LITTLE ROCK — In the wake of a patient report of rape at the State Hospital, federal Medicaid officials have extended the deadline by which the hospital must fix documented problems with patient treatment or lose the federal funding.
The Arkansas Department of Human Services, which operates the Little Rock hospital, confirmed the agreement Friday, hours after it released the results of an internal investigation of the sexual-assault allegation.
That “root-cause analysis” investigation found that a male patient with a history of exposing his genitals entered a room in a women’s-only unit as workers who were supposed to be monitoring a female patient gathered in a nearby dining room on an unapproved break without first assuring that coworkers would relieve them.
“We’ve made a lot of progress at the hospital, but, as this root-cause analysis shows, there’s still more that needs to be done,” Human Services Department spokesman Amy Webb said. “We know that.”
The extension — which moved the end date of an agreement between the hospital and the federal Centers for Medicare and Medicaid Services from July 18 to Sept. 18 — frustrated a patient advocate, who said the state’s only public psychiatric hospital has had too many second chances to remedy “systemic problems” with patient treatment and staff behavior.
“The need for an extension should be an indication to all parties concerned and to the public of how serious and how deep the systemic failures at [the State Hospital] are,” said Dee Blakley, an advocate for the federally funded Disability Rights Center of Arkansas who has called the purported rape “predictable and preventable.”
The hospital lost its “deemed status” as a Medicaid provider last year after federal site reviewers documented four situations of “immediate jeopardy,” or conditions and treatment that threatened the health and safety of patients, dating back to 2010.
The hospital’s $46 million budget for fiscal 2012, which ends June 30, includes $3,842,499 in Medicare funding and $8,276,565 in Medicaid funding.
The federal Centers for Medicare and Medicaid Services has threatened multiple times to pull the hospital’s Medicaid funding.
Each time, the agency offered the hospital a last-minute extension to fix problems and policies related to episodes such as the improper restraint of a suicidal child who bloodied his face by banging it into a doorjamb while he was held unmonitored in a seclusion room.
In July 2011, hospital leaders signed a Systems Improvement Agreement, agreeing to work with private consultants to rework policies and educate staff members.
Site reviewers will make an unannounced visit to the hospital before the deadline, which is now September, to confirm that it complies with all conditions of participation in Medicaid.
The Centers for Medicare and Medicaid Services has received a copy of the investigation related to the patient’s rape report, spokesman Bob Moos said Friday.
“As part of the Systems Improvement Agreement process, we are continually reviewing all events at the hospital and assessing the facility’s ability to come into full compliance with our program requirements,” Moos wrote in an e-mail.
“We expect a prompt resolution to any substantiated findings that affect the quality and safety of care at the hospital.”
Webb said hospital leaders are waiting for results from the state Crime Laboratory before they determine whether a rape occurred. The hospital’s internal police turned its report over to Pulaski County Prosecuting Attorney Larry Jegley, she said.
The root-cause analysis said the male patient was in the female patient’s room for 11 minutes, as documented by hallway security cameras.
Twenty minutes later, the woman told staff members that the male patient had forced her to have vaginal and anal sex, a report by the hospital’s Police Department said.
Complaining of pain, she was transported to the emergency room at UAMS Medical Center, where nurses completed a rape examination and collected her clothes as evidence, the police report said.
While the assault purportedly was happening, a hospital worker sat at the nurses station with her back to the hallway, sending text messages from a mobile phone that was prohibited on the unit, the investigation said.
Hospital leaders on Wednesday fired two behavioral-health aides for disobeying patientmonitoring rules and they disciplined three other employees.
The investigation also confirmed details previously reported by the Disability Rights Center of Arkansas.
When another female patient told a social worker that a man was exposing his genitals in the woman’s room, the social worker did not intervene, telling the patient to find another staff member to help, the Human Services Department investigation showed.
A security worker who had stopped the male patient from entering the women’s hallway earlier in the day failed to notify other workers of the patient’s behavior, the report said.
And workers on the unit did not read a report from workers on a previous shift warning that the two patients had previously attempted to interact, the investigation said.
“One of the biggest things that the analysis shows is that we still have an issue with the culture out there,” Webb said. “We knew from the beginning that that would be the hardest issue.”
Since the episode, the hospital has required workers to check on their patients and document conditions every 15 minutes, a task workers previously completed hourly.
The hospital has also held staff education sessions on patient monitoring and conducted “spot checks” to ensure compliance, the investigation said. Leaders also will train staff members in “never ignore” conditions and “red flag” circumstances related to patients, the report said.
Webb said the extension will give the hospital more time to implement new nursing plans and hire workers in key positions related to areas such as patient complaints and infection control.
A recent update by Compass Clinical Consultants, hired to get the hospital back into compliance with Medicaid rules, said the hospital’s relatively low starting pay for licensed practical nurses had been a hurdle in filling positions.
Webb said the hospital is researching whether it can adjust the pay level, which is set by the state Office of Personnel Management.
Blakley said she remains concerned that the hospital will not successfully improve by its new deadline.
The report released this week does not mention a 2010 sexual assault that occurred on the unit, after which the hospital made similar commitments to improving its policies, Blakley said.
“The problem is we can’t not have an Arkansas State Hospital,” she said.
“The question is when are we going to have one that’s able to provide competent and clinically appropriate services to people in a safe environment.”
Front Section, Pages 1 on 05/26/2012