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Tampa General Hospital faces Medicare sanctions

TAMPA — In the wake of two recent suicides at Tampa General Hospital, federal regulators are threatening to stop Medicare funding to the hospital, citing serious safety problems in its psychiatric unit.

Regulators found psychiatric patients to be in "immediate jeopardy" in an investigation prompted by the suicides. The hospital has until Sept. 6 to fix the problems or lose funding, said the Centers for Medicare & Medicaid Services.

Investigators found that psychiatric staff did little to improve safety after the first suicide, a 44-year-old woman who hanged herself with a bedsheet over a closet door on July 21.

In fact, when a 28-year-old patient asked for a room change because of a roommate problem, they moved him to the dead woman's room — apparently without discussing with him whether being in that room would bother him. On July 23, he, too, was found hanging from a bed sheet.

Hospital records show a 33-minute gap from the time the man was found until staffers started trying to resuscitate him. It's not clear whether the delay was real or a mistake in the records.

There was no evidence that certain safety changes were made, and the hospital refused to cooperate with investigators by disclosing all of its internal investigation for fear of lawsuits, investigators said.

Ron Hytoff, the hospital's president and CEO, said Tampa General already is working to fix the problems.

"I am saddened, embarrassed and concerned reading the surveyor's observations about our psychiatric unit," Hytoff said in a statement.

The hospital is changing the procedures cited by CMS, increasing how often patients are observed and making physical changes to the unit, Hytoff said. The hospital released the statement and the 42-page CMS report Thursday, without waiting for the report to become public. It also posted them on its Web site — a dramatic contrast to its lack of cooperation with CMS.

"All of the employees, physicians and volunteers understand that the community must have absolute trust in the operation of our Psychiatric unit," Hytoff said. "Restoration of that trust is our number one goal."

The report also said:

• Staffers were told to increase observation after the first suicide, but no such changes were made. After the suicides, documents also showed that hospital officials planned to explore adding video monitoring of patients, along with other safety measures. But when investigators arrived on August 14, nothing showed such changes were being made.

"There was no evidence of the facility ensuring patient safety after the (first) incident and a delay of implementing safety approaches after the second incident," the report said.

• After the suicides, the hospital held training sessions on suicide, but only 17 of 137 staffers attended.

• Investigators found that cleaning solutions, staplers and other potentially hazardous items weren't properly secured.

• Five other patients who needed to be constantly watched had to sleep in the hallway so that one staffer could monitor all five.

When safety problems occur at a hospital, CMS investigates and can threaten to end its agreement to have the hospital treat Medicare patients.

"The concern is always to be sure the patients are receiving quality care in a safe environment," said Lee Millman, a CMS spokeswoman.

Rarely is the threat carried out. In one recent year, only five hospitals across the nation lost CMS funding. But the prospect usually prompts a hospital to take immediate action. At Tampa General last year, more than $168-million, or over 20 percent of the hospital's patient revenues, came from CMS.

To avoid the cutoff, Tampa General must send CMS a plan to fix problems before the deadline. Investigators will make a surprise visit to see whether the plan is working.

On Thursday, hospital officials couldn't recall a time that Tampa General ever has been threatened with losing CMS funding. In recent years in the Tampa Bay area, CMS has threatened to remove funds from Brandon Regional Hospital and Northside Hospital in St. Petersburg. Both hospitals resolved their problems.

Lisa Greene can be reached at greene@sptimes.com or (813) 226-3322.

Tampa General Hospital faces Medicare sanctions 08/21/08 [Last modified: Wednesday, August 27, 2008 12:52pm]
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