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Wyoming hospital faces increased oversight after investigation into patient's discharge

Wyoming hospital faces increased oversight after investigation into patient's discharge

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Cheyenne Regional Medical Center’s discharge of a blind patient to a shelter unequipped to deal with the person’s needs resulted in an investigation that will lead to increased oversight by the state Department of Health.

Laura Hudspeth, the administrator and state survey agency director for the department of health, said the hospital had lost its deemed status for Medicare and Medicaid but that it is still certified for the services, meaning it will continue to receive payment for patients covered under them.

That could change, she said, and the hospital could lose that funding if it doesn’t take action to correct the discharge-related issues identified by state regulators.

Essentially, she said, the loss of status means the hospital will face increased oversight by the department of health, rather than by a federal joint commission, which is the typical overseer.

A complaint prompted a state investigation of the hospital on behalf of the Centers for Medicare and Medicaid Services. According to the state report, law enforcement brought a blind patient to the hospital on May 2. The hospital discharged the patient, whose name and gender is not identified in the report, on May 19.

The patient had suffered a stroke in his or her past and had a history of not taking medications. The hospital had been in contact with three family members, who ultimately declined to take in the patient, at least in part because no one was available to care for him or her, the report said.

Hospital spokeswoman Kathy Baker said the hospital has appealed the decision. She said that the hospital believes health department surveyors could return to Cheyenne Regional in the coming weeks, though she stressed that’s far from certain. If surveyors were to return and make a favorable recommendation to CMS, the hospital’s status could be restored shortly after, she said.

Hospital staff told one of the family members that the patient would be sent to a shelter on May 19 because “there is no medical reason to continue to hold the patient.”

The hospital made arrangements with the shelter for the patient to take his or her medications, and a taxi took the person first to a pharmacy and then to the facility. Hospital staff made follow-up appointments for the patient to meet with support agencies and physicians.

Prior to admission to the shelter, “the hospital reported the patient was independent,” the report said. “At the shelter, the patient required assistance, monitoring and care that the staff at the shelter were not trained to provide.”

The patient would leave the facility to smoke and then would be unable to find his or her way back in, the report said.

“The patient was reliant on the other residents at the shelter to assist him/her to the bathroom and when no one was available the patient was incontinent,” the report said.

The shelter’s case manager called the Cheyenne hospital on May 22 and 23 “and reported that staff at the shelter were unable to provide the care the patient needed. The hospital was unable to help.”

In an interview with state investigators, hospital officials said that staff tried to convince the patient to stay, but that he or she was determined to leave. “The medical necessity had expired and the patient was his/her own responsible person,” the officials told investigators, according to the state report.

The report concluded that hospital staff knew three days prior to discharge that family wasn’t able to take care of the patient but did not pursue other options than the shelter. It also charged that the “staff did not complete a thorough safety assessment of the post-hospital discharge destination” and that “there was no evidence of staff providing the patient with information about the safety risks associated with residing at the shelter.”

It’s unclear when the report was given to the hospital. It was filed online Friday and is dated June 21.

The report includes the hospital’s plan to address the concerns. The plan includes revising the discharge policy to include one step that staff “research and present all options of placement destinations” and another that requires staff “verify a community based destination has the capability ... to meet the patient’s needs prior to discharge.”

The plan also calls for the hospital’s director of case management to monitor discharges for patients who have mental health concerns. An audit of discharges will be conducted every quarter beginning Sept. 1 and ending September 2018. It will continue periodically after that.

Hudspeth said that if action is not taken by the hospital, it could lose its Medicare and Medicaid funding, she said.

“Our goal isn’t to remove the funding,” she said. “Our goal is to come back into compliance.”

She said the loss of deemed status “does happen at times” but that she couldn’t remember the last time it happened in Wyoming.

Star-Tribune staff writer Arno Rosenfeld contributed to this report.

Follow education reporter Seth Klamann on Twitter @SethKlamann


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Education and Health Reporter

Seth Klamann joined the Star-Tribune in 2016 and covers education and health. A 2015 graduate of the University of Missouri and proud Kansas City native, Seth worked for newspapers in Milwaukee and Omaha before coming to Casper.

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