Misconduct charges include accepting kidney from patient

The New York State Health Department has revoked the license of an Elmira psychiatrist who has admitted charges of misconduct including accepting a kidney from a patient.

Dr. Carlos Delos-Reyes received his license to practice medicine in New York in March 1987. His license will be permanently restricted, effective June 21, and he will be prohibited from practicing in New York State.

According to a statement of charges issued by the state Board for Professional Medical Conduct, Delos-Reyes provided psychiatric care to patients at St. Joseph’s Hospital in Elmira, Family Services of Chemung County Mental Health Clinic or at the patients’ homes.

The misconduct charges filed against him include gross negligence, moral unfitness, willfully making a false report and failure to maintain adequate records for each patient.

» Between January 2010 and October 2010, Delos-Reyes failed to document a patient’s psychiatric, drug and alcohol use histories, and didn’t notice the patient’s adverse reaction to lithium, a mood stabilizing drug that Delos-Reyes prescribed without first evaluating the patient’s baseline kidney and thyroid function. Delos-Reyes was also charged with prescribing Xanax, used to treat anxiety attacks, without documenting the prescription. He also transcribed a prescription for Wellbutrin, an antidepressant, in the patient’s medical records but didn’t actually prescribe the medication.

» Between December 2008 and October 2009, Delos-Reyes failed to coordinate his treatment of a patient with her therapist, did not appropriately follow up on the patient’s levels of Valproic acid, a mood stabilizer used to treat conditions such as epilepsy, and did not refer the patient for metabolic lab studies.

» Between November 2005 and April 2009, Delos-Reyes accepted a kidney from a patient while serving as the patient’s psychiatrist. He also prescribed several medications for the patient without adequate medical justification, failed to document the prescriptions, and, in one instance, allowed the patient to write his own prescription. He was also charged with keeping inadequate medical records for the patient.

» From August 2005 to April 2008, Delos-Reyes failed to consult a patient’s primary care physician before treating the patient for hypersomnia, a disorder characterized by excessive amounts of sleepiness, failing to maintain an appropriate medication list for the patient and allowing the patient to complete the physician’s section of his behavioral health intake evaluation.

» From January 2004 to February 2009, Delos-Reyes did not perform an adequate psychiatric evaluation of a patient and failed to refer the patient for lab work to monitor his blood glucose and triglyceride levels.

URL:  http://www.stargazette.com/article/20110616/NEWS01/106160393/Elmira-psychiatrist-lose-license

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Daily News Staff Writer
Posted: 06/09/2011 06:12:59 PM PDT
Updated: 06/10/2011 12:11:49 AM PDT

The wife of Dr. William Ayres, a once-renowned child psychiatrist now accused of molesting several of his young male patients, testified in court Thursday that her 79-year-old husband can’t remember conversations, mixes up his words and once forgot his son’s name.

“He asks a question, he asks the same question 10 minutes later,” Solveig Ayres said during her husband’s competency trial, which began this week in San Mateo County Superior Court.

Defense attorney Jonathan McDougall is seeking to prove that his client suffers from Alzheimer’s-related dementia to such a degree that he is not competent to stand trial again on nine counts of lewd and lascivious conduct with minors under the age of 14.

Several of the doctor’s former patients — now in their 20s and 30s — claim he molested them during physical and genital exams he conducted as part of psychiatry sessions. Ayres was prosecuted for the alleged crimes in 2009, but a jury could not agree on a verdict and a mistrial was declared. The district attorney’s office announced in August 2009 it would refile charges, just a month after the first trial ended.

In opening statements Thursday, Deputy District Attorney Melissa McKowan said she does not dispute that Ayres suffers from dementia. But she said he is capable of understanding the legal proceedings well enough to aid in his own defense. She told jurors that two court-appointed doctors will testify that Ayres is competent.

In
a competency trial, the burden of proof falls on the defense to prove that the defendant is incompetent, she added.

“I will never disagree with the fact that he has some cognitive impairment,” McKowan said. “That is going to be obvious. … But the fact that he is suffering from this mental defect does not mean he cannot stand trial for the crimes he is accused of.”

McDougall said he plans to call as many as seven doctors to the witness stand to cast doubt on Ayres’ competency.

“How is that person that is not able to remember the name of his son, able to function in the legal world?” McDougall asked during his opening statement.

Solveig Ayres, the first witness called by the defense, said her husband began worrying about his memory at the end of the 2009 trial — he couldn’t remember former patients who testified.

