08/20/08 — State has team at Cherry

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State has team at Cherry

By Matthew Whittle
Published in News on August 20, 2008 1:51 PM

With the help of state officials who have spent the last week in Goldsboro, Cherry Hospital Director Dr. Jack St. Clair said today the hospital hopes soon to have a plan of correction in place that will satisfy the needs of the Centers for Medicare and Medicaid after two incidents reported earlier this month put the institution's federal funding in jeopardy.

"They're helping us assess the situation and helping us put together a plan of correction," St. Clair said. "We welcome their input. They've been very helpful and have given us an additional perspective.

"We've sent that tentative plan of correction to the (state) Division (of Mental Health) for their review, and hope to get that back today."

Sending in such teams, Tom Lawrence, director of public affairs for the state Department of Health and Human Services, added, is a standard operating procedure.

"It's done, and it has been done in the past. These are the experts, and they're working directly with the hospital management and staff to correct these problems," he said.

The need for the plan of correction comes after federal investigators filed their report regarding two April incidents on Aug. 11.

One involved the lack of basic care for a patient who sat in a chair in a dayroom for more than 22 hours.

The other involved an incident in which a patient bit a physician, who then struck him on the back to force him to let go.

The latter, St. Clair explained, resulted in only very minor injuries, and the physician was placed on an investigatory leave with pay. He emphasized that the leave was not a punitive measure, but rather simply a matter of procedure.

The former, however, ultimately ended with the death of the patient -- although St. Clair has been clear that the autopsy report did not blame the hospital for the death.

"The autopsy report cited the cause of death as lymphocytic myocarditis -- an enlarged or inflamed heart -- and that was a pre-existing condition he came here with," St. Clair said, adding that nothing in the report indicated the hospital's actions had exacerbated the condition.

"It's just a real difficult time right now. It's an unfortunate incident we deeply regret. But we've got a good plan of correction in place," he said.

As part of that, he explained that the hospital is revamping its training procedures -- blaming the biting incident on a failure to follow proper techniques.

The other piece of that puzzle, he continued, is improving documentation and communication protocols -- citing failures in both as contributing to the man sitting unattended for so long.

"I know there were attempts made by staff to offer nourishment to the patient, and that the patient refused on a couple of occasions those offers of food and fluid," St. Clair said.

He also noted that it is not unusual for a patient to want to sit outside his or her room for an extended period of time.

"There are occasions patients prefer not to go to bed, and prefer to sit out in an open space," he said.

However, he continued, for those things to continue to happen over such an extended period of time without more attention was not acceptable. He said the patient's refusals should have all been documented and relayed to the physician and to each shift.

He also said that the alleged actions of the staff caught on videotape -- the reported dancing, hugging, kissing and card-playing -- were not appropriate and that the behavior has been addressed.

"It was most inappropriate, clearly unacceptable and something we're addressing," he said. "Not all of the people who were involved in that incident are here anymore."

But, he also noted that such incidents are rare, although this is the second time since September 2007 the hospital has been cited by federal investigators.

"We serve upwards to 3,000 people a year here, and the majority of those are without incident," he said. "We serve some of the most challenging people in the system."

The potential combination of mental illness, developmental retardation and physical illness, he explained, often can make treatment difficult.

Add to that the fact that each ward nurse is responsible for overseeing about 20 patients a shift, communicating with physicians and supervising their health care technicians, and it becomes an "extremely challenging" environment.

And, he acknowledged, while he does believe there is a good staff at Cherry, the low rate of pay -- starting at about $24,000 for health care technicians -- does make it difficult to find employees.

"We've advocated the state for higher pay in recognition of the complex work they perform here. It is extremely difficult to recruit in the marketplace with that rate of pay and the challenges they face here," St. Clair said.

But in the meantime, he continued, hospital officials are confident they will be able to fix the problems and restore the hospital's federal funding status before Sept. 1.