PHOENIX — A federal agency is threatening to revoke the certification of the Arizona State Hospital, saying it found violations of regulations dealing with patient rights and nursing services.
In a letter to hospital chief executive Donna Noriega, the Centers for Medicare and Medicaid Services, said deficiencies inspectors identified in a September visit “substantially limit the hospital's capacity to render adequate care to patients or are of such character as to adversely affect patient health and safety.” Ruth Arther, manager of survey, certifications and enforcement for the agency's non-long term care division, said her agency is immediately removing the hospital's status as a provider considered meeting requirements to participate in — and get reimbursed — by Medicare and Medicaid.
Arther said if sufficient corrections are not made, Medicare payments will cease on Feb. 12. Those federal dollars make up about a fifth of the $30 million budget for the hospital's civil commitment unit.
Both CMS and the Department of Health Services say the actual inspection report detailing the problems is not subject to public review until January.
Health Director Will Humble said the inspectors — who actually are health department employees — did find various instances where procedures were not followed and patients were injured. But he said that, in some of the cases, procedures were followed but hospital personnel failed to document what they had done.
Humble said he intends to send a corrective plan to the federal agency today.
The report is drawing particular scrutiny by Gov. Jan Brewer. Aside from being the state's chief executive, she has a particular interest in what goes on at the facility: One of her sons, Ronald, has been a patient in a different unit of the state hospital for more than 20 years after being found not guilty by reason of insanity in the 1989 sexual assault of a woman.
But the governor, after being briefed by Humble, told Capitol Media Services she is confident that patients in the facility are safe.
“If the policy is followed, and it is documented, there should not be a problem,” Brewer said. “They're just as safe there as they would be anywhere else.”
The investigation is the direct outgrowth of a report by the Phoenix ABC affiliate about a patient death in September. The Maricopa County Medical Examiner's Office says the man died of complications of having swallowed multiple “foreign bodies.”
That led CMS to require state inspectors, under contract to the federal agency, to take a closer look.
Cory Nelson, the health department's chief of behavioral health services, said the report found no instances of abuse. But what it did find, he said, were situations which affected “a patient's ability to be in a safe environment.”
“The hospital works with people that have the most challenging set of illnesses and the symptoms associated with that,” he said. “We have individuals out there 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, but 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.
Inspectors also found situations where there was not the level of staffing that 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.
Brewer said she will continue to keep a close eye on the situation.
“My ultimate goal is that the hospital is run securely and obviously very safe for patients,” she said.
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.
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 allowed back on the streets.