“He said, ‘There’s something wrong in my brain,’” Solveig Ayres said.

His condition has worsened since then, she said. William Ayres could not remember what time the judge had told them to be at court the day before. During meetings with McDougall to talk about the case, Solveig said she takes notes and reviews them with William to remind him what was discussed.

On one occasion last December, he couldn’t remember his son’s name, she testified.

Lately, she added, he has been mixing up his words. For example, while talking with her about the Russian composer Sergei Rachmaninoff, her husband said “Republican” instead of “Rachmaninoff.” Solveig testified that William makes lists of the words he switches and tries to find a correlation between them.

Under cross-examination, Mc-Kowan portrayed that as an indication that William Ayres is well enough to be aware that he is making mistakes and is trying to figure out why.

“So he will think rationally and logically even though, at a moment in time, he switched a word?” she asked Solveig Ayres.

The trial is scheduled to resume on Monday.

Email Diana Samuels at dsamuels@dailynewsgroup.com.-

URL: http://www.mercurynews.com/breaking-news/ci_18242724?nclick_check=1

Related stories: Ayres’ Dementia Too Severe For Him To Face Molestation Charges

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Opening statements were given in San Mateo County Superior Court this morning in the competency trial of William Ayres, 79, who has been charged with nine counts of performing lewd acts with seven boys during psychiatric examinations that took place between 1991 and 1996.

Ayres admitted in a 2009 trial that he conducted exams in which boys were naked from the waist down, but said that nothing inappropriate happened. The trial ended in a hung jury when jurors were unable to reach a unanimous verdict on any of the counts.

The district attorney’s office decided in August 2009 to retry the case, but criminal proceedings have been suspended to allow a jury to decide whether Ayres remains competent enough to face charges.

In his opening statement Thursday morning, defense attorney Jonathan McDougall said Ayres’ mental deterioration has made it increasingly difficult for his client to understand his place in the legal proceedings or aid in his own defense.

McDougall said that at times, Ayres is unable to remember his own address, what he ate for dinner or the name of his son.

Deputy District Attorney Melissa McKowan said court-appointed psychiatrists agree with the defense that Ayres is showing signs of early-onset dementia and mental atrophy, but that the defendant remains well aware of the charges against him and is fit to stand trial.

Testimony in the competency trial began later Thursday morning.

URL: http://www.ktvu.com/news/28185802/detail.html

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A third former Hernando County Jail inmate filed suit against a psychiatrist accusing him of sexually harassing her.

The lawsuit, filed by a woman identified as “Jane Doe III,” was filed Tuesday in Hernando County Circuit Court, less than two weeks after the first suit was filed against the same doctor.

Dr. James Yelton Rossello is accused of fondling and molesting the three women while they were under his care last year. All three plaintiffs were inmates at the jail while Yelton was on the medical staff.

Corrections Corporation of America, which managed the jail, also has been named in the suits.

The latest plaintiff said CCA kept her in solitary confinement for 10 days after she reported the incidents to a correctional officer.

She alleges Yelton asked her intrusive questions about her sex life, propositioned her to have sex with him and told her to pull down her pants so he could touch her tattoo.

No criminal charges have been filed against Yelton, but the State Attorney’s Office is still investigating.

When the allegations first came to light in March, the Florida Surgeon General restricted Yelton from treating female patients.

Yelton is no longer employed by CCA.

Reporter Tony Holt can be reached at 352-544-5283 or wholt@hernandotoday.com.

URL: http://www2.hernandotoday.com/content/2011/jun/07/071406/another-suit-filed-against-embattled-jail-psychiat/

Related stories: Florida restricts license of ex-Hernando jail psychiatrist accused of molesting female inmates

Updated information.

