09/14/08 — Cherry funding will take months to regain

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Cherry funding will take months to regain

By Matthew Whittle
Published in News on September 14, 2008 10:55 AM

As state officials and members of an independent management team work to correct the problems at Cherry Hospital that led to the facility's loss of federal funding, the agency that pulled its certification explained that restoring that money could take some time.

But, in a news release Friday, Dempsey Benton, secretary of the state Department of Health and Human Services, said the state would be working to make sure Cherry and its patients receive the support they need in the meantime.

Effective Sept. 1, the federal Centers for Medicare and Medicaid revoked Cherry Hospital's certification, after it was placed under "immediate jeopardy" following an Aug. 13 investigation into problems of patient care and safety, specifically those involving 50-year-old Steven Sabock who died after being left unattended in a dayroom for 22 hours.

Then, when the federally contracted state survey team arrived on-site Aug. 26 to determine whether the hospital's plan of corrective action was being implemented, two more incidents occurred -- one involving a patient-on-patient assault and one involving a staff-on-patient assault.

Those incidents, explained Tom Lawrence, director of public affairs for DHHS, caused the team to reach the conclusion that not enough had been done and that the facility's certification needed to be revoked.

Lee Millman, spokeswoman for CMS, explained that during those surveys, which can occur anytime up to 23 days after the immediate jeopardy, the teams look to see if the facilities have met all their conditions of participation -- namely the "delivery of quality care" and a "safe environment."

"The purpose is to see that the plan is in place and is working," said Sandra Pace, the associate regional administrator for the Division of Survey and Certification.

Failing that, the decision to revoke certification is made.

Now the facility will have to go through the whole application process again, she added.

"With Cherry, what they have to do is re-apply to the program," Ms. Pace said.

How soon they do that is up to them, but the state has indicated that such steps will not occur until the management team, Compass Group Inc., has had time to evaluate the hospital, make recommendations and help implement those recommendations on how to fix the hospital's current organizational structure, its staffing patterns, its policies and procedures and its management procedures.

"The loss of Medicare and Medicaid certification by Cherry Hospital in Goldsboro is more than a matter of lost funds," Benton said in the release. "It speaks to me of a need to look at the circumstances which led to this point and determine what needs to be fixed and how quickly and safely we can restore the public's trust in the operations of the hospital. As I have already stated, the department is dedicated to providing quality care to consumers in the state facilities, and substandard care will not be tolerated.

"While this action might seem drastic to some, circumstances have proven that changes need to be made at Cherry Hospital. I will take whatever actions I deem necessary in order to make Cherry Hospital a safe and secure environment for the patients under its responsibility."

Compass' initial report is expected by the end of the month.

Even then, Ms. Pace explained, it could take up to 120 days -- a period of "reasonable assurance" -- and the passage of two full surveys before federal funding begins flowing again.

Until then, the state psychiatric hospital is facing the loss of about $800,000 a month, meaning that no Medicaid and Medicare payments will be made on behalf of newly admitted patients, and that near the end of the month, payments on those already in the hospital will end.

That means, Benton explained, the state will have to pick up the tab -- something Gov. Mike Easley has assured him will be done.

He also said that Easley has directed the Office of State Personnel to approve procedures to allow adjustments in health care technician pay to help retain and hire qualified staff. Currently such employees earn an average of $25,000 a year.

Additionally, and perhaps most importantly, Benton also announced that by Nov. 1, eight mobile crisis unites will be operating in the 36-county catchment area covered by Cherry Hospital to help provide care to people in crisis, hopefully reducing the need for treatment at Cherry.

He also announced that another 30 to 40 community hospital beds will be under contract for the eastern region, and that East Carolina Behavioral Health -- the largest local management entity in the east -- will be assigning certified peer specialists to any patient referred to Cherry to help develop, implement and monitor discharge planning so that patients are placed into the proper community care, lessening the chances they will return.

But, Ms. Pace said, all of this does not necessarily mean that Cherry is a bad facility, that the investigations that led to these situations are complaint driven and take place in facilities across the country.

"Mental health requires very skillful care," she said. "Our procedures only look at a snapshot in time. How recurring these issues are is hard to determine. And it just so happens that this month was North Carolina's turn. We got a complaint about Cherry Hospital -- it was an anonymous complaint -- and they went to investigate and they validated that complaint.

"Unfortunately, the only recourse we have is termination (of funding and certification). It's a regulatory procedure."