MACHIAS, Maine — In the last few years, Down East Community Hospital has faced financial uncertainty, the departure of longtime physicians and dueling rhetoric in the community about the hospital’s management team and board of trustees.
While weathering those difficulties, the hospital last year came under investigation for violating federal licensing requirements and putting patients in jeopardy.
Those investigations escalated to their most serious point this week.
The Centers for Medicare and Medicaid Services, the federal licensing authority for hospitals, has informed DECH that as of July 10 the hospital will no longer be able to accept Medicare reimbursements.
“After a careful review of the facts, [CMS] has determined that Down East Community Hospital no longer meets the requirements for participation as a Medicare provider,” read a letter from CMS to hospital President and CEO Wayne Dodwell that was obtained by the Bangor Daily News.
For DECH, a critical access hospital that serves a rural and aging population, losing the ability to collect Medicare reimbursements is a crippling proposition. A state takeover is being considered.
In its letter, CMS outlined four areas of noncompliance: emergency services, organizational structure, provision of services, and periodic evaluation and review. However, unlike in the past, CMS will not allow the hospital to submit a plan of correction, according to the agency’s regional spokeswoman Roseanne Pawelec, putting the hospital’s future in limbo.
“Having said that, CMS is also in very close communication with the state Department of Health and Human Services, and we’ll continue to talk about what to do next,” Pawelec said.
DHHS Commissioner Brenda Harvey said Friday that the situation involving the Machias hospital is fluid for the moment, but she stressed that all parties are doing what they can to ensure the hospital remains open.
“We have a short period of time to develop a plan to assure that the citizens of Washington County are provided with good care and that the hospital is functioning,” Harvey said. “But it’s important for people to know that we are doing everything to keep that hospital in the community.”
One of the options for the hospital’s future is placing it into a receivership. Under that scenario, Harvey said, the state would assume temporary management of DECH and appoint someone to manage the facility.
“First, we have to talk with the hospital and their lawyer and make sure we understand what their intent is,” Harvey said. “We’re also talking with the [Maine] Attorney General’s Office about our options.”
Ultimately, the decision could be made in court, she said.
DECH released a statement Friday that said the following:
“Efforts are ongoing to assure DECH’s continued participation in the Medicare program. The hospital has been working closely with CMS and DHHS to ensure the continuity of care for its patients and the community.”
Quorum Health Services, a national firm that provides management services to numerous hospitals, including DECH, offered a little more information in a statement from spokeswoman Susan Hassell.
“Over the last 18 months, the DECH board has developed a clear preference in how they desire to manage the hospital, particularly in relation to regulatory compliance,” the statement read. “In some instances, their preference differs from our company’s approach to hospital management. More recently, the board has made numerous decisions inconsistent with [Quorum] recommendations. For example, the board refused to allow [Quorum] consultants and other experts to be involved in surveys by state and federal investigators and rejected changes in hospital leadership strongly proposed by [Quorum].”
Walter Plaut, chairman of the hospital’s board of trustees, did not return a call for comment Friday.
Down East Community Hospital has faced increased scrutiny since the high-profile death of Reid Emery in January 2008. Emery was a DECH patient who checked out of the hospital against doctors’ wishes on a cold, snowy evening. The Eastport man, heavily drugged from his stay at the hospital, was found dead the next day in a snowbank near the hospital.
Emery’s death prompted the first federal survey into policies and procedures at the hospital. DECH submitted a plan of correction to address deficiencies cited. Later in 2008, state and federal authorities were back at the hospital conducting an investigation into new deficiencies. Once again, DECH implemented changes.
Earlier this year, another investigation was launched, this one more serious. DECH was on a conditional license for several weeks related to numerous failures in emergency room procedures.
Even before Emery’s death and the subsequent investigations, numerous physicians and other staff members at DECH were either fired or quit over clashes with management. Before that, the hospital climbed out of a significant financial hole. Quorum Health Services took over management of the hospital in 2002 when DECH was in serious financial trouble. It picked Dodwell to lead. The president and CEO reversed the hospital’s financial outlook, but recent incidents, including the CMS investigations, have overshadowed that success.
Sen. Kevin Raye, R-Perry, has been following the DECH issues for some time and said he was informed of the recent CMS decision late Thursday evening.
“Nurses and other employees have made it clear that serious problems exist at the hospital, and today marks the beginning of the healing process for the institution, its dedicated employees and the community,” Raye said in a statement.
“The important thing to convey is that this doesn’t meant the hospital will close,” he added.
Rep. David Burns, R-Whiting, said that as far as he’s concerned, the hospital had ample opportunity to rectify its problems and failed to do so.
“I’m very willing to do anything to correct these problems and keep [the hospital] going,” he said.
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