By TONY HOLT | Hernando Today

She was offended, violated and wasn’t going to take it anymore, she said.
The former Hernando County jail inmate reported the alleged sexual harassment by her psychiatrist to a female correctional officer.
She consoled the shaken inmate. The two women talked. They cried. The officer promised to report it to her supervisors.
Less than an hour later, the inmate was led to a dark, isolated cell with no windows. She remained in solitary confinement for another nine days, she said.
She only received one visitor – an investigator from Corrections Corporation of America, the company that ran the jail.
Feeling ignored and intimidated, she was too scared to push the matter further, she said.
When she learned last month two of her former inmates filed lawsuits against Dr. James Yelton Rossello, she changed her mind and joined them, said attorney Samuel Rogatinsky.
Rogatinsky, of South Florida, is representing all three women in the lawsuit.
The latest plaintiff, identified in court documents as Jane Doe III, filed her suit Tuesday in Hernando County Circuit Court.
She sobbed during a conference call with her attorney.
“It wasn’t about me getting money,” she said. “It’s about him not being able to do this to anyone else.”
Jane Doe III was incarcerated at the jail from May to October 2010. CCA managed the jail until late August of that year.
She was released from solitary confinement about two weeks before the Hernando County Sheriff’s Office took over jail operations.
By then, the officer who consoled her was no longer employed at the jail and the other CCA managers who supposedly handled the complaint were gone. Yelton also had transferred.
CCA eventually fired him following a slew of sexual misconduct allegations.
Yelton has never been criminally charged, but the State Attorney’s Office is still investigating the Hernando cases.
Jane Doe III described Yelton as a large, broad-shouldered man who weighed about 250 pounds.
“He could have restrained one of us easily if he really wanted to,” she said.
In his court filing, Rogatinsky stated Yelton “sexually molested the Plaintiff on numerous occasions by touching the tattoo that was just above her buttocks while counseling her.”
Jane Doe III said Yelton repeatedly asked her about her sexual preferences, including whether she was bisexual or had any “lesbian relationships” in the jail. He also asked her to describe her favorite sexual positions.
Rogatinsky said Yelton initially would ask his patients sexually charged questions, but made them think it was part of his psychoanalysis.
Eventually, he stopped asking questions and started beckoning his patients to shed their clothes or perform other sexual favors, Rogatinsky said.
During her second visit with Yelton, the latest plaintiff told him she had gained weight. She assumed it was a side effect from one of the drugs the doctor had prescribed her.
“He told me to pull my pants down,” she said. “He told me he wanted to have sex with me.”
At one point, Yelton ordered her to show him her tattoo. When she lifted her shirt and revealed her lower back, he caressed it, she said.
The other two plaintiffs accused Yelton of rubbing, kissing and fondling them during their visits.
Yelton would invite his patients into a small office and he would lock the door to prevent correctional officers from entering, Rogatinsky said.
Jane Doe I accused Yelton of “threatening her with additional criminal charges and threatening to withhold her medications if she refused to cooperate with his deviant behavior,” the attorney wrote.
Jane Doe II accused him of forcing her to sit on his lap while he was sexually aroused, grabbing her crotch area and sexually battering her.
When the allegations first came to light in March, the Florida surgeon general restricted Yelton from treating female patients.
Rogatinsky said Yelton told at least one of the plaintiffs he was “98 percent faithful” to his wife and claimed he had an expense account and a hotel room for when she would be released from jail.
Rogatinsky said he would contact the State Attorney’s Office about the latest allegations.
CCA, based out of Nashville, Tenn., has declined to comment on the Yelton lawsuit.

Reporter Tony Holt can be reached at 352-544-5283 or wholt@hernandotoday.com.

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CoxHealth terminated six employees and overhauled its policies for psychiatric patients after a suicide at Cox North in December.

An inspection, triggered when CoxHealth self-reported the suicide to the state, found that employees falsified paperwork about how often they checked on the safety of psychiatric patients.

Anthony Gillham, 34, who was described as homeless in state reports, hanged himself in a 50-minute period on Dec. 5 when staff at the Adult Psychiatry I unit failed to monitor him as required, according to a report from the state Department of Health and Senior Services. The report said employees filled out paperwork indicating that they had checked on him every 15 minutes, but video showed the man hadn’t been checked on from 4:20 p.m. to about 5:10 p.m., when the man’s roommate discovered him and began screaming.

The inspection, done after the state Department of Health and Senior Services was notified Dec. 7, found that the problems at Cox North “created an unsafe psychiatric patient care environment.” The inspection, which began Dec. 9, found that the hospital was out of compliance with federal requirements to receive payments from Medicare and Medicaid. That means the hospital was at risk of losing these payments.

Jacqueline Lapine, the spokeswoman for the state Department of Health and Senior Services, said the hospital took immediate action to correct the problem. When the agency left on Dec. 15, the safety of psychiatric patients was no longer considered to be in immediate jeopardy, Lapine said.

Lapine said Cox had 90 days to fix the problems that could have affected payments from Medicare and Medicaid. The agency returned to survey the hospital and found conditions acceptable.

