The Arizona State Hospital is finally meeting federal standards and will not lose its certification – and millions in federal dollars.
In a letter to state health officials, Rufus Arther of the Centers for Medicaid and Medicaid Services said his agency is scrapping its plans to terminate the certification of the mental health facility. He said the latest survey done by an independent inspection unit of the state Department of Health Services for the federal agency shows the hospital is now complying with all the requirements to participate in the Medicare and Medicaid programs.
A copy of the March 10 letter was obtained Friday by Capitol Media Services.
The move comes four months after Arther, manager of survey, certification and enforcement for the federal agency's non-long-term-care division, removed the hospital's status as a provider considered to be meeting the required standards.
Arther said a September inspection found violations of regulations dealing with patient rights and nursing services. He said that review found deficiencies that substantially limit the hospital's capacity to render adequate care to patients, or are of such a character as to adversely affect patient health and safety.
Failure to comply with CMS standards comes with a risk: Cutoff of federal dollars. That federal cash makes up about a fifth of the $30 million budget for the hospital's 120-bed civil commitment unit.
Cory Nelson, the health department's chief of behavioral health services, said he is pleased with the new findings.
“This is obviously the outcome we were all expecting,” he said. Nelson said
State Health Director Will Humble acknowledged last year that the inspectors, who are state health department employees but independent of the hospital, did find various instances where procedures were not followed and patients were injured.
But he also said that in some of the cases, procedures were actually followed. The problem, he said, was that hospital personnel had failed to document what they had done.
The investigation is an outgrowth of a report by the Phoenix ABC affiliate about a patient death in September. The Maricopa County Medical Examiner's Office said the man died of complications from having swallowed multiple “foreign bodies.”
Nelson said the report found no instances of abuse. What it did find, he said, were situations which affected “a patient's ability to be in a safe environment.”
Nelson said the hospital works with people with serious mental illnesses, including some “who have very serious self-harm issues.”
He said protocols require that some of the people be monitored closely – one staffer to one patient – with direct visual contact and at a distance of no more than six feet. Nelson said investigators found six instances where that did not occur.
And in several of those, patients were able to harm themselves by doing things like swallowing foreign objects or using items – or even their own nails – to cut themselves.
Last year's inspection also found situations where there was not the level of staffing the hospital itself had said was necessary. Nelson said while some of that was lack of documentation, there also were situations where someone did not show up at work.
Nelson said CMS orders special inspections when they get complaints. But he said they serve a legitimate purpose.
“We appreciate the fact that outside entities come in and help us identify things that we may not see on a day-to-day basis,” he said. “The survey process is simply part of an overall quality process that health care facilities utilize.”
Arther said the last inspection was not entirely a clean bill of health, with some “standard level deficiencies” found.
For example, it said that that the hospital's own policies and procedures did not ensure that patients were provided the same level of care for urgent medical needs 24 hours a day. And it found situations where the hospital did not document evaluations of patients placed on a “sick call” log.
Arther said these violations are not sufficient to require the hospital to submit a plan of correction to maintain its eligibility for federal dollars.
Nelson said policies will be adjusted.
In the case of that question of 24/7 care, he said the practice until now had been if a patient complained of something like a headache at night, that would be noted and a doctor or physician's assistant would examine him or her in the morning. Now, he said, the patient will get the same attention that would otherwise be available during normal business hours.
The inspection was only of the civil commitment unit of the hospital. It houses 120 patients, virtually all of whom were sent there under court order because they were found to be a danger to themselves or others.
A separate 120-patient unit is reserved for those who essentially have been found “guilty but insane,” people who would otherwise be behind bars except for their mental condition. And a third unit, with between 80 and 90 patients, houses those who have served their time in prison for violent sexual offenses but are considered too dangerous to be back on the streets.