The Montana Department of Health and Human Services has ordered a Townsend nursing home to close by Saturday, displacing 30 residents.
The Broadwater County Health Center board has also suspended the emergency room privileges of its former medical chief of staff for 60 days, and it’s interviewing for a new CEO.
In a June 12 audit of the nursing home portion of the health center, DPHHS found “serious deficiencies,” several of which “were viewed as a pattern that constitutes immediate jeopardy to resident health and/or safety, whereby significant corrections were required,” a letter Tuesday from the Quality Assurance Division of DPHHS said.
“It breaks our heart,” said Joni Carlton, chair of the health center’s board of directors. “We have staff here that loves our patients and have known them most of their lives. It’s going to be very difficult for them and their families.”
Joan Davis, CEO of the health center and administrator of the nursing home, who had already given the facility 90-day notice of her resignation back in May, acknowledged there have been problems at both the hospital and nursing home and did not directly disagree with the state’s findings. But she denied that there was ever immediate jeopardy to residents.
Thursday, family members of residents were assisting with moving. Some staff cried as they helped.
“It’s just such a shock,” said Audrey Montgomery, moving furniture and other items from the room of her husband, Bill.
She said many of the residents have some level of dementia and would have a hard time comprehending the situation