Federal report shows UnityPoint Health –Meriter failed to prevent abuse

Published: Mar. 8, 2018 at 2:42 PM CST
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A Madison hospital did not do enough to protect patient rights and prevent suspected abuse, that’s according to the Center for Clinical Standards and Quality/Survey & Certification Group.

A report by the federal agency said UnityPoint Health – Meriter will no longer be able to bill Medicare and Medicaid Services because they are not in compliance with patient rights. The Medicare program will not make payment for services furnished to patients admitted on or after May 24.

The Center for Medicare and Medicaid Services “conducted a complaint investigation” on Feb. 19.

They determined that the hospital failed to “develop and implement an effective policy to prevent suspected abuse related to injuries of unknown origin for patients in the Newborn Intensive Care Unit.”

According to the report, five patients had unknown injuries including from “unexplained bruising,” “bruising on face,” “scalp bruising,” and “skull fractures and arm fractures.”

Documents stated during a incident report review, the first case of abuse happened on April 12, 2017. The most recent abuse was identified on February 7.

The report states on February 2, bruising was identified on the arm of an infant, "Patient #1". The bruising was documented. Medical records state that the injuries may have “been from patient clutching wires or peripheral intravenous device arm board used for stabilization.”

On February 3, the report stated unidentified bruising was found on another infant, "Patient 2." Staff identified that the bruising was similar to Patient 1's injuries. A physician was notified and determined the injuries were “related to blanket wrapping.”

On February 4, the report states a nurse noted that Patient 2 had additional injuries “documented as bruising on face.” A few days later, on February 7, a lump was discovered on the side of the infant's head.

A child abuse expert was consulted regarding the unexplained injuries. The expert recommended additional tests including a skeletal survey which revealed “recent skull fractures and arm fractures.”

A nursing manager suspended the suspected registered nurse, disabled another their badge, and revoked their access to electronic medical records.

On February 9, the hospital, in collaboration with Child Protective Services “commended an internal investigation.”

Through interviews and reviews as part of the hospital’s investigation revealed, staff came forward with other stories of infants with unexplained bruising, according to the CMS report.

A physician recalled a third NICU patient with “unexplained bruising” in September 2017. During "Patient #3's" hospitalization, the infant had “bruising of left foot and scalp bruising.”

The patient’s mother took photos of the bruising at the time. Those photos were not presented to a child abuse specialist, until February 9, 2018. The specialist determined that the bruising “was consistent with child abuse" and reported the case to the Madison Police Department.

The report stated the nurse that was the primary caregiver for Patient 3 on the night the suspected abuse took place did not note the bruising on medical records. Two other physicians documented the bruising the following morning.

A fourth patient was identified on February 9. The records show "Patient #4's" abuse took place in the NICU on April 12, 2017. The medical record stated the infant had bruising on both feet, legs and ankles.

According to the report, the parents of a fifth infant were notified of the investigation. On January 20, the infant was staying in the NICU and had "scattered bruising on lower extremities" during their hospital stay.

The report states that the infant's parents informed hospital staff that they were uncomfortable with the nurse later suspected of the abuse. That nurse was the primary caregiver of the infant while in the NICU.

Due to these concerns, on February 12, a child abuse expert recommended a CT scan of the infant. That scan revealed multiple fractures, including rib and arm fractures.

As part of the investigation, a Director of Performance Improvement stated that there was "no policy or process that guided the staff or physicians how to report abuse or neglect other than what was given already."

UnityPoint Health-Meriter has submitted a plan of correction to avoid having Medicare and Medicad funding cut.

Findings of "immediate jeopardy" must be resolved within 23 days of the completed February 19 investigation. Other types of compliance "allow for more time."

Policies and procedures will be reviewed and revised — as indicated every three years per hospital policy.

UnityPoint Health-Meriter will have mandatory education for all NICU providers and NICU staff will complete online education module. A log monitoring process will be maintained to ensure 100 percent completion with the tracking of NICU providers and NICU staff — including volunteers who may be absent and/or on a leave of absence.

UnityPoint Health-Meriter will maintain its patient safety plan in collaboration with Child Protective Serices (CPS).

The plan includes two people present during all patient care activities —unless responding to patient emergencies, and a change in registered nurse staffing from one registered nurse per three patients to one registered nurse per two or one patient.

Parents concerned about possible abuse against their child or with questions about the abuse investigation are encouraged to call Meriter's NICU abuse hotline at: (608) 417-5270.

The Madison Police Department is still investigating the incidents at Meriter Hospital.

UnityPoint Health – Meriter releases statement:

“Our hospital has been and continues working cooperatively with local, state and federal agencies involved in the review of our NICU. We have successfully worked with the Centers for Medicare and Medicaid Services to address their most immediate concerns, and we continue to work on a longer term corrective action plan for their review. We cannot comment on protected and private patient information nor on the substance of the ongoing reviews. We have implemented enhanced safety measures, and our commitment to provide safe care to our patients and families has never been stronger.”


CMS releases response:

“Patient care and safety are top priorities for CMS. In response to patient concerns that were raised CMS conducted a complaint investigation on February 19, 2018 at UnityPoint Health Meriter Hospital. During the course of the investigation, CMS determined the facility was out of compliance with our conditions of participation. The only remedy available for hospitals that are out of compliance with our conditions of participation is termination.  

A plan of correction (POC) for the immediate jeopardy has been submitted by the facility and has been accepted by CMS. During the course of the recent survey other levels of non-compliance were discovered. As a result, CMS finalized the full survey report and issued it to the facility yesterday, March 7. They now have the opportunity to submit another plan of correction (POC) which CMS will then review. If that POC is found to be acceptable, the next step in the process would be an unannounced, on-site survey.

Because non-compliance occurs at varying degrees of severity, the timeline in which a facility must come back into compliance also varies. Findings of immediate jeopardy, for example, must be resolved within 23 days. Other types of compliance allow for more time that is again, based on the severity and type of noncompliance.  The proposed termination date for this facility is May 24, 2018.”