CMS Report Details Negligent ER Proceedures At Pine Ridge IHS Hospital

Nov 6, 2017

The Centers for Medicare and Medicaid Services is releasing reports that led to their decision to cut ties with the Indian Health Service hospital in Pine Ridge.

CMS placed the hospital on “Immediate Jeopardy” late last week.

CMS found the hospital failed to comply with standards they set for providing care. The organization made the “Immediate Jeopardy” designation after the third of three unannounced visits to the Pine Ridge IHS hospital.

After the third visit in late October, they found staff was negligent when monitoring diabetic patients that arrived at the emergency room. The CMS report says staff failed to get an accurate determination of the severity of patients’ conditions.

One patient was brought into the emergency department around noon on October 16. The patient’s blood glucose level was severely high, but staff didn’t get a proper reading of that person’s levels until an hour and a half after they initially arrived.

The patient’s condition got severe enough that the patient was finally flown to the intensive care unit at Rapid City Regional.

Doctors took the patient into surgery where they found blood wasn’t getting to part of his intestines. That tissue was dead and the patient died during surgery.

CMS says that and similar cases are leading to their involuntary termination of contract with the Pine Ridge hospital.

Medicare and Medicaid payments will no longer be made to the hospital starting November 18.

IHS statement regarding the "immediate jeopardy" designation:

The Pine Ridge IHS Hospital was recently surveyed by the Centers for Medicare & Medicaid Services (CMS). Today, CMS issued a final notification to the IHS Pine Ridge Hospital that it is placing the hospital on “Immediate Jeopardy” status and terminating the hospital’s provider agreement, effective November 18, 2017. Termination means that IHS can no longer bill Medicare for services, impacting Medicaid funding as well. The IHS Pine Ridge Hospital remains open and patients are receiving care, including emergency department, inpatient, outpatient, and all other hospital services.
Providing access to quality medical care remains a top priority for IHS. The agency is committed to making improvements to ensure the safe delivery of care for patients at Pine Ridge Hospital and to implement reforms to stabilize, strengthen and raise the overall quality of care in the IHS Great Plains Area. These issues did not happen overnight and it will take time to correct them. We are constantly striving to improve and we recognize that there is a lot more work to be done. We have made measurable improvements over the past year through implementation of the Quality Framework and other quality improvement efforts, and are working diligently to continue to improve.
Moving forward, the agency will continue to partner closely with tribal leaders and health care stakeholders in the Great Plains Area to pursue reforms that achieve sustainable improvements, enhance accountability of IHS staff and providers, and expand access to quality care for patients at Pine Ridge Hospital.  
The agency is pursuing immediate, short-term and long-term actions to achieve sustainable improvements to ensure the safe delivery of care for patients at Pine Ridge Hospital and to implement reforms to stabilize and strengthen the overall quality of care in the IHS Great Plains Area and across IHS.  Upon learning of these survey results IHS immediately began instituting improvements at Pine Ridge. For instance, Pine Ridge is enhancing staffing levels in the emergency department; extending deployment of U.S. Public Health Service officers to reduce staff turnover; and continuing to improve emergency department operations through federal oversight and more effective utilization of telehealth consultation. The IHS has also taken significant steps in the last year to make a difference in the Pine Ridge Hospital and across IHS including:
•    Release of the IHS Quality Framework in November 2016 outlining how IHS will develop, implement, and sustain an effective quality program that improves patient experience and outcomes, strengthens organizational capacity, and ensures the delivery of reliable, high quality health care at IHS federal-government-operated, direct service facilities.
•    Awarding a master contract for accreditation of hospitals – IHS awarded a new contract to The Joint Commission as the single accrediting organization for all IHS hospitals. This will result in a uniform set of health, quality, and safety standards across the organization.
•    Acquiring a credentialing software system – IHS is modernizing the way provider credentialing and privileging is carried out across the agency to facilitate more efficient hiring of qualified providers and ensure patient safety.
•    Developing a quality assurance accountability dashboard – The National Quality Accountability Dashboard is a system to aid in evidence-based strategic decision-making. The dashboard will allow the Indian Health Service to monitor data on key performance indicators in a succinct and easily viewed display.
•    Establishing Patient Wait Time Standards for primary and urgent care settings – IHS federally-operated service units are collecting and tracking this data to improve patient care and services.
•    Developing a standard patient experience of care survey and an implementation strategy using electronic tablets – A well-designed survey will help identify gaps in the care experience that can be addressed to improve health care delivery and quality. IHS developed a standardized patient experience of care survey for uniform use and administration across all IHS ambulatory primary care sites, including hospital outpatient departments.
•    Implementing Emergency Department (ED) telehealth consultation in the IHS Great Plains and Billings Areas – This service is available to providers handling complicated or unusual cases in the ED. At the push of a button, IHS emergency department staff has immediate tele-video access to a team of highly specialized, emergency medicine doctors and nurses.
Additionally, the IHS awarded a new contract to provide emergency department staffing services at Pine Ridge Hospital to Central Care Incorporated of Alexandria, Virginia. Services will begin in mid-November. The emergency department will be federally managed, which will allow for staffing with both contractors and federal employees working together under federal direction. IHS is working to ensure there is a smooth transition with no disruption in services.