New Problems, Same Result: Federal Payments Still Halted For Osawatomie State Hospital

Jun 19, 2017

Safety concerns continue to prevent recertification of Osawatomie State Hospital, although a recent inspection didn’t find any evidence of the patient violence that prompted federal officials to decertify it in late 2015.

Staffing shortages and concerns about security and patient safety prompted the initial order. Certain they had addressed those issues, state officials appeared confident the state-run psychiatric hospital would pass muster. 

But when inspectors visited the facility in May, they discovered new problems with sanitation, infection control and fire safety.

Read the new inspection summary letter from federal officials to Osawatomie State Hospital.

That means the state-run psychiatric hospital remains decertified and will not receive federal payments for patient care that average $1 million a month. It is one of two state-run hospitals for people deemed a danger to themselves or others because of severe mental illnesses.

The Centers for Medicare and Medicaid Services cut payments to Osawatomie State Hospital in December 2015 after a patient attacked an employee and federal officials determined hospital administrators didn’t take adequate measures to control patient violence. 

The new setback may put the hospital in a budget bind. Lawmakers recently approved about $5 million less than the Kansas Department for Aging and Disability Services estimated it would take to run the hospital for the upcoming fiscal year, perhaps believing that recertification was close after inspectors made their first visit last month.

But KDADS spokeswoman Angela de Rocha said she doesn’t anticipate a budget squeeze from the delayed recertification. 

“We expect them to return promptly (for another inspection) after notification that we are ready,” she said Monday in an email.

KDADS recently released reports from the May inspection.

Food safety and health issues

Osawatomie State Hospital has operated at 60 beds below its 206-patient capacity since mid-2015, when federal officials ordered renovations because of concerns about patient safety.

To address CMS concerns about staffing, KDADS officials said in July 2016 that they had hired a consultant to assist them with retraining employees and “hard-wiring” new policies. 

KDADS Secretary Tim Keck and other hospital administrators prioritized hiring enough staff to provide a high level of care and increased wages for nurses. 

But other staffing issues raised concerns during the inspection last month.

Tim Keck, secretary of the Kansas Department for Aging and Disability Services, suggested in February 2016 that the state consider privatizing operations at Osawatomie State Hospital. KDADS received one bid for the contract, from a company that has a history of problems at its Florida mental health facilities.
Credit File Photo / Kansas News Service

During their May 10 visit, inspectors found problems with the main kitchen used by the hospital’s food service contractor. The report noted garbage, “dead pests” and cobwebs in a food storage area, and that employees weren’t trained to use safe procedures for food handling.

The inspector also found that a meat slicer and a food-grinding machine weren’t properly maintained, which could allow rust, paint chips or pieces of metal to mix with patients’ food.

Hot and cold foods weren’t stored at the appropriate temperatures before serving, which put patients at risk of food poisoning. The freezer and dishwasher also weren’t at the proper temperatures.

Read the inspection report on food safety and health issues at Osawatomie State Hospital.

The Minnesota-based contractor, A’Viands, has addressed the immediate food safety concerns, de Rocha said. She said department officials will evaluate the contractor’s performance and decide whether to continue the contract.

“No one has been infected or made ill by the food at OSH or at (the unit inspected), nor did the survey say they had been,” she said.

Inspectors also cited a failure to isolate patients with contagious illnesses. Two patients who had streptococcus throat infections were allowed to mingle with other patients without precautions, and a patient with a Clostridium difficile infection was allowed out of isolation before the bacteria was eliminated. The bacteria causes serious diarrhea and can be life-threatening for patients with immune system problems.

Hospital staff are trained to avoid contamination from patients’ infections, de Rocha said. The hospital has to strike a balance between controlling infection and allowing patients freedom within the facility, she said. 

The inspection also noted the hospital didn’t have qualified staff to provide complementary therapies.

Read the inspection report on staffing and treatment plan issues at Osawatomie State Hospital.

Other problems flagged in the inspection included:

  • Doors and other barriers weren’t adequate to stop a fire from spreading.
  • The facility didn’t conduct fire drills.
  • No one tested the emergency power generator.
  • The hospital didn’t have a committee to review unusually long patient stays, because it didn’t have enough professional staff.
  • Patient treatment plans didn’t include strengths or what activities might help them.
  • Activity therapists didn’t have the necessary degrees for their jobs.

Read the inspection report on safety issues at Osawatomie State Hospital.

‘A halt in the process’

The inspection results are a setback for recertifying Osawatomie State Hospital, but state officials won’t have to start from scratch. Inspectors will return to check if the hospital has addressed the new violations, de Rocha said, and then conduct a third inspection to finish the recertification process.

“This is just a halt in the process while we fix these new deficiencies, ones that had not been brought to our attention earlier,” she said in an email.

The inspection only looked into a 60-bed unit that has been renovated to address CMS patient safety concerns. The state hasn’t pursued regaining federal payments for the other beds.

The problems at Osawatomie State Hospital have deep roots, including insufficient staffing, low state funding that failed to keep up with increases in the number of patients and the failure to build a robust system for community mental health care. 

Related Story On Osawatomie State Hospital: A Leading Light For Mental Health Care Slowly Dims

After a patient attacked a hospital employee in October 2015, inspectors found that security staff had falsified records to show they had performed required checks. CMS gave the hospital one more chance to prove it was safe for patients but cut payments in December 2015 after it found staff failed to address violence on a unit during a follow-up inspection. 

Since renovations began in 2015, Osawatomie State Hospital has been under a moratorium and does not admit voluntary patients. Other hospitals in the state reported that they had been treating mental health patients in their emergency rooms due to the lack of space at Osawatomie State Hospital. 

In February 2016, Keck suggested that the state seek a public-private partnership to operate Osawatomie State Hospital.

However, privatization also doesn’t appear to be an easy answer. KDADS issued a request for bids late last year and received a single proposal, from a company that has a history of problems at its Florida mental health facilities. 

De Rocha said the department hasn’t made a decision about the bid, and it has not been presented to lawmakers. Provisions in several laws forbid KDADS from privatizing the state hospital without approval from the Legislature.

Meg Wingerter is a reporter for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. You can reach her on Twitter @MegWingerter. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.