The feds granted St. Joseph Medical Center another lifeline Thursday, again delaying the date they plan to pull Medicare and Medicaid funding from the hospital unless administrators can present a convincing plan to fix systemic issues that, according to federal officials, put patients there in “immediate jeopardy.”
The downtown hospital has been under pressure from the federal Centers for Medicare and Medicaid Services (CMS) ever since an off-duty Houston Police Department officer moonlighting as security shot a combative, but unarmed, patient in the chest. That patient, 26-year-old Alan Pean, had checked himself into the hospital amid a severe panic attack and had a history of mental illness. Medical staff who responded to his room on the hospital's Medical Psychiatric Unit, where Pean was shot, found him on the floor, in handcuffs, in the throes of psychiatric crisis. The bullet nearly hit a vital artery.
Earlier this month, CMS announced that after an investigation, it was prepared to pull all funding from St. Joseph, which could be catastrophic for the hospital, if staff didn't fix problems that could put patients in danger, problems that were brought to light by Pean's shooting. In a letter to St. Joseph CEO Mark Bernard Thursday, CMS for the fourth time extended the date on which the hospital will be terminated from the program to November 13 “unless the immediate jeopardy to patient health and safety is removed.”
CMS investigators interviewed hospital staff five days after the off-duty cop shot Pean, who drove himself to the hospital that day because of his panic attacks; Pean crashed his car in the hospital's parking lot and was taken to the emergency room before being admitted to St. Joseph's mental health unit.
CMS's 51-page inspection report, released earlier this month, says that once he was hospitalized, Pean, who has a history of manic depressive disorder and anxiety disorder, became confused and repeatedly left his room naked. Nurses managed to get him to return to his room without issue. But, according to their statements to investigators, Pean became combative when they asked him to stay in his room and put on some clothes. Eventually they called for help from hospital security, which just so happened to be a couple of off-duty HPD officers.
According to the federal report, Pean became aggressive with the officers, in part because they entered his room unannounced. The officers tased Pean when they couldn't calm him down. At one point, according to the report, an officer was hit with a hospital tray table and responded by firing a bullet in to Pean's chest.
The hospital's chief nursing officer told federal investigators she rushed to Pean's room shortly after he'd been shot. She found him struggling to get up off the ground, “hollering and screaming, talking gibberish.” He was in handcuffs. Pean's doctor eventually got to the room and saw no fewer than 20 cops surrounding the patient. Pean had some type of clothing or sheet draped over his chest; when the doctor removed it, he saw the bullet hole. The doctor had to ask that Pean be put in medical restraints in a hospital bed instead of being left handcuffed on the floor.
CMS investigators asked Pean what he remembered of the incident. According to their report: “[H]e said he remembered he was confused and could not find his clothes.” He told investigators he felt his life was threatened when the cops came into his room.
According to CMS's inspection report, hospital administrators appear to have unequivocally blamed Pean for the shooting when questioned by federal investigators, saying the officer was justified in shooting a patient committed to a hospital's mental health unit who, while in psychiatric crisis, grew combative.
For instance, CEO Bernard told investigators the off-duty cop had entered “police mode” during the shooting, and that he was justified in using lethal force against a combative patient. “If it should happen today, they would not have done anything different,” Bernard told investigators. The hospital's chief financial officer told investigators that the officer who shot Pean, who remains unidentified, was acting as a police officer and not hospital staff, and therefore argued the hospital shouldn't be considered liable.
“According to the CFO, his general understanding is that when the police officer mode comes into force it was a criminal investigation and the facility now have no jurisdiction [sic],” the report states. “Once that event occurs it trumps hospital policy.”
In case that wasn't clear, CMS put it another way in its report: “During a meeting on 9/4/2015, at 9:50 am, with Administrative staff the facility's attorney, Risk Manager and Director of Quality, they all stated the Police Officers were justified in tasing and shooting [Pean] because the patient's aggression towards the officers was a criminal offense.” (According to CMS's report, HPD would not let hospital staff interview its officers following the shooting.)
If you like this story, consider signing up for our email newsletters.
SHOW ME HOW
You have successfully signed up for your selected newsletter(s) - please keep an eye on your mailbox, we're movin' in!
The hospital has told the feds it plans to implement a Behavioral Emergency Response Team that will “bring resources and skills to the bedside to assist in managing the patient's disruptive or atypical actions that are perceived as scary or risky behaviors.”
CMS spokesman Bob Moos says the agency is now reviewing a second inspection conducted at the hospital on October 15. He told the Houston Press that an official report on that inspection is still pending.
So it's unclear at this point if St. Joseph's officials have managed to assuage the serious concerns of federal health officials. Earlier this week, Bernard issued a statement saying "survey teams have been constructive in their review of our operations" and that the hospital is "on a solid path of continuous improvement that we believe will carry us long into the future.”
The hospital has, after all, revised the job description for “commissioned peace officers” to state that their “primary function is to maintain the peace.” So there's that.