Joe Nelson and Jim Steinberg, Staff Writers
Posted: 05/06/2010 07:15:56 PM PDT

COLTON – Arrowhead Regional Medical Center, the county’s public hospital, has until May 17 to provide a plan to federal officials as to how it will improve its patient care, or face losing its contract for Medicare and Medical services.

In November, the Centers for Medicare and Medicaid Services (CMS) launched an investigation at the hospital based on four patient complaints, reported to CMS by hospital administrators, said Patrick Petre, hospital director.

Findings from the investigation, which also included a hospital validation survey, were summarized in a letter dated April 30 and received by Petre on Monday.

Rufus Arther, a CMS branch manager, stated in the letter that the hospital was not in compliance with conditions set by CMS for the Medicare program, citing nine areas of deficiency.

“We are initiating a process that could result in termination of the hospital’s Medicare provider agreement on or before July 30, 2010,” Arther wrote.

Fifty-percent of Arrowhead’s revenue comes from Medicare and Medical funding, Petre said.

Most hospitals receive 50 to 60 percent of their funding from Medicare and Medical, and losing the contracts can wield a serious blow, said Jack Cheevers, CMS spokesman.

“No hospital, including ours, could survive without this funding,” said Dr. Dev GnanaDev, the hospital’s medical director. “We are taking this very seriously…we are not expecting to lose CMS accreditation. We are there to serve the taxpayers of this county.”

The complete report, which details the nature of the complaints and deficiencies discovered during the investigation, will be made available to the public once the hospital presents its corrective plan to CMS officials, Cheevers said.

The nine areas of deficiency include:

• Compliance with federal, state and local laws.

• Governing body.

• Patient’s rights.

• Quality assessment and performance improvement program.

• Nursing services.

• Pharmaceutical services.

• Food and dietetic services.

• Infection control.

• Surgical services.

“We have further determined that the deficiencies identified by both these surveys substantially limit the hospital’s capacity to render adequate care to patients or are of such character as to adversely affect patient health and safety,” the letter said.

GnanaDev said that one incident can result in a ripple across several hospital departments.

For example, the inspector for CMS felt ARMC did not sterilize instruments used in endoscope procedures quickly enough. This lead to deficiencies being filed against both surgical services and infection control.

A survey group from another agency found no fault with ARMC’s practices in this area, he said.

“But we are not going to argue about it. We have already changed,” he said.

Changes have been implemented in the other areas deemed deficient by CMS, he said.

CMS initially gave the hospital until Monday to present a corrective plan to prevent the termination of its Medicare contract, but the hospital was granted an extension until May 17, said Jorge Valencia, hospital spokesman.

Petre said hospital officials began working on the plan as early as November, and have a significant portion of the deficiencies already corrected.

“We fully expect we’ll have a solid plan that they will approve, based on our collective experiences with this process,” Petre said.

Once Arrowhead presents its corrective plan, CMS will likely conduct another survey of the hospital, and if the follow-up survey determines the hospital is in full compliance, CMS will reinstate the hospital’s status with the federal organization.

Hospital officials say such investigations are routine and done all the time at hospitals of similar size and capacity.

“These validation surveys are a routine part of the hospital,” Petre said, stressing that investigators did not determine any of the hospital’s operations were serious enough to be placed in a status known as “immediate jeopardy,” which can call for an immediate shuttering of a unit, laboratory or other hospital function until the problem is remedied.

“We’ve been operating the same the last five or six months,” Petre said.

San Bernardino County Supervisor Josie Gonzales, who sits on the county’s joint conference committee for the hospital, called the CMS action “par for the course” and “normal” in the hospital business.

“As a person responsible for the good working administration and delivery of health care services at the hospital, I don’t have a problem with anyone pointing out things that are are wrong. It’s how we make an organization stronger,” Gonzales said. “This is a way to keep personnel on their toes.”

In recent months, the hospital has been rife with internal conflict over hospital politics and patient care, say hospital doctors, current and former, who have wished to remain unidentified.

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