New trouble for NC hospital after ‘inappropriate’ conduct with patient, medical error

An “inappropriate” encounter between a male nurse and a female psychiatric patient helped trigger the federal government’s latest threat to pull funding from a troubled Wilson County hospital, newly obtained documents show.

The nurse’s conduct so disturbed some staff at Wilson Medical Center that they repeatedly reported it to supervisors. And although he was effectively fired the next day, the hospital failed to report the incident to the state nursing board for more than a month.

Revealed in a 72-page inspection report, the details shed new light on conduct that prompted the Wilson Police Department to investigate “an alleged inappropriate sexual interaction” at the hospital in late January. Investigators closed the case about a month later, Sgt. Eric McInerny said in a statement, after they determined “no criminal act occurred.”

But what N.C. Department of Health and Human Services regulators learned about contact between a nurse and patient at the for-profit hospital during their own investigation was enough to declare an “immediate jeopardy” to the health and safety of patients there.

The report also faults hospital staff for injecting contrast dye into a patient scheduled for a CT scan in violation of his doctor’s orders – a mistake that damaged the man’s kidneys and left him dependent on dialysis.

It’s the third time in less than a year that regulators have slapped Wilson Medical Center, a 300-bed facility about an hour east of Raleigh, with an immediate jeopardy designation. It’s a serious and relatively rare regulatory action, according to at least one study, and it carries with it the threat of lost Medicare funding.

The termination of the hospital’s Medicare contract will occur April 7, according to a letter from the federal Centers for Medicare and Medicaid Services, unless a follow-up inspection finds the hospital has fixed issues identified in the report.

‘It looked inappropriate’

Although the report doesn’t name patients or medical staff, it details the case of a 27-year-old woman – Patient #28. She arrived at Wilson Medical Center’s emergency room by ambulance on Jan. 13 after an intentional overdose of medication to treat seizures and bipolar disorder.

She was involuntarily committed that evening after exhibiting erratic, “hyperverbal, hypersexual, restless” behavior and demanding to leave, the report said. She was moved to the hospital’s behavioral health unit three days later.

As patients were preparing for bed around 10 p.m. that evening, a nursing assistant saw a male contract nurse from the emergency department walk toward the patient’s room. When the nursing assistant went to check the room 30 minutes later, she opened the patient’s door to find the woman sitting on the bed with the male nurse, her head resting on his shoulder.

“Interview revealed both the male ED RN and Patient #28 looked startled and jumped up,” the report said.

The nursing assistant reported the interaction to the nurse in charge, who spoke to the man in the patient’s room. “The male ED RN did not leave at that time,” the report said.

Other employees “were still uneasy and called the house supervisor,” who told them the male nurse shouldn’t have been there. So another nurse returned to the patient’s room.

“Patient #28’s head was face down in the lap of the male ED RN. Interview revealed Patient #28’s jolted her head up out of the male ED RN’s lap and the male ED RN did not move or say anything,” the report said.

After the charge nurse was again notified, she returned to find the male nurse and the patient sitting separately on the patient’s bed.

The charge nurse told the man “that it looked inappropriate, and he had to leave the floor.”

“Interview revealed the male ED RN said ok and left,” the report said.

The patient was discharged from the hospital three days later.

Hospital tight-lipped about incident

The inspection report does not describe the incident as a sexual assault.

But the next day – Jan. 17 – the nurse was “released from contract due to inappropriate behavior not consistent with industry standards,” according to the hospital’s corrective action plan.

When The News & Observer asked about a potential sexual assault at the facility in late January, Sara Crawford, a spokesperson with Wilson Medical Center’s parent company, said the hospital launched a “formal investigation” into the allegations, finding them “unsubstantiated and without merit.”

Responding to a complaint, state health regulators arrived at the hospital about a month after the incident. But it wasn’t until the day their inspection ended – Feb. 22 – that hospital leadership reported the male emergency room nurse to the North Carolina Board of Nursing “in an abundance of caution.”

In North Carolina, anyone who suspects misconduct by a nurse is required to report what occurred to the board of nursing.

Nunery did not respond to a question from The N&O Thursday about why the hospital took more than a month to report the nurse to the state’s disciplinary board.

He said leadership at Wilson Medical Center, including interim CEO Chad French, would not be available for an interview, pointing to a statement from the hospital last week – prior to the release of the report.

In that statement, Nunery said the incident involved “a contractor from the emergency department who was found to have visited privately with a patient in the behavioral health unit,” adding that the hospital “cooperated fully” in the Wilson police investigation.

“We appreciate the work of the surveyors and have since updated our policy and access levels to specific areas of the hospital to address this complaint,” Nunery said in that statement. “Quality care, patient safety and regulatory compliance are our top priorities, and as always, we will work with CMS to ensure that these concerns are addressed as quickly as possible.”

A rare, one-star ranking

Wilson Medical Center is operated by Duke LifePoint, a joint venture between Duke Health and Nashville-based LifePoint Health, a for-profit company owned by private equity firm Apollo Global Management.

It’s one of only three one-star hospitals in North Carolina, according to Medicare’s quality rating site. Of the more than 3,000 hospitals nationwide with a CMS rating, only about 6% have a rating that low.

The hospital received immediate jeopardy designations twice in 2022. Regulators inspecting the facility in May first unearthed problems related to the deaths of two patients early in the year. One man died after a fall and sedation at the facility. The other passed away shortly after his heart monitor was disconnected.

Then in October, CMS determined the hospital violated the Emergency Medical Treatment and Labor Act, a federal law that requires hospitals to care for patients who show up to emergency rooms regardless of their ability to pay.

Although it’s an unlikely outcome, compliance experts say the possibility of losing Medicare funding is enough to force hospitals facing immediate jeopardy to correct serious problems.

At Wilson Medical Center, many of the problems in the most recent report look familiar.

In a letter to the hospital March 15, Centers for Medicare and Medicaid Services officials wrote that the hospital violated rules governing six patient care and quality issues. Four of those – regulations governing the hospital’s oversight, patient rights, quality assessment and nursing services – are identical to the violations federal regulators noted in June 2022.

In an email notifying staff of the latest immediate jeopardy designation earlier this month, French said state inspections were initially prompted by “a few isolated complaints.” The hospital’s action plan, he said, will ensure doctors’ orders are reviewed before medical procedures and that certain levels of the hospital are restricted to authorized clinical staff.

“We’ve been through this process before, and our swift response and thorough action plan quickly resolved all concerns,” French wrote on March 16. “We intend to do the same this time.”

But the previous process was far from quick.

All told, Wilson Medical Center spent about a third of 2022 under threat of losing its Medicare funding, the result of repeated compliance issues.

French’s message to staff also noted that the hospital is now working with Chartis, a regulatory consulting company. Chartis is owned by Audax Private Equity, which acquired the firm in May 2019.