Laurie Duff, the vice president of corporate communications for CoxHealth, said the company “is committed to providing patients with the best and safest possible care.”

Gillham’s death is the only suicide that has happened at the psychiatric facility. The hospital has four inpatient units for psychiatric patients – two adult, one senior adult, and one child/adolescent. The first unit opened in the 1980s.

Nationwide, there were 67 suicides at hospitals last year, according to The Joint Commission which accredits hospitals. Two suicides were reported at hospitals in Missouri last year.

“We are greatly saddened by this tragic event and offer our deepest sympathies to the patient’s family,” Duff said in a statement. “Due to privacy laws and pending litigation, we are unable to discuss the details of the situation. However, we can say that we have taken this situation very seriously. Immediately following the incident, we conducted a thorough investigation and put in place extensive additional measures to ensure the safety of the patients on the unit. We also self-reported the incident to the Department of Health and Human Services and cooperated fully with its investigation. We submitted our plan of correction to DHHS, which was approved, and all items outlined in our plan have been implemented.”

The News-Leader was unable to find any civil lawsuits connected to the death in online records or at the Greene County Clerk’s Office. However, sometimes litigation can be signaled with a notice to a party without a public docket being started.

Changes outlined in the correction plan include requiring psychiatric patients to remain in view of hospital staff during waking hours, hiring more employees to help monitor the patients, and checking patients at 12- to 18-minute intervals. That is designed to limit patients’ ability to predict when they will be checked.

The hospital also removed potentially unsafe objects from patient rooms such as heavy shower curtains and updated a policy for resuscitating patients.

The hospital told state regulators that six staff members were put on administrative leave and terminated in January “for improper documentation and/or inadequate supervision.” Staff members were not identified by name, but they included a charge nurse and a unit manager. An assistant unit manager “was counseled and placed on an action plan to address deficiencies in supervising,” according to the plan of correction CoxHealth gave the state.

Fifty-two patients were at the Cox North psychiatric units about the time Gillham died. The facility is licensed for 72 psychiatric beds. The psychiatric ward provides treatment for people with mental disorders, including patients who are suicidal.

The News-Leader obtained the details of the suicide at CoxNorth after a records request to the state seeking its most recent inspection reports for the CoxHealth system. Other details from the state’s findings, called a “summary statement of deficiencies,” include:

» Gillham, who was unemployed and estranged from his family, had been living in a homeless shelter and had previously attempted suicide. He was released from another psychiatric facility about a day and a half before coming to the emergency room complaining about auditory hallucinations and thoughts of harming himself. He was admitted to the psychiatric unit for recurrent major depression.

» On Dec. 5, Gillham talked about plans for Christmas and was looking forward to positive things, according to a review of medical records mentioned in the agency’s report. Paperwork said that staff at Cox North had checked on him at 4 p.m., 4:15 p.m., 4:30 p.m. and 4:45 p.m. and indicated that he was behaving appropriately. But video showed that staff didn’t check on Gillham after 4:20 p.m. At 4:23 p.m., he was seen on video sticking his head out of the room and looking into the hallway. At 4:24 p.m., the door to the room closed. At 5:10 p.m., Gillham’s roommate found him with a sheet tied around his neck and looped over the door.

» Employees told an investigator that they would at times — the report didn’t note how often — write that they had done safety checks on psychiatric patients even though those checks hadn’t been performed.

» After Gillham was discovered, an employee called for help in trying to resuscitate him, but didn’t use the switchboard, meaning emergency room staff weren’t notified. The call was limited to the intercom for psychiatric units only. Advanced life support efforts didn’t start until Gillham was taken to the emergency room at Cox North.

» The investigation also found that the psychiatric facility was short-staffed on the day Gillham died with only one psychiatric technician responsible for 13 patients in the section that Gillham was in. On Dec. 5 one of the psychiatric technicians assigned to cover the 3 to 11 p.m. shift called in sick, leaving only two technicians assigned to the adult halls.

The staffing guidelines called for the charge nurse to ensure sufficient staffing, but the hospital told the state that the employee failed to secure additional staffing or ask for help in getting additional staffing.

URL: http://www.news-leader.com/article/20110513/NEWS01/105130329/1007/?odyssey=nav|head

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Statistics from Birmingham and Solihull Mental Health Trust show that, in the last year, 51 people in the city were treated with the controversial therapy, of which 22 were detained against their will.

