The homeless man identified only as Patient No. 5 was in a wheelchair, recovering from a suicide attempt and three broken bones when Parkland Memorial Hospital staff discharged him to a homeless shelter. He didn't want to go. "The patient stated he did not feel safe going to the shelter with three casts on," says a social worker's note.
An unnamed doctor gave the staff permission to call the cops if he didn't comply. "Dr. ... says that if patient refuses shelter and transportation, that we can call the police," say notes written by a hospital nurse last month. So when the patient "stated he wanted to file an appeal on his discharge" and refused to get in a van that would take him away, the staff took the doctor's advice. "Police called," conclude the hospital staff notes detailing that episode. The cops seemed to do the trick, with the hospital somehow finally getting him off the property. But now Parkland's treatment of Patient No. 5 is coming back to bite the hospital.
Centers for Medicare and Medicaid Services sent a letter to Parkland, made public last week, saying the hospital risked to lose $400 million in Medicare funding because it had placed a patient in "immediate jeopardy."
In a more detailed report, the CMS gets specific about all the things Parkland did to place him in jeopardy.
The man was hospitalized after a suicide attempt and seemed to exhibit more self-destructive behavior while there. He was supposed to stay off of his feet so his fractures could heal, but at one point, "patient jumped out of bed onto both feet stating, "See what you made me do are you happy now?" according to progress report notes from the hospital. After jumping up, "patient returned to bed screaming for therapist to leave the room."
Despite all that, the hospital never gave him a psychological or psychiatric evaluation. The CMS interviewed hospital staff afterward to find out why. One of the unnamed hospital personnel (the report keeps everyone anonymous) told the CMS that another hospital staff member said he didn't need one. Other staff said they didn't realize he had any mental health issues or insisted that the homeless shelter was safe.
But an employee of a homeless shelter told the CMS that all of its residents "would have to be independent and able to care for themselves as the facility did not provide any physical assistance." And buses that all the residents have to board each night to go to another shelter are old and not wheelchair accessible.
Last year, the federal government determined that Parkland "has caused or is likely to cause serious injury, harm, impairment or death to a patient." Investigators reviewed cases involving a death, a sexual assault and "hygiene lapses," covering just about everything that could possibly go wrong during a hospital stay. Then, a year ago, the CMS had some good news, announcing that Parkland Hospital "put themselves in a position to provide sustainable safe care."
Now that the CMS is mad at Parkland again, the hospital promises to fix its errors. In fact, CMS spokesman Bob Moos says his agency has already approved Parkland's plans. At some point before September 6, the CMS will make an unannounced visit to Parkland "to ensure that the hospital's planned corrections have indeed been implemented," Moos says in an email. So if you need to go to Parkland soon and want top-notch treatment, it sounds like between now and September 6 is the time to do it.
The CMS' report about Patient No. 5 is below: