By Brad Dress

 

After a patient was discharged from the University of Maryland Medical Center, Midtown Campus into the frigid cold in nothing but a hospital gown, the government has found that the center violated several rules and has threatened it with funding termination unless it fulfills certain requirements.

The Centers for Medicare and Medicaid Services (CMS) released a report after it authorized an investigation into the matter, which said the Baltimore hospital “clearly represent[s] an aberration from our commitment to high quality patient care,” and that it “failed to meet regulatory requirements” for certain policies.

In response to the incident, the government agency has threatened to cut the hospital’s funding for its Medicare program by May 23 of this year unless they pass future inspections, said Lorraine Ryan, a spokesperson for CMS. Ryan said the hospital failed to adhere to policies following the Emergency Medical Treatment and Labor Act (EMTLA), which many of the staff– including security guards who led the patient out of the hospital and personnel who discharged the patient– seemed unaware of, according to a CMS document.

This center failed to comply with many of the act’s mandates, including failure to mentally examine the patient on a return visit, negligent action to relog the patient in the database system when the patient returned, refusing to give the patient access to the emergency department and failure to designate someone to examine the patient.

CMS documents showed that hospital staff and security were instructed on EMTLA guidelines and received additional training to correct the behavior, as well as new instruction for incoming staff and auditory behavior of a director. The probationary period will end if the center exhibits progress toward following the guidelines.

“The next steps are follow-up surveys prior to the termination dates,” Ryan said, “to evaluate whether the plans of correction have been successfully implemented.”

The original incident happened in January, when a young adult, only known as Rebecca, fell from a motorcycle and hit her head on a curb. After registering at the hospital, she was given a mental status examination and cleared for discharge. Rebecca, though, did not want to be discharged and refused to dress.

According to CMS documents, she said, “I do not feel normal, and do not know what normal is,” but this complaint was not logged by the hospital. Still, security escorted her out of the hospital wearing only her gown, and she was brought back later that day in an ambulance. The document cites that she was not examined again and hospital staff was told not to re-registered her.

The University of Maryland Medical System (UMMS)–which operates this hospital as well as 14 other affiliate hospitals independently from the College Park campus–launched its own investigation into the matter, said Lisa Clough, the director for media relations and corporate communications at the hospital.

“We take responsibility for the combination of circumstances in January that failed to compassionately meet our patient’s needs,” she wrote in an email. “We pledged to our community to do and be better, and we are confident that we already are.”

Clough said UMMC submitted correction plans, and CMS accepted them. She also said they took “personnel action” and have restructured reporting procedures, although she declined to cite specifics of the changes.

In February, the Baltimore Sun reported that there would be a new president of the Medical Center and other executives were stepping down.

Clough also said the hospital had failed previous procedures since August 2017 and investigations had begun even before the January incident. Ryan confirmed this, and added that this is not an entirely unique case–there have been roughly five EMTLA violations at hospitals in Maryland since October 2017.

Rebecca’s lawyer, James E. Farmer, said he is seeking action against the hospital for “many, many reasons.”

“Obviously [there were] many violations committed by the University of Maryland,” Farmer said. “Violations specifically against her mental health. … A lot of investigations need to be done.”

Farmer said he is still very early in the process to make claims against the hospital.