The 61-year-old woman was found unconscious in a bathroom, with a bra wrapped around her neck and a bottle of pills in her hand. Despite the suicide attempt, when she was admitted to St. Joseph Medical Center on October 1, suicide risk assessment wasn't part of her treatment plan. Neither did staff note suicide precautions for a delusional 63-year-old woman admitted to the downtown hospital nine days later, after she was found running naked down the street, threatening to kill herself and her brother with a knife.
Problematic handling of suicidal patients at St. Joseph is nothing new. The federal Centers for Medicare and Medicaid Services investigated the hospital this past summer after a patient who had already told staff she was suicidal hanged herself from the hinges of a bathroom door. And, according to a federal inspection report released yesterday, the hospital's troubling treatment of suicidal patients was one of several reasons the feds have decided to pull all Medicare and Medicaid funding from the hospital, starting December 3. The blow could shutter Houston's oldest hospital, known for treating the city's homeless, elderly, and poor.
Federal investigators began to again look into patient care at St. Joseph in September after a patient committed to the hospital's psychiatric unit was shot in the chest by an off-duty HPD officer moonlighting as security. When questioned, hospital staff told investigators that Alan Pean, a 26-year-old with a history of mental illness who had checked himself into the hospital amid a severe panic attack, repeatedly left his room naked after being admitted. An officer shot him in the chest, barely missing a vital artery, when Pean became combative and threw a hospital tray table.
The feds first announced last month that they planned to cut St. Joseph's funding, saying hospital administrators failed to implement safeguards that protected the rights of patients, flaws that, according to federal regulators, put the hospital's patients in “immediate jeopardy.” That finding was in part based on hospital administrators' responses when questioned about the shooting—St. Joseph CEO Mark Bernard, for instance, told investigators the off-duty officer was justified in shooting a confused, combative psychiatric patient because the security guard had entered “police mode”; other hospital administrators told CMS investigators guards were justified in tasing and shooting Pean because “the patient's aggression toward the officers was a criminal offense,” according to a federal inspection report.
But it wasn't just Pean's shooting that convinced federal investigators to pull St. Joseph's funding. Another inspection report released the day after CMS officials made its decision documents a host of other problems investigators discovered at the hospital, including shoddy documentation in the dialysis unit and nurses reusing contaminated gloves.
The CMS report also describes problems with the hospital's psychiatric unit. Here's how the report describes the unit's intake floor:
“The room contained 4 pull out vinyl covered beds and the floor was smeared with copious amounts of what appeared to be brown fecal matter. The fecal matter was observed to trail out of the room and into the carpeted entry. There was a white towel placed over one large brown spot. There was no barrier to prevent the three patients sitting in the outer room from accessing the area.”
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Staff eventually removed the towel, but didn't clean up the brown stain. On two separate occasions, CMS investigators saw staff escort patients “through the fecal covered carpet.” According to the report, “The patients were only wearing socks, and their feet could have come in contact with the fecal matter.”
While St. Joseph's administrators promised dozens of fixes—from requiring suicide assessments upon admission to cracking down on hygiene—those apparently weren't enough for federal regulators. The hospital does have some last-ditch options, from filing an appeal with federal regulators to seeking an injunction in court. Congresswoman Sheila Jackson Lee and state Rep. Garnet Coleman have both said this week that they're helping with negotiations to save St. Joseph.
Whether any of that will assuage concerns from federal regulators remains to be seen. The hospital itself hasn't commented on the feds' decision, other than to provide this message CEO Bernard sent to hospital staff after CMS announced it would defund the hospital:
“We are meeting with CMS officials to discuss the situation and we are hopeful of finding a solution where our hospital remains in these governmental programs and able to continue to provide care to our Medicare and Medicaid beneficiaries. We are working with CMS and the Texas Department of State Health Services (DSHS) to demonstrate our commitment to quality and safety and to excellent patient care.
Each of you knows that the important work you do every day is often on behalf of the most vulnerable residents in and around Houston. The care you give must continue uninterrupted. Thank you for your continued, tireless efforts on the part of all of our patients.”