Hospital oversight extended
The three Connecticut hospitals owned by the California-based for-profit network Prospect Medical Holdings Inc. will remain under additional state Department of Public Health oversight for at least the next 18 months.
The extended oversight, which continues a period of scrutiny that state officials say is among the longest the state has seen, is the result of concerns about quality that have arisen at all three Prospect hospitals — Manchester Memorial Hospital, Rockville General Hospital, and Waterbury Hospital — over the last three years.
Among the issues that alarmed health officials were the suicide and attempted suicide of two patients this year at Waterbury Hospital and the 2018 death of a woman experiencing a high-risk pregnancy after receiving care at Manchester Memorial Hospital.
Both hospitals were placed in “immediate jeopardy” following those events, a designation that the Centers for Medicare and Medicaid calls the “most severe and egregious threat” to the health and safety of patients.
Rockville General also was found this year to have violated conditions pertaining to the care of patients at risk for suicide. The findings led to a full survey at the hospital of all 23 conditions required for Medicaid participation. The survey found the hospital in violation of several standards.
The extended oversight followed two months of negotiations between Prospect, DPH, and the state attorney general’s office. The negotiations were over a “pre-licensure consent order” struck between the parties in 2016 when Prospect purchased the three hospitals that was set to expire Sept. 30.
Such agreements are part of DPH’s “due diligence” as a regulatory agency, though health officials have said those agreements typically last about a year. DPH took the unusual step in 2016 of striking a three-year oversight agreement due to concerns about quality issues at some of Prospect’s California hospitals.
The original agreement called for Prospect to engage an independent monitor to assess quality at the hospitals.
The new agreement, which replaces the old agreement, covers a period of 18 months with the possibility of an additional six months added on. Among its many provisions, it similarly calls for the hiring of an independent monitor, this time to specifically assess the hospitals’ emergency departments and behavioral health units for regulatory compliance.
The monitor, who the agreement stresses will serve the interest of DPH and not Prospect, will conduct an initial assessment of the hospitals’ regulatory compliance in those areas and compile a report of its findings within a month of the assessment. If the monitor’s recommendations are approved by the department, Prospect must provide DPH with a timeline outlining how it will implement the recommendations within 21 days.
The agreement also calls for the corporate vice president of facilities for the hospitals to conduct an assessment of each hospital’s physical location within 45 days of the official date of the agreement. The assessment is meant to ensure compliance with state statutes and regulations pertaining to behavioral health facilities and also will look at each facility’s water management plan and emergency preparedness plan.
The agreement calls for the independent monitor to conduct another assessment of each hospital’s emergency department and behavioral health unit in January 2021. The agreement says this second assessment will determine the hospitals’ ability to “implement and maintain” quality of care and services and ensure the implementation of recommendations previously made by the independent monitor, as well as compliance with regulatory requirements.
If the state health department determines any of the hospitals are not in compliance, the agreement states the independent monitor’s services can be extended by up to six months.
The agreement also calls for the hospitals to continue working with their local advisory committees; hospital executives to meet quarterly with DPH to discuss quality for the first six months of the agreement and once every six months thereafter; and maintaining a Quality Assurance Performance Improvement Program overseen by a committee that will meet at least every 60 days to review reports and complaints related to patient care and compliance with standards.
Health department spokesman Av Harris said the long duration of the department’s oversight — which will be at least 4½ years as a result of the new agreement — is among the longest such oversight periods the department has seen.
“That tells you that this is out of the ordinary,” he said.
Harris said the parties engaged in some “very substantive discussions” to hash out the agreement, and now the “ball” is in Prospect’s and the hospitals’ “court.”
“It all depends on what happens in the next 18 months,” he said. “If they do what they’re supposed to do, there’s plenty of opportunity for them to come out of this with flying colors.”
In a statement, Prospect said it “looked forward” to working with the independent monitor as it has previously done and said it is committed to “continuously striving” to improve the care it provides its patients, “including those in our ED and behavioral health units.”
“We remain committed to our mission of providing quality, compassionate care to our patients and being good stewards of the hospitals for our communities,” the company said. “We look forward to being held to the same standards as all other Connecticut hospitals.”
Last month, the state Office of Health Strategy released Prospect ECHN, which operates Rockville General and Manchester Memorial hospitals, from compliance monitoring required as a condition of the former state Office of Health Care Access’ approval of Prospect’s acquisition of the hospitals in 2016.
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