The reported rape of an employee at Osawatomie State Hospital in October exposed security concerns that federal officials cited when they decided last week to stop sending Medicare payments to the facility after Monday.
Osawatomie had submitted a correction plan for the security issues to the Centers for Medicare and Medicaid Services, but federal inspectors who visited the hospital Dec. 15 and Friday to follow up decided to proceed with cutting payments, said Angela de Rocha, a spokeswoman for the Kansas Department for Aging and Disability Services.
De Rocha said she did not know why inspectors determined the facility wasn’t in compliance, and documents provided by CMS didn’t detail the results of the follow-up inspections.
CMS inspectors cited the reported Oct. 27 sexual assault in a deficiencies report last month. They identified multiple problems with security, including insufficient nursing staff to perform patient status checks, security staff who were present but didn’t perform required safety checks and inadequate supervision in areas where patients at risk of suicide could be in danger.
The plan of correction involved requiring nurse managers to spend more time directly supervising activities on the floor; assessing patients for their risk of violence toward others; retraining nurses and security staff, including reminding security officers not to leave the facility while on breaks; and instructing staff to use personal alarm devices and to respond if someone else’s alarm activates.
The plan also involved recruiting more security staff, including a dispatcher, and monitoring for “adequate” staffing levels. All provisions of the plan had been implemented before the follow-up inspections, de Rocha said.
Rebecca Proctor, executive director of the Kansas Organization of State Employees, said Osawatomie workers told her staffing was a factor in the Oct. 27 attack.
Proctor said mental health technicians used to make their rounds in pairs but are now going into patients’ rooms alone.
“I’ve had some employees tell me that’s what put the employee who was raped by a patient in danger, is that she was out by herself without a partner, but that staffing levels do not allow you to have a partner any more,” Proctor said.
The female employee, an unidentified mental health technician, said she was taking gowns to a patient’s room about 8:30 p.m. Oct. 27 when the patient grabbed her and covered her mouth.
“I was trying to scream and was banging on the walls and he raped me,” the report quoted her as saying.
The mental health technician said she didn’t think any staff could hear her, but two patients “saved” her by coming into the room and shoving the assailant off her. In a separate interview, one of the patients said he heard “someone screaming, crying and the word ‘rape,’” and found the staff member on the assailant’s bed.
The patient charged with the rape reportedly suffered from psychosis, which causes delusions or hallucinations, and was to receive checks from nursing staff every 15 minutes due to a risk of suicide.
But surveillance video footage showed that neither the nursing checks nor required safety checks by security personnel were performed during that hour.
Hospital administrators told federal regulators the facility didn’t have enough registered nurses and, though concerns about missed safety checks had come up in the past, security staff had not been retrained.
Federal regulators determined that the conditions leading up to the alleged rape were not isolated.
The CMS deficiencies report said nursing staff didn’t provide proper oversight of patient care, security staff didn’t perform rounds checks and nursing staff didn’t perform status checks. Some patients also weren’t supervised in bathrooms with fixtures that would allow them to commit suicide by hanging, something inspectors noted after watching video recorded in the hallway in the half-hour before and after the attack.
“The cumulative effect of the systemic failure to supervise the provision of care, to perform required safety checks and to protect suicidal patients from hanging risks placed all patients receiving services at risk for harm,” the report said.
Proctor said staffing always has been a key challenge at the hospital.
But she said it has become more challenging since the state transferred inpatient mental health beds and state jobs from the Rainbow Mental Health Facility in Kansas City, Kan., to Osawatomie in early 2014.
Stagnant pay for longtime employees and increasingly difficult working conditions also have made it hard to recruit and retain staff, she said.
“When you hear about a 20-something female employee being raped by a patient, it makes you think (about) whether putting yourself in harm’s way like that is really worth 13 bucks an hour,” Proctor said. “I think a lot of people don’t think so, and therein lies your staffing problem.”
A letter dated Nov. 27 noted CMS could immediately cut off Medicare payments to Osawatomie but offered opportunities to make changes because of the hospital’s role in the state mental health system.
“This offer is being extended in light of the unique role Osawatomie has in the provision of mental health services in the state and is being offered despite the facility’s failure to make substantial improvements in the facility’s ongoing non-compliance with Federal Conditions of Participation,” the letter said.
CMS reversed that decision last week.
Osawatomie is one of two state-run inpatient treatment facilities for Kansans with severe and persistent mental illness. The other is in Larned. The Osawatomie facility is usually equipped for 206 patients but is allowed only 146 now, while renovations are under way to correct deficiencies that threatened the hospital’s federal reimbursements last year. In 2014, Medicare payments made up 23 percent of the hospital’s total budget.
De Rocha said the state will continue to serve patients at Osawatomie. The facility could pursue recertification with Medicare or could take other routes, she said, adding it was too early to know what the state would do.
“We will continue to cover patients that are there,” she said. “We will continue to admit patients. The hospital is not closing.”
Andy Marso and Megan Hart are reporters for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach Marso on Twitter @andymarso.