Federal regulators have issued a preliminary determination to terminate the Medicare provider agreement of Granite City, Ill.-based Gateway Regional Medical Center, as of Nov. 17.
The move follows an Emergency Medical Treatment and Labor Act complaint investigation the Illinois Department of Public Health conducted Aug. 3-7 that found deficiencies in the hospital’s emergency care and governance.
Seven things to know:
1. What CMS decided. In an Aug. 20 letter, CMS said it plans to end Gateway Regional’s Medicare participation Nov. 17 unless the hospital corrects the cited deficiencies and the agency confirms it has returned to compliance. A formal notice of termination would go to the hospital and be made public by Nov. 2. Because Gateway Regional is Joint Commission-accredited, the findings also stripped its deemed status, placing it under state survey jurisdiction until it is found in compliance.
2. EMTALA findings center on two patients. Investigators cited three EMTALA standards: medical screening, stabilizing treatment and appropriate transfer.
A minor arrived at the emergency department July 31 with shoulder pain after a fall and left 11 minutes later without a medical screening exam, vital signs or triage after staff could not reach a guardian for consent. Hospital policy requires an exam for patients under 18 regardless of guardian consent.
In a second case, a patient brought in by police on an involuntary psychiatric petition after a self-harm attempt had a low potassium level of 2.5 milliequivalent/liter — a level that raises the risk of cardiac arrhythmia — received a single dose of potassium and was not re-evaluated. The patient was then transferred without a documented accepting physician, signed consent or the required transfer forms.
3. CMS said Gateway Regional had no governing body. CMS also found the hospital out of compliance with the Medicare condition of participation for governing body. Gateway Regional had operated without a board since late April, when several members — including local elected and public safety officials — resigned, citing the hospital’s financial position, significant vendor and utility arrears, and delays in receiving financial and audit information.
CEO Joseph Ottolino told surveyors he was appointed by the owner but never approved by a board, and that the hospital had no institutional plan or budget. “We have not had a governing body since the end of April,” he said.
4. Staffing was flagged on the behavioral health unit. On an overnight shift in early August, the adult behavioral health unit had one registered nurse and two behavioral health technicians for a census of 12 to 13 patients, and only one registered nurse from 3 a.m. to 7 a.m. A quality specialist acknowledged this is below the hospital’s own staffing plan.
5. The action lands after financial distress. More than 600 employees saw delayed pay in late July; the hospital issued paper checks July 31 and told staff not to cash them until Aug. 3. American Healthcare Systems founder and CEO Michael Sarian and his wife made a $1 million personal loan Aug. 1 to cover the shortfall. Mr. Ottolino has attributed the cash-flow problems to the hospital’s former billing vendor and said wages and health savings account contributions have since been paid.
6. The hospital says it expects to stay in Medicare. In a statement, American Healthcare Systems said CMS placed the hospital on a standard 90-day compliance track, used when deficiencies need correction but do not pose an immediate threat to patients.
Gateway Regional submitted a plan of correction Aug. 28 after addressing the cited governance items. Remaining items, involving staff education and monitoring, are on track for completion by Sept. 30. The hospital said the ambulance diversion that drew earlier scrutiny was not among the deficiencies CMS cited. The Illinois Department of Public Health included it in a preliminary survey report, but CMS did not adopt that finding.
7. What’s next. Verification of the hospital’s compliance is underway with IDPH, the hospital said. The next formal milestone is the Nov. 2 termination notice, which CMS would issue only if the hospital has not demonstrated compliance. Terminations are rare; most hospitals cited for condition-level deficiencies correct them and remain in the program.
The Illinois Department of Public Health did not respond to Becker’s request for comment.
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