Last spring the state threatened to cancel its provider agreement with a Garner inpatient mental health institution, but the company made required fixes and never lost crucial eligibility to receive Medicaid dollars.
A March 17-28 survey of Strategic Behavioral Health which specializes in days-to months-long inpatient stays for teenagers, found three cases of “immediate jeopardy” of patients along with numerous “statements of deficiencies.”
The facility opened in late fall 2012. SBH president Jim Shaheen – who oversees the Memphis-based company’s nine facilities, three in this state – said it meets a drastically under-served need, with a focus on months-long stays for children under 18 with severe mental problems. A call to Garner facility CEO Bobby Eklofe was forwarded to Shaheen, who characterized the issues as growing pains for a young facility.
“We knew about every issue they identified and were in the process of correcting them,” Shaheen said. “No child was harmed or hurt or anything. Our procedures were not what the state would have liked them to be. An action plan put us back into compliance as quickly as the time period would allow.”
An April 17 letter informed SBH it had been ruled out of compliance and that the Department of Health and Human Services would terminate its provider agreement, cutting off Medicaid and Medicare dollars.
The first cited incident of immediate jeopardy, on Dec. 7, involved staff failing to call for emergency medical help when policy dictated such a call should have been made in a situation involving a 17-year-old patient. On Jan. 18, a 15-year-old boy set fire in the facility with a lighter that a policy-required search failed to uncover. And on Jan. 20 neurological checks were not completed on a 16-year-old after a head injury, as ordered by a physician.
Cited deficiencies included: an under-qualified director of nursing, lack of an effective hospital-wide data-driven assessment and improvement program, documentation indicating a physician’s malpractice insurance had lapsed, unnecessary use of patient restraint, poor documentation and monitoring of restraint, infection control lapses (including lack of proper hand hygiene practices) and entire shifts without a house supervisor nurse on duty.
But in an April 29 letter, SBH informed DHHS of steps it “enacted prior to, and subsequently in response of” the DHHS findings. It said SBH contracted with Moore Medical Group to provide on-site primary health services in March, added psychiatrists and direct care staff, and had company leadership and other experienced staff from other SBH facilities come on-site to train local staffers.
In return, DHHS accepted the plan of correction, and verified corrective action and compliance on May 30, after a May 27-29 on-site survey.
Shaheen noted the difficulty of treating the types of children that come into facilities like SBH, and largely passed the turbulence off as a learning curve.
“These things happen sometimes with health care providers where you have to put in a corrective active plan,” Shaheen said. “I think our main takeaway is that every day we have to be more and more vigilant in the way in which we provide care and make sure we are crossing every ‘t’ and dotting every ‘i’.”
DHHS would not quantify how common an occurrence such findings of noncompliance are, nor how comparatively egregious the violations were compared to conditions in other comparable facilities.
“DHHS takes all matters affecting patient very seriously, and in this case the facility was able to put in place measures to abate the citations so that the potential loss of certification could be avoided,” DHHS spokesperson Kevin Howell said in a statement.
As the facility opened, UNC-Wilmington social work and psychology expert Art Frankel praised the outcomes of a sister facility in Leland, outside Wilmington. And on the employer review site glassdoor.com, anonymous employees and former employees said the program mission, agenda and stated process was sound.
But reviews from Garner and Leland on the site also criticize execution at the company. They point out other characteristics consistent with flaws in Garner cited by the DHHS report: unqualified management, understaffed shifts and unsanitary conditions. Some conditions were said to only be brought up to speed when a survey was expected. High turnover is also frequently mentioned.
The SBH plan of correction had to address each stated deficiency. Most of them consisted of training in a number of areas of various types of staff. That work was completed largely on April 17, according to the company.
For the Director of Nursing position, the state requires a master’s degree or equivalent, or that the director “be qualified by education and experience in the care of the mentally ill.” The director had only an associates degree, the report said.
The plan of correction noted the director had more than “23 years of psychiatric experience.” It also said a master’s level nurse was brought on-site to further train the director, and that a state-level job requiring a master’s in nursing had been posted.