Hospital: Plan written to prevent blood mixups

A blood transfusion mixup that led to the death of an elderly patient at Pitt County Memorial Hospital in Greenville came close to costing the hospital its right to collect payment from Medicare and Medicaid.

Hospital leaders provided few details today about the transfusion, in which the patient was given incompatible blood during a hospital stay in February. The problem came to light in the last week, when the federal agency that oversees Medicare and Medicaid published a legal notice stating that Eastern North Carolina’s largest hospital was set to lose its Medicare and Medicaid reimbursement after today.

The hospital avoided the action, however, by writing a plan to prevent future blood mixups and proving to inspectors that the plan was in place.

State hospital inspectors, acting on behalf of the federal Centers for Medicare and Medicaid Services, or CMS, wrapped up a two-day inspection at Pitt County Memorial today . Inspectors called CMS to confirm that hospital staffers were checking and double- checking blood types, plus making other improvements — just in time to avert an interruption in funding.

Losing payment from Medicare and Medicaid would have been devastating to the hospital, which depends on the two government health insurance programs for more than half its total revenues. Pitt County Memorial collected $357 million from Medicare and Medicaid during the budget year that ended Sept. 30.

Lee Millman, a spokeswoman for CMS, confirmed that the hospital remains in good standing with the federal government.

“We are not in the business of shutting down hospitals,” she said. “We are in the business of ensuring that hospitals provide quality care.”

David C. McRae, chief executive of University Health Systems of Eastern Carolina, which owns Pitt County Memorial, said the hospital took full responsibility for the transfusion mixup. He said that an elderly patient received a blood transfusion of a type that did not match the patient’s blood type, and that the patient subsequently died of causes “related and unrelated” to the mistake.

McRae said Pitt County Memorial immediately notified the patient’s family of the mismatch when it occurred in February and then voluntarily reported it to the U.S. Food and Drug Administration, which regulates blood and blood products. He said FDA then notified the federal Medicare and Medicaid administration about the incident. That led CMS to order a surprise inspection of Pitt County Memorial, which occurred Dec. 5. Regulators cited the hospital for the blood transfusion incident, as well as several other minor violations not considered a threat to patient safety.

McCrae emphasized that it was the plodding regulatory process — not slowness by Pitt County Memorial to fix problems — that caused the funding threat to come down to the wire. He said the hospital’s new checks and improvements, including new processes for ordering and distributing blood, were in place the same month the transfusion mixup occurred.

“It just took eight or nine months for the regulatory process to catch up,” McRae said. He said the Christmas holidays, which caused state and federal offices to be closed for at least two days this week, further delayed the resolution of the matter.

Dropping a hospital from the federal programs is the most severe punishment CMS metes out. But it is a threat regulators rarely make good on.

In recent years, Duke University Hospital and Durham Regional Hospital in Durham and UNC Hospitals in Chapel Hill all have been threatened with the loss of Medicare and Medicaid privileges at least once. In all cases, the hospitals took steps to correct problems and preserved the right to collect from the federal programs, which are typically among the largest sources of hospital revenues. Medicare covers older Americans and people with disabilities, and Medicaid covers poor children and some adults.