Stanislaus Surgical Hospital is facing a federal agency decision to remove the Modesto facility from the Medicare program, effective April 30, after the hospital failed to comply with health and safety standards.
The action by the Centers for Medicare and Medicaid Services will cut off payments to the 23-bed short-stay hospital on Oakdale Road for services rendered to Medicare patients. Those payments are often essential for healthcare facilities.
Some facilities booted from the Medicare program are able to make improvements to satisfy regulators and return to the program, a process taking six months or more. Stanislaus Surgical said Thursday it may legally contest the CMS order. But it hasn’t said how the CMS action will affect hospital operations after April 30.
Stanislaus Surgical “plans to make every effort possible to continue providing high quality and important medical services to our community,” a hospital statement said Thursday.
California Department of Public Health surveys in August and February found the hospital was not in compliance with nine conditions of participation in the Medicare program. The state surveys focused on the hospital’s handling of patient emergencies after surgeries and issues with infection prevention and control, sterilization processes, governance and use of certified nurse anesthetists, in place of anesthesiologists, to put patients to sleep for surgery.
Healthcare facilities that receive payments from Medicare, the national program for seniors and certain disabled people, are expected to meet certain health and safety standards. Medicare and California’s Medi-Cal program will no longer make payments for patient care at Stanislaus Surgical on or after April 30, a CMS legal notice said.
The CMS action does not apply to services provided for patients with private health insurance.
“Safe, comprehensive health care is a top priority for CMS,” a spokesman for the federal agency said Wednesday. The CMS statement said inspectors investigating complaints in August found that Stanislaus Surgical was not meeting the standards and revisits in January and February determined the hospital remained out of compliance.
The findings were detailed in two survey reports totaling 562 pages. A hospital statement said Thursday that Stanislaus Surgical is addressing the issues raised by CMS but also is exploring legal action in response to the action.
“Stanislaus Surgical Hospital (SSH) is committed to the delivery of high quality care to its patients,” the hospital said. “Given the level of engagement that SSH has had with CMS, and the efforts that we have made to drive operational excellence, the hospital is dismayed by the recent CMS decision to withdraw essential reimbursements for patient care. (Stanislaus Surgical) is exploring legal recourse to this action.”
According to the statement, Stanislaus Surgical for 40 years has provided critically needed care in Stanislaus County, including diagnostic imaging services, physical therapy, pain management and complex surgical procedures. The hospital treats about 1,500 patients a month. The hospital said the federal action will have a “serious negative impact” on its 200 employees, their families and on patients.
Stanislaus Surgical is one of four acute care hospitals in Modesto, but has no emergency room and primarily focuses on surgeries including joint replacements, general surgeries, fracture repair, plastic surgery and other procedures. From 400 to 450 procedures are performed every month at the for-profit hospital.
State officials issued an “immediate jeopardy” citation Aug. 18 at Stanislaus Surgical because of noncompliance with standards for endoscope storage, workflow patterns, prevention of cross-contamination and biohazardous waste management. “Immediate jeopardy” means the conditions were likely to cause serious injury to a patient or death and can lead to financial penalties against the hospital.
The orders are lifted when the state accepts the facility’s plan for prompt corrections.
The August survey also alleged the hospital failed to maintain infection prevention and control measures adhering to recognized standards and failed to have an effective governing body to resolve patient complaints, maintain quality assurance and ensure medical staff credentialing and a well-organized staff.
Another immediate jeopardy citation Jan. 17 charged that nurse anesthetists, or CRNAs were providing anesthetic drugs outside their scope of practice. The state Department of Public Health rejected several hospital plans for dealing with the issue and the order was not removed until Feb. 5.
The scope of practice of nurse anesthetists in California has been debated in legal settings. According to the survey report, top medical staff at Stanislaus Surgical told inspectors the duties of CRNAs are the same as anesthesiologists and they don’t require supervision.
The survey pointed out, however, that the hospital’s policy states that board-certified anesthesiologists, and doctors with training and experience, administer anesthesia at the facility.
The regulatory survey was sharply critical of CRNAs’ performance at Stanislaus Surgical. In November, a CRNA decided to give a patient with kidney failure Celebrex and another drug prior to surgery, prompting the nurse to question the order due to the patient’s abnormal lab readings.
“Celebrex and Gabapentin (an anti-seizure drug) should be used with caution and in consultation with a medical provider for patients with abnormal lab tests,” the survey report said.
The report described CRNAs working alongside students studying to be nurse anesthetists, in one case changing a doctor’s order for general anesthesia for surgery to a higher-risk spinal anesthesia and sedation. There was no documentation the patient gave consent.
When the patient was moved to an inpatient room after surgery, records show he became lethargic, fell back on the bed and was unresponsive. His blood pressure plummeted and a doctor gave the order to call 911 and transfer him by ambulance to another hospital.
Patient safety issues at the hospital
The survey raised questions about patient safety in general at the surgical hospital, citing other instances of patients becoming unstable after surgery and requiring transfer by ambulance to a regular hospital. In talking with staff, the regulators found that a surgeon wasn’t familiar with treating anesthesia complications and other medical staff members had no advanced life-support training.
The state survey found Stanislaus Surgical was not meeting a standard for providing written policies and procedures for medical staff to handle emergencies. The report alleged the hospital failed to offer treatment for nine patients who suffered medical emergencies when anesthesiologists and surgeons were not on call.
Physician assistants were often on-call 24/7 in case of emergencies. It placed the patients at risk of harm and possible death, the survey alleged.
The report includes accounts of Stanislaus Surgical patients who became unstable after surgery, with dangerously low blood pressure or oxygen levels in their blood. Some patients were unable to breathe or were unresponsive. The inspectors usually found no record the patients received urgent treatment from hospital staff.
The practice for assisting patients in a medical emergency was to call for an ambulance and transport them to another hospital for a higher level of care, the survey alleged.
Although the hospital has a code blue policy, there was no code blue or rapid response team in the hospital. Training in advanced life-support techniques was not required of the physicians, the report said.
The CMS action against Stanislaus Surgical Hospital could disrupt the scheduling of surgeries in the coming weeks. The CMS legal notice said that for patients admitted before April 30, the hospital may seek reimbursement payments for up to 30 days after the effective date of termination from the program.
This story was originally published April 18, 2024 5:03 PM.