According to guidelines from the Mental Health Foundation (MHF), the treatment should only be used for severe depression where a life is at risk.

But the Birmingham figures show it was also given to catatonic and prolonged manic cases.

A trust spokesman said it was difficult to quantify the effectiveness of ECT as it was given in conjunction with other therapies.

Michael Dunn, aged 59, of Erdington, was first treated after attempting suicide in his teens.

Diagnosed with bipolar at Highcroft Hospital, in Erdington, he was administered a weekly course of electroconvulsive therapy (ECT).

Over the next 20 years, he received the treatment more than 20 times.

Michael said it was only effective in the short term at jolting him out of his depression and the more he had it, the less effective it was.

What’s more, it left him with severe memory loss. “I feel like I’ve had parts of my life blanked out. There’s whole chunks that I can’t remember,” he said.

“I suppose it did lift the depression for a short while but it always came back.

“I would never have it again. I have found that just talking to people and taking medication has been far more effective.

“In this day and age, it shouldn’t be used. It’s barbaric.”

Dr Andrew McCulloch, from the MHF, said it should only be used “as a last resort”.

“It can have very serious side-effects, including memory loss, yet it can lift a person quickly out of a life-threatening depression,” he said.

In Birmingham, the treatment is used at the Oleaster unit, at the Queen Elizabeth hospital. The unit is currently undergoing its three-year audit by the Royal College of Psychiatrists.

URL: http://www.birminghammail.net/news/birmingham-news/2011/05/05/electric-shock-therapy-blanked-out-parts-of-my-life-says-erdington-man-97319-28638091/

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A yearlong investigation by the federal government confirmed what mental health advocates in the state have long maintained: New Hampshire does not have adequate community support systems for people with mental illness.

As a result, individuals are institutionalized in more expensive and more restrictive settings, primarily the New Hampshire Hospital in Concord and Glencliff Home, a nursing home for people with mental illness in Benton.

“In spite of a challenging fiscal environment, the state has continued to fund costly institutional care, even though less expensive and more therapeutic alternatives could be developed in community settings,” the study found.

The situation is particularly frustrating because the state could actually be spending less money to get better results for people struggling with mental illness. As the report points out, reliance on institutional care is not only less effective and more expensive, it violates the civil rights of people with disabilities.

While some may see this as another example of federal overreach, the fact is that Congress did pass the Americans with Disabilities Act, and the Department of Justice has to enforce it. If New Hampshire does not take appropriate action, it could face a costly federal lawsuit.

None of this comes as a surprise to lawmakers and state officials. New Hampshire already has a blueprint for improving mental health services – a 10-year plan released in 2008.

The plan called for creating “supporting housing,” where individuals get housing subsidies and community treatment, expanding residential treatment programs, providing additional mental health beds in community hospitals, and developing “Assertive Community Treatment teams,” which provide services like nursing and case management in the community.

But as is often the case, the plan has never been funded. There has been no money for adding community mental health beds; additional treatment teams were never created; no additional community hospital beds have been provided.

The roadmap is there, and it must be implemented.

“Many of the things the Department of Justice cites as ways that the state is falling short of its obligations would be remedied by simple adherence to the 10-year plan as it was outlined,” Jeff Fetter, president-elect of the New Hampshire Psychiatric Society, told the Concord Monitor.

Instead, the state is moving in the opposite direction. The recently passed House budget recommended major cuts to community mental health centers, removing eligibility for about 7,000 community mental health patients. Many of them would end up in institutions, costing the state more money and impeding their chances for recovery.

The budget is now pending in the state Senate, which must restore the mental health center funding, especially in light of the federal report.

Gov. John Lynch has proposed closing a New Hampshire Hospital unit and using the money to create two community treatment teams. This is exactly the approach the state needs to take on this critical issue, not just to avoid costly federal sanctions, but because it’s the right thing to do.

URL: http://www.nashuatelegraph.com/opinioneditorials/916250-263/mental-healthsystem-is-failing.html

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NAPA, Calif — A six-month Cal-OSHA investigation triggered by the murder of a psychiatric technician has found several safety inadequacies at the troubled Napa State Hospital and levied more than $100,000 in fines, according to documents released to KTVU Wednesday.

The state agency found the violations while investigating the circumstances behind the murder of Donna Gross at the hospital last October.

