The Centers for Medicare and Medicaid Services has entered into an agreement with Texoma Medical Center to address violations found during a January inspection. The violations show deficiencies in practices at the Texoma Medical Center Behavioral Health Center that CMS says led to the death of a patient.

The Centers for Medicare and Medicaid Services has entered into an agreement with Texoma Medical Center to address violations found during a January inspection. The violations show deficiencies in practices at the Texoma Medical Center Behavioral Health Center that CMS says led to the death of a patient.

The agreement, called a Systems Improvement Agreement "allows a hospital to continue receiving CMS funding while a third-party monitors its policies, facilities and patient care until the serious problems that caused the facility to fall out of compliance are fixed," CMS Public Affairs Specialist Bob Moos said. "The agreement grants the hospital additional time to make sustainable improvements in complex quality, cultural, policy and procedural deficiencies. CMS uses the SIA to ensure long-term problem resolution, not just quick fixes."

Texoma Medical Center declined an interview request from the Herald Democrat but in a statement said the agreement relates to operations at its Behavioral Health Center, located in Sherman.

"While there were some noted deviations attributed to acute care services at Texoma Medical Center, these matters did not rise to the level to warrant termination independently and have already been remedied," TMC said in a statement issued Friday. "Texoma Medical Center has been consistently recognized as one of the finest hospitals in the nation and has won numerous awards and designations for the high-quality care and treatment we provide."

‘Immediate jeopardy’

The agreement relates to a complaint in January regarding patient care and discharge procedures that were deemed an "immediate jeopardy" to patient health and safety by CMS, say documents obtained by the Herald Democrat through Freedom of Information Act requests.

The deficiencies described by CMS relate to an inspection conducted on Jan. 27, following a complaint. A patient, called Patient #8 in the report from CMS, was admitted on Jan. 9, 2015. The patient expressed to hospital staff that he had suicidal thoughts and plans to jump off a bridge.

Patient #8 was left at a bus stop upon discharge on Jan. 19 and, according to the CMS report, was directed to take a bus back to his home nearly 200 miles away. The bus trip involved a bus change in Dallas, before arriving Longview. The report states that personnel interviewed by CMS were "concerned that (Patient #8) would not get off one bus and on to the other one" or that he "would get off and not pay attention."

Patient #8 was found deceased under a bridge in Dallas near the Trinity River on Jan. 21. A source, called non-hospital personnel #99 in the report, told CMS that Patient #8 "fell or jumped" off the bridge.

The patient was discharged from the hospital without the completion of a safe discharge plan, the CMS report concludes. The section for the plan was left blank, the report states.

The CMS report states that a discharge plan must include an evaluation of the likelihood of a patient needing post-hospital services and where these services may be available. Additionally, the plan must evaluate the patient’s capacity for self-care.

In a letter dated Feb. 18, 2015, CMS alerted TMC that it would terminate its Medicare provider agreement on March 20, 2015, following inspections of the hospital in late January. Eight days later, CMS received a request from the hospital to enter into a System Improvement Agreement to resolve the deficiencies and retain its CMS funding. On March 17, CMS agreed.

Moos said the CMS regional office, which covers Texas and four other states, has entered into agreements with less than 10 health care providers in recent years.

"In this region, all providers that have entered into Systems Improvement Agreements have successfully resolved their problems," Moos said.

At the end of the agreement, an inspection of the facility is conducted to ensure it is in full compliance with Medicare’s conditions for participation.

TMC’s parent company, Universal Health Services, disclosed the Systems Improvement Agreement in a regulatory filing on Aug. 7, 2015. The Systems Improvement Agreement was signed on April 2.

Other violations

The January inspection also found deficiencies related to the TMC’s maintenance of hemodialysis machines — devices used for the filtration of blood in patients whose kidneys are not functioning properly. The report concludes that five of the 10 machines did not have records of water testing, and all 10 of the machines were also lacking records of heat disinfection with bleach. The inspection also found that three of the 10 devices had expired electrical safety testing.

In response to the water testing violation, the report states that hospital personnel informed the inspectors that the machines were newly installed and "our policy allows us not to have the history," the report quotes one hospital employee as saying.

The Systems Improvement Agreement also follows an inspection on Oct. 9, 2014, that found additional violations related to patient rights, quality assurance and nursing. Following the inspection, CMS sent TMC a letter stating it would terminate its provider agreement with the hospital on Dec. 19, 2014, unless action was taken to correct the deficiencies.

The Herald Democrat sought clarification on how the violations from the October inspection were resolved but has yet to receive the additional information from CMS.

The October report detailed a case from Sept. 22, 2014, of a psychiatric care patient who reported suicidal thoughts to staff and intentions to hang himself with a bedsheet. The next day the patient continued to display warning signs two hours before staff discovered him with a knotted sheet around his neck and over a door, the CMS documents state. Hospital staff were able to remove the sheet.

The report states that, while the hospital implemented an action plan following a patient attempting self-strangulation that resulted in injury nearly two months before the incident, the September event did not result in an improvement plan. Items that could have been used for self-harm were still accessible to patients during the inspections on Oct. 8.

In regards to its current agreement with CMS, the hospital said it has already had success in resolving the issues at the facility. "We have already completed initial phases of the SIA and are confident that we will successfully complete the terms of the agreement including confirmation that Texoma Medical Center meets all Medicare conditions of participation," the hospital’s statement said.