Inaction is focus of clinic inquiry

A federal agency's investigation of Old Vineyard Youth Services is focused on charges of inaction by nursing staff toward a patient having a medical emergency in September.

The report by the Centers for Medicare and Medicaid Services, obtained by the Winston-Salem Journal, also found that members of Old Vineyard's nursing staff "were not competent in the use of emergency equipment" during an inspection conducted on Oct. 13 and Oct. 16.

The details are the latest development since the agency filed a legal notice Oct. 26 that Old Vineyard had been placed in the "immediate jeopardy" category. At that time, Old Vineyard was given until Nov. 8 to resolve the compliance issue.

The agency defines immediate jeopardy as "a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment or death to a resident."

On Nov. 24, the agency said it had removed the immediate-jeopardy status, which makes it less likely that it will lose Medicare payments for new impatient services or face a management change.

However, Old Vineyard has "some outstanding condition-level deficiencies" that require correcting by Jan. 14, said Lee Millman, the media-affairs officer for the agency's Atlanta office. If those issues are not resolved, Medicare payments still could be stopped.

The N.C. Division of Medical Assistance is conducting "an active program review" of Old Vineyard in conjunction with the program-integrity unit of the N.C. Mental Health, Developmental Disabilities and Substance Abuse Services.

The N.C. Division of Health Service Regulation said yesterday that its complaints unit has received seven complaints regarding Old Vineyard in 2009.

"Three of the seven complaints investigated by the agency resulted in substantiated allegations," said Jim Jones, a spokesman for the division. "These three complaints were investigated in October and November and are part of the ongoing CMS survey process."

In the CMS report, the patient was admitted to Old Vineyard on Sept. 15 with a diagnosis of major depression. The patient was in a dayroom on Sept. 17 when he had a seizure at 12:49 p.m.

After the patient was initially treated for 17 minutes by medical staff, the staff left the room. Soon after, the patient began vomiting and complaining of having a headache "like his head was going to explode."

The report found that the patient was not treated by his nurse or other nursing staff for 14 minutes despite requests for help from nonmedical staff. The patient was assessed by a doctor at 1:24 p.m. and transported 12 minutes later to a hospital emergency room.

There is no indication in the report as to the patient's condition after being transported.

The report found that a staff member expressed concern at 2:27 p.m. to Old Vineyard's director of clinical services and its chief executive, Rob McCartney, about no nurse being present during the 14-minute period. The report determined Old Vineyard's administrative staff did not investigate the allegations "regarding lack of nursing response."

During the audit on Oct. 16, the agency found that "licensed nursing staff was not competent in the use of the hospital's emergency equipment." Those findings prompted the decision to place Old Vineyard in the immediate-jeopardy category, the agency said.

The agency said that Old Vineyard took immediate action "to assure that nurses can respond promptly and competently to patients having a medical emergency." That included all nurses on staff being retrained in how to use medical-emergency equipment.

"The CMS surveyors were able to observe evidence of the retraining and successful implementation of the action plan that was submitted during the onsite review," McCartney said in a written statement yesterday. "It was this response that prompted CMS to lift the immediate-jeopardy threat from Old Vineyard."

Local advocates have expressed concern that Old Vineyard may have been getting money from the state, and possibly from Forsyth County, for training and technical assistance from CenterPoint Human Services. Old Vineyard is owned by a for-profit company, Universal Health Services Inc.

CenterPoint, a local management entity that oversees mental-health services in four counties that include Forsyth, has a provider contract with Old Vineyard.

"I can unequivocally tell you it would not be appropriate for CenterPoint to provide county or state funds to be used to assist any provider -- whether they be for-profit or not-for-profit -- in dealing with any action by CMS," Betty Taylor, the director of CenterPoint, said yesterday.

"It is not occurring, has not occurred and will not occur with Old Vineyard."

rcraver@wsjournal.com


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