Cal-OSHA said it found a “lack of adequate employee alarm systems on the units, non-existent alarm systems in the STA outside of the units, inadequate police presence in the event of assaults, no enforcement of written policies …by the employer, and an ineffective Injury and Illness Prevention program.”

The hospital was ordered to correct specific violations, by either April 25 or May 15, depending on the type of violation.

The hospital can appeal the fine, but must correct the violations, state officials said.

Meanwhile two California lawmakers were decrying safety conditions at state-run mental hospitals and calling on the governor to push for immediate improvements.

State Sen. Noreen Evans and Assemblyman Michael Allen in a letter Tuesday called the level of violence at Napa State Hospital and others “unacceptable.”

On Monday night, a hospital patient died when he was subdued after he allegedly attacked his roommate, a Napa County sheriff’s captain said.

William Roebling, 47, allegedly attacked another patient in ward T-12 at the hospital just after 5 p.m. Monday, Capt. Tracey Stuart said.

Roebling died when psychiatric technicians intervened in the attack and subdued him, Stuart said.

Roebling was given CPR, but he was pronounced dead at 5:43 p.m., Stuart said. An autopsy is scheduled for today.

The patient who was attacked was not injured, Stuart said.

Roebling was being held in a secure area of the hospital, indicating he was not at the hospital under a civil commitment, Stuart said.

Hospital staff members have renewed calls for increased security at the hospital since Gross’ death in an outdoor courtyard on Oct.23.

Patient Jess Williard Massey, 37, is suspected of strangling Gross and stealing her jewelry, some gum and less than $2. His preliminary hearing is scheduled for May 2 in Napa County Superior Court.

Since the murder, two other Napa State Hospital patients who were charged separately with assaulting hospital employees have been found incompetent to stand trial and were ordered back to mental health hospitals.

URL: http://www.ktvu.com/news/27534002/detail.html
Related story: Patient dies at Napa State Hospital

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ABC7 learned the incident happened on Monday afternoon, between 5 and 6 p.m. in a high security section, surrounded by fencing and razor wire. It is an area where people found incompetent to stand trial are housed.

According to the sheriff’s department, 47-year-old William Roebling was subdued after he allegedly attacked another patient. The staff performed CPR, but Roebling died at the hospital and now staff members are worried what other patients might do.

“There’s some individuals, some of the patients, who are now threatening other staff because one of the patients died. And patients and staff are both really worried. They’re scared. They’re scared that something else is going to happen,” said Kathleen Thomas-Morris, a SEIU steward.
Tuesday St. Sen. Noreen Evans and Assm. Michael Allen sent a letter to the governor saying “Quite simply, this ongoing situation in our state hospitals is unacceptable — and deadly. More than 80 percent of those being treated at state hospitals arrive… through the criminal justice system. It is time we have laws, regulations, and on-site practices employed that reflect this new reality.”

Earlier this year employees held several protests demanding more peace officers, a campus-wide alert system and more staffing. That followed the killing six months ago of a psychiatric technician who was attacked by a patient, another patient attacked a therapist in December, and now this incident on Monday.

It’s unclear how the patient died. An autopsy is scheduled for Wednesday.

ABC7 attempted to reach the hospital for comment and were told to call back in the morning.

URL: http://abclocal.go.com/kgo/story?section=news/local/north_bay&id=8069772

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A Kansas City psychiatric hospital with a history of patient-care problems failed to adequately monitor a suicidal patient, federal records show, and then bungled attempts to resuscitate her after she strangled herself with a strap.

Now the hospital faces federal sanctions.

The March 12 suicide is at least the second at Two Rivers Psychiatric Hospital since 2008.

Federal officials plan to drop Two Rivers from the Medicare program on Monday unless the hospital has adequate suicide precautions in place.

The 105-bed hospital at 5121 Raytown Road also faces a June 2 deadline to demonstrate to Medicare that it has taken care of several other serious problems, including keeping patients who’ve committed sex offenses away from other patients.

Termination means the government Medicare and Medicaid programs would no longer pay Two Rivers to care for patients. The measure is considered a last resort when medical facilities fail to meet critical standards.

“Two Rivers disputes any contention that there is an immediate jeopardy to patient safety,” Kevin Young, the hospital’s CEO, said Friday in a written statement.

“The hospital continues to participate in the Medicare program and is working diligently with (Medicare) and the Missouri Department of Health and Senior Services to demonstrate that the hospital is in compliance with the Medicare rules,” Young said. “We have instituted significant improvements and enhancements in patient care and safety.”

