Services (CMS) has made a finding that these transfers violated the Federal Emergency Medical Treatment and Active Labor Act (EMTALA). No negative patient outcomes resulted from these actions. Response from CMS: As part of their standard initial response to an EMTALA violation, CMS has provided us with a Statement of Deficiencies and required our response within ten days. Also, as part of their stan- dard response, CMS has tendered to us a "Letter of Termination"that, if not reversed, would mean that we would no longer be able to bill for Medi-Cal and Medicare services. The termina- tion letter is the only enforcement tool available to CMS and is used as a routine practice. CCRMC responded to the citation with a Plan of Correction on November 13, 2006. We have not yet received any formal response from CMS regarding our Plan of Correction. However, we did begin to implement the training and changes in processes that are required to prevent similar problems in the future. What does it mean? It means that these violations, and any violations of federal regulations, are to be taken seri- ously. We have responded to the Statement of Deficiencies, and will provide the appropriate remedial action needed to correct the situation. Although CMS standard procedure requires them to send a "Letter of Termination" with the citation, we fully anticipate that the satisfactory Plan of Correction will void the termination letter. Related Discussion of CMS Findings as Reported in the Newspaper: The Contra Costa Times stated that, "The county has a written policy on transfers, but an inter- nale-mail Weigold sent in March appears to add new guidelines. It states that uninsured psy- chiatric patients should be sent to other hospitals once they are stabilized unless "there is sig- nificant clinical reason to do otherwise." The Times misinterpreted "uninsured" and linked the County to patient dumping. That is incor- rect. All CCRMC psychiatric hospital "uninsured"transfers are Short-Doyle (State mandated) pa- tients and come with a guaranteed payment source from the County. Every county makes placement determinations based on beneficiary eligibility, payor source and contracts. PES must evaluate anyone who walks through the door, and arrange hospital disposition re- gardless of payor source or ability to pay. The Health Department has contracts with all local area hospitals and if a transfer is made be- cause of a lack of beds or available staff at CCRMC, the receiving hospital 1) has the option to accept or deny the transfer, and 2) is paid a contracted rate if the transfer is made. ADDENDUM TO ITEM D.2 December 5, 2006 On this day, the Board of Supervisors accepted report from the Health Services Director regarding patient transfers from Contra Costa Regional Medical Center Psychiatric Emergency Services to other facilities and concerns about those transfers raised by the federal Centers for Medicare and Medicaid Services. Health Services Director Dr. Walker reported on citations received by the Contra Costa Regional Medical Center for patient transfers. He advised the federal agency accused the county of violating the Emergency Medical Treatment and Active Labor Act and the county-owned hospital in Martinez would lose it's Medicare contract on February 1, 2007 unless it takes steps to prevent inappropriate transfers. The action would result in an annual loss of more than $300 million and would essentially force the hospital to close. Dr. Walker described the two transfers as paperwork errors— 1)A 15-year-old girl who arrived at Contra Costa Regional Medical Center on October 20, 2005 had cut herself who was transferred to an adolescent treatment facility because the hospital's inpatient psychiatric unit is licensed only for adults; and 2)the other case involved a man who was transferred to a Marin hospital the same day he arrived. Dr. Walker advised that Contra Costa officials failed to complete paperwork stating the reason for the transfer and the name of the person who agreed to take the patient. Dr. Walker acknowledged the errors, and said no problems resulted from any of the transfers. He said training has been instituted for all staff involved to make sure the EMTALA(Emergency Medical Treatment and Active Labor Act)regulations and procedures for transferring patients are being followed, and said in their correction plan, county officials and all psychiatric emergency employees will have training on federal transfer laws by December 15. He said the county is awaiting word on a correction plan submitted to the U.S. Centers for Medicare &Medicaid Services. Dr. Walker also clarified in a Contra Costa Times story in which the psychiatric unit's medical director stated that "adults without insurance should be referred to other hospitals unless there is good clinical reason to admit to CCRMC." Dr. Walker advised the Board the County never had a policy of"dumping" uninsured patients, and all patients are accepted into psychiatric emergency services. Chair Gioia noted the Board should be notified as standard practice when a citation is issued. Supervisor Uilkema asked if the three transfers from Contra Costa Regional Medical Center were accepted at the receiving hospitals. Dr. Walker responded proper notification was not made on the first transfer but on the second and third violations they were accepted at the receiving hospitals. Supervisor Piepho asked for an explanation on patients being provided by an unlicensed provider. Dr. Walker said Mental Health Clinical specialists working in the Psych Emergency support the Psychiatrist but when a transfer occurs the transfer information should be supplied by the psychiatrist and not by the Mental Health Clinical Specialist. Supervisor Piepho asked if there was a double check to make sure the plan in complete. Dr. Walker responded this is being carried out in their plan of correction. By unanimous vote with District N seat being vacant the Board took the following action: ACCEPTED the report from the Health Services Director.