Inspections at UNC, Wilson hospitals find more problems, keeping funding at risk

·5 min read

Two North Carolina hospitals, including one of the state’s largest, remain in danger of losing critical federal funding over continued problems with patient care.

In separate letters to UNC Medical Center and Wilson Medical Center last week, the Centers for Medicare and Medicaid Services cited both hospitals’ “substantial noncompliance” with federal health care rules. UNC and Wilson have until early next week to provide new plans to fix the problems or face the cancellation of their Medicare contracts in late September.

The letters come months after inspectors at both facilities discovered issues that put the health and safety of patients in “immediate jeopardy.” That’s the most serious and least common category of problem for hospitals and other health care facilities, and it can carry the most severe regulatory sanctions.

The issues of immediate jeopardy have been fixed, the letters, obtained by The News & Observer through public records requests, said. But regulators found more problems when they returned to each facility for follow-up inspections.

Wilson Medical Center is also facing scrutiny for potential violations of the Emergency Medical Treatment and Labor Act, the 1986 law that requires hospitals to treat patients needing emergency care, including those in labor, regardless of their financial status.

“The EMTALA investigation is still ongoing and there is no information available for public release,” Daniel Trucil, a spokesperson for CMS, said in an email to The N&O on Aug. 5.

Wilson hospital spokeswoman Melanie Raynor said those allegations have not yet been substantiated at the 294-bed for-profit hospital located about an hour east of Raleigh.

“But we are of course collaborating to investigate,” Raynor said.

Penalties for an EMTALA violation include substantial fines as well as the termination of Medicare contracts, according to the American College of Emergency Physicians.

Both hospitals say they plan to submit new corrective action plans by the deadline and work with federal and state regulators to bring the facilities into compliance.

Patient safety experts say it’s not unusual for inspections like these, both initiated by complaints, to bring issues to the surface that need fixing — some more serious than others. And although potentially devastating to a hospital’s financial future, losing Medicare coverage is an unlikely outcome as regulators work with medical providers to bring facilities into compliance.

Problems with patient falls, restraint, screening

When state regulators were originally on-site at the hospitals earlier this year, they focused much of their investigations on patient deaths.

At the state-owned UNC Medical Center, inspectors concluded the hospital failed to “communicate, escalate and resolve issues” related to the treatment of 29-year-old Troy Simoncelli, who killed himself shortly after he was released from the emergency room — over the repeated objections of his family.

In a statement, UNC Health spokesperson Alan Wolf said Thursday that when state regulators returned in July, they investigated a new complaint related to patient falls.

“They determined that we had not followed our policy for two patients. We are in the process of correcting those two findings and will submit plans of correction by Monday,” Wolf said. “We are confident those correction plans will be accepted.”

CMS has not yet provided a copy of the related inspection report of UNC Medical Center, requested by The N&O late Thursday, but the agency’s letter notes rule violations related to hospital oversight and nursing services.

At Wilson Medical Center, state surveyors declared immediate jeopardy in May, prompted by the deaths of two hospital patients in the early months of 2022. One man died after a fall and subsequent sedation, and another died shortly after his heart monitor was disconnected. In a third incident, a suicidal patient locked himself in an emergency room lobby bathroom and threatened to overdose on medication regulators say should have been confiscated.

At the latest inspection in mid-July, state regulators rebuked the Wilson hospital for five rules related to hospital oversight, patient rights, quality assessment, nursing services and emergency services. The inspection report, obtained by The N&O Friday, details cases in which staff failed to properly document violent restraint incidents and problems screening and assessing emergency room patients.

‘Customary’ part of inspection process?

In response to questions from The N&O, Raynor reiterated that it’s “customary” for hospitals that run afoul of CMS rules to provide multiple corrective action plans and submit to multiple follow-up surveys.

“These surveys are thorough and designed to ensure hospitals’ top performance, and it is not unusual for additional areas to be identified for evaluation,” Raynor said in an email Wednesday. “We continue to be firmly committed to quality care and patient safety, and to working with surveyors to conclude this process as appropriate.”

She said the hospital plans to submit an updated corrective action plan ahead of the Aug. 14 deadline, and she added in a statement Thursday morning that “our whole team is taking it very seriously.”

Dr. Joseph F. Antognini, a California anesthesiologist who’s worked both in hospital administration and as a surveyor for the Joint Commission, a nonprofit health care accreditation agency, said in an email to The N&O that he’s not surprised to see another inspection in the works for the two hospitals.

And he said Wilson’s statement that this is a “customary” part of the process is accurate, in his opinion.

“When surveyors come in, they can look everywhere and thereby uncover other deficiencies,” said Antognini, who’s been a part of more than 90 hospital inspections during his career. “No hospital is perfect. I repeat: no hospital is perfect. It is easy to find deficiencies.”