CMS report details abuse allegations at Mercy hospital

Jon Swope is serving as interim executive leader of Mercy Springfield.

Mercy issues plan of correction

After the review by the Centers for Medicare and Medicaid Services, federal officials ruled there was “immediate jeopardy” to the health and safety of some patients at the Mercy campus. The hospital was notified its ability to bill Medicare would end Sept. 22 if the conditions were not improved, and that deadline was later extended by a week.

In response, Mercy quickly fired 12 staff members, including two who it reported to the state board of nursing, according to the hospital’s plan of correction furnished by CMS. Additionally, a nursing manager resigned and a behavioral health charge nurse left for an unspecified reason.

Mercy also appointed an interim leadership team Sept. 12 for Mercy Hospital Springfield to address the issues. The team adds another layer of Mercy leaders from outside of Springfield, and they work in tandem with the current leadership in certain areas, according to a hospital statement provided by Kullmann.

Dr. Alan Scarrow, a surgeon who also has served as president of Mercy Springfield Communities since 2015, is not listed on the interim team and he’s described as “taking on other responsibilities for the time being.” A staff member at Scarrow’s neurosurgery office said he remains president of Mercy Springfield Communities.

The interim team comprises:

• Jon Swope, Mercy central region president, is serving in executive leadership for Mercy Springfield Communities, including Mercy Hospital Springfield.

• Jeff Johnston, president of Mercy’s communities in the St. Louis area, is serving as interim hospital COO. Current Mercy Springfield Communities COO Brent Hubbard remains heavily involved, according to the hospital’s statement.

• Di Smalley, president of Mercy’s communities in Oklahoma and a registered nurse, is working with current Clinical Administrative Director Dea Geujen.

• Cynthia Mercer, chief administrative officer for Mercy in St. Louis, supports current Chief Human Resources Officer Tanya Marion.

• Marc Gunter, senior vice president and COO for Mercy Clinic and a St. Louis-area physician, is working with current Chief Physician Officer Rob Cavagnol.

• Keith Starke, Mercy’s chief quality officer, and members of his team, are working on quality and safety issues.

The hospital’s plan of correction includes additional training for staff and a system for monitoring performance during such patient incidents.

“This plan, which includes training for our co-workers in de-escalating tense situations, has already shown significant success in reducing the number of situations in which our public safety department is called for assistance,” the statement reads.

The hospital instituted a patient rights dashboard, according to the plan of correction, which monitors the reporting and responses to allegations of abuse and neglect, as well as the data on the effectiveness and appropriateness of restraint and seclusion practices.

Mercy Hospital Springfield is addressing allegations of patient abuse by a small number of staff members – and the possible consequence for the city’s second largest employer has serious financial implications.

The Centers for Medicare and Medicaid Services on Oct. 13 released a detailed report of the incidents at Mercy Hospital Springfield that led to the firing of a dozen staff members, the installation of interim leadership and the risk of the hospital losing its Medicare agreement. The Medicare deal represented over $48 million for Mercy in Springfield as recently as 2014, according to Springfield Business Journal reporting.

A monthlong investigation began Aug. 22 into alleged abuse or neglect of four patients, according to documents CMS sent to SBJ. During unannounced, on-site surveys, CMS representatives interviewed Mercy staff and screened security camera footage of patient care in the emergency and psychiatric departments between April and August 2017.

The 105-page report concluded that in four cases, hospital leaders failed to prevent abuse or neglect, remove staff after allegations and adequately investigate allegations in a timely manner. Staff members also were cited as not using the least restrictive method or following policy in the use of restraints with three of the patients.

SBJ’s calls to current president of Mercy Springfield Communities, Dr. Alan Scarrow, and interim leader Jon Swope were not returned by deadline, and Mercy spokeswoman Sonya Kullmann said hospital officials would not be granting media interviews until after the next CMS survey.

The hospital presented a plan in late September to correct the situation, and it is under review by CMS. Among the actions, Scarrow has been reasigned to unspecified duties.

Jon Swope, central region president for St. Louis-based Mercy, is serving as executive leadership for Mercy Springfield Communities, including Mercy Hospital Springfield.

“With drug addiction and mental health issues at an all-time high, especially in our part of the state, our co-workers are managing increasingly difficult patient needs,” Swope said in a previous statement, released by Kullmann. “Even so, we are committed to providing a safe environment for our patients and our co-workers, and to honoring our Sisters of Mercy founders by cherishing all our patients as created in the image of God.”

Patient No. 1
One incident allegedly began with a security guard asking a patient in the emergency room to stop cursing, shortly before the patient slid out of his chair – his body shaking on the floor. According to CMS, a nurse failed to immediately assess the patient’s changing condition, simply stating, “You’re alright.”

The patent was listed as taking medications for allergies, anxiety and pain, as well as one antipsychotic used to treat schizophrenia, bipolar and depression.

When the security guard brought a gurney over, investigators said the patient indicated he didn’t want to be assisted by the guard who asked him to stop cursing. An argument ensued, and the patient decided to leave with a companion. The security guard allegedly followed them outside. According to the investigations, a second security guard joined the interaction and pushed the patient and his friend, both in the back. The patient sat on a curb and allegedly was eventually tackled by the two security guards and handcuffed.

According to CMS, Springfield Police Department officers arrived, interviewed the patient and his friend, and released them.

Patient No. 2
The second of the four documented incidents involved staff members moving closer to an upset psychiatric patient, instead of using preferred de-escalation techniques and giving the patient space, according to CMS’ review of security footage.

During an argument with the patient – a 28-year old woman who was being voluntarily treated for suicidal concerns, depressive and anxiety disorders, and post traumatic stress – the staff kept moving toward the upset patient, according to the report’s description of the video. When she picked up a pitcher of tea, a security guard allegedly grabbed her and she threw the pitcher – striking the guard. Documents say the staff then wrestled her to the floor.

A behavioral health technician and another guard attempted to help move the patient to a seclusion room, the report said, when she grabbed the hair of the technician and refused to let go. A third guard approached and appeared to use his knuckles to hit the patient’s hand, finally causing her to release her grip. The patient cried out in pain during both altercations.

She was then allegedly placed in a room by herself and held in restraints for two hours.

The CMS report said staff did not recognize this as assault on a patient, but an unnamed director of security interviewed acknowledged a staff member shouldn’t have approached the patient when she was upset.

CMS’ investigations resulted in conflicting accounts of what happened – particularly how much force was used and whether the guard used his knuckles to strike the patient. Two staff members involved said during interviews the technique used to release the patient’s grip was not an approved method.

Medical assessments of the patient after the struggle revealed bruises on her arms.

Patient Nos. 3 and 4
A third incident involved an 18-year-old, female psychiatric patient who reportedly was held down and forced to swallow a pill. Two behavioral health technicians who were asked to hold the patient against a bed while a nurse administered the pill told CMS surveyors the action was wrong, and one reported the incident to an unnamed psychiatric center manager. The nurse denied the allegation to CMS.

A fourth patient, according to CMS, was injured during a struggle and not given pain medication.

The video surveillance and the survey interviews gave conflicting accounts of how a security guard used his knee to place the weight of his body on the patient’s arm, while bending the patient’s thumb back toward the wrist.

One staff member reported a cracking sound, and the patient complained broken bones. The report said the patient eventually was held down to a bed with restraints by the ankles and by both arms, which were placed above her head.

The patient calmed down but was not removed from the restraints for more than six hours, according to CMS’ report, and was not given requested pain medication.

At least one staff member complained about the lack of treatment for the patient, without success.