Federal inspectors could be preparing to place the state psychiatric facility on "immediate jeopardy" status, the most serious deficiency designation that carries serious sanctions for facilities receiving federal reimbursement dollars.
While details of what raised flags for federal inspectors have not yet been released, the Centers for Medicare and Medicaid Services revisited the Montana State Hospital in Warm Springs last week after the Montana State News Bureau questioned how the federal agency approved an inspection of the facility in September that found staffing numbers were below the level needed to prevent patients from falling. Inspectors found patients had fallen 113 times between June and August 2021, and employees told inspectors staffing documentation had been altered to not list patients whose needs required one-on-one attention from staff.
People are also reading…
The state health department on Thursday said CMS inspectors preliminarily indicated that findings might reach immediate jeopardy status. The department is "proactively working toward corrective action as if that is the case," spokesperson Jon Ebelt said in an email.
The Montana Department of Public Health and Human Services has time to furnish its plan to correct the situation before the full survey is complete and becomes public. The department already has one plan underway: In late November, in partial response to the state hospital's needs, DPHHS put out a request for proposal seeking a third party to fill a "temporary management" role at the state's medical facilities and to help stabilize the workforce. The submission period for contract bids has closed, and DPHHS said last week it was reviewing the proposals. Last month DPHHS Director Adam Meier said the incoming contractor would first examine the state hospital, which has the most acute needs of all the state's health care facilities.
Roughly 40% of positions at the state hospital are vacant, according to November figures from the Montana Department of Public Health and Human Services. Many of those functions are being performed by traveling staff at a much more expensive rate.
The entrance to the campus of the Montana State Hospital at Warm Springs.
DPHHS, which operates the state hospital, had conducted that federal inspection on behalf of CMS, a spokesperson for DPHHS said in January. CMS had approved that finding, despite a number of deficiencies cited the in report, including a failure by an in-house investigator to determine if negligence had played a role in a patient's death.
"We were very short staffed that day," a staff member told inspectors.
The state hospital's staffing crisis has drawn scrutiny from lawmakers in recent weeks, with staff speaking out in news reports and eventually in a public legislative hearing against what they described as untenable working conditions and an unresponsive administration in Warm Springs.
Some staff testified in the January hearing that patient care seemed to be improving in their time at the facility, although lawmakers pointed out a discrepancy in the information brought forward.
Rep. Danny Tenenbaum, D-Missoula
"One thing I noticed was that there were very few people who said things were doing OK at the state hospital, but it was basically the management," Rep. Danny Tenenbaum, D-Missoula, said during the Jan. 21 hearing. "It was the families of residents and the employees who, people who are on the ground in the state hospital who to me have a more accurate perception of what actually goes on in the state hospital."
A spokesperson for CMS this week declined to confirm the immediate jeopardy status, but said in an emailed statement the facility has the opportunity to respond to any inspection findings.
"Until a survey has been completed … we are unable to provide any additional information," the spokesperson said.
State guidance from CMS on immediate jeopardy designations list the three components required to meet the threshold for the designation:
- noncompliance of one or more federal health, safety and/or quality regulations;
- as a result of the identified noncompliance, serious injury, serious harm, serious impairment or death has occurred, is occurring or is like to occur to one or more identified recipients at risk;
- and the need for immediate action by the provider to prevent serious injury, serious harm, serious impairment or death.
The next phase includes requesting a written plan outlining the immediate actions the entity will take to address the noncompliance. Failure to come back into compliance could result in fines totaling several thousand dollars a day and eventually termination of the facility's reimbursement agreement with the federal government.
The state hospital nearly lost its federal reimbursement funding in 2017, when CMS had also placed the facility on immediate jeopardy status. In that case, DPHHS had "abated" the situation that put residents at significant risk, a turnaround that took place between Jan. 13 and Jan 25. The department said then the deficiencies were related to staffing shortages, as well as the hospital's physical environment.
This story has been changed to correct the current status of the state hospital. The story previously stated the hospital was under an immediate jeopardy designation. DPHHS provided clarifying information that the hospital could be placed under immediate jeopardy status.