Medicare officials said Friday that they were awaiting the results of a recent inspection to see whether Two Rivers had improved its suicide precautions.

If Medicare and Medicaid are terminated, the programs will continue to pay Two Rivers for 30 days for patients already in the hospital, but not for new admissions. Provisions have been made to transfer Two Rivers patients to other hospitals, officials said.

Two Rivers is one of just a handful of in-patient psychiatric facilities in the area, and beds for people in crisis are in short supply, said Susan Crain Lewis, president of the advocacy group Mental Health America of the Heartland.

“Our community cannot afford to lose 105 beds,” Lewis said. “But individuals in our community who are struggling with a mental health issue can’t afford substandard treatment.”

Repeated problems

Two River opened about 25 years ago. For the past three years, the for-profit hospital has had repeated run-ins with Medicare.

“We have had intermittent issues with other psychiatric hospitals, but we don’t see them happen over and over,” said Jeri Jackson, an expert on psychiatric hospitals with the Kansas City office of the Centers for Medicare and Medicaid Services.

Two Rivers has faced Medicare decertification several times before, but has been able to correct problems to the satisfaction of federal officials.

Medicare began identifying chronic problems in May 2008, when a complaint about Two Rivers led to a visit by inspectors. They turned up an abuse case in which a staff member poured water over a patient’s head and another in which a nurse put a towel over an elderly patient’s mouth to stop the patient from screaming, according to inspection reports.

Another visit about six weeks later uncovered cases in which bed alarms had failed. One patient found on the floor at 3:12 a.m. had suffered a broken hip and shoulder, according to the Medicare reports.

Treatment plans showed that staff had failed to include suicide precautions for a patient who had thoughts of suicide, or physical therapy for a patient who had recent hip surgery.

In September 2008, an Army soldier committed suicide at the hospital by using bed linens to hang himself in a closet.

The soldier had been experiencing post-traumatic stress disorder and had attempted suicide before. That death triggered another investigation.

After the suicide, Medicare threatened to withhold money from Two Rivers. But the program agreed to continue paying if the hospital improved and an outside expert monitored its progress.

Early in 2009, inspectors examined medical records at Two Rivers and found little evidence that patients were receiving psychotherapy or medical treatment other than medications. In September 2010, the hospital refused the emergency admission of a teenager who had threatened to kill someone. Federal law requires hospitals to see emergency patients.

The teen’s caseworker already had signed admission paperwork at Two Rivers before the police van arrived with the patient. Three officers were needed to restrain the teen, who was placed in shackles.

Instead of admitting the youth, a staff member told the officers to take the teen to detention. The teen was admitted to another psychiatric hospital.

Recent suicide

The case that triggered the current threat of Medicare termination occurred a month ago.

The 59-year-old woman who took her own life had a history of depression, hallucinations, paranoid delusions and thoughts of suicide. She was transferred to Two Rivers from a nursing home on March 9 after she had asked her ex-husband to leave her in the woods to die. Two Rivers immediately placed her under suicide precautions.

Two days later, the patient became very agitated at the hospital, hitting the bathroom walls.

Two Rivers staff were supposed to check on her every 15 minutes. But surveillance videos showed that the patient went for 20 to 31 minutes without anyone looking in on her after midnight.

Hospital staff told inspectors that when they checked on the patient, her blanket was pulled up to her neck. She appeared to be sleeping.

The first sign something was wrong came shortly after 5 a.m. when the patient didn’t respond when asked to raise her arm for a blood pressure check. The surveillance video showed the staff member walking “casually” to the nurse’s station.

Two nurses went to the patient’s room. One started CPR while the other struggled to bring resuscitation equipment.

More nurses arrived at the patient’s room. They found the first nurse doing chest compressions on the patient. The second nurse stood by, nudging the patient’s feet and saying “wake up, wake up.”

Only as staff tried to give the patient oxygen did a nurse discover the two things around the patient’s neck that she had used to strangle herself. One was the black nylon strap of a wrist support. The other suicide device was a bright green stretchable ring toy used to provide sensory stimulation.

By this time, the patient’s face was mottled purple and gray from lack of oxygen. An automated external defibrillator was brought out to shock the patient’s heart to a steady beat. But it was too late.

URL:http://www.kansascity.com/2011/04/08/2787552/after-suicides-two-rivers-hospital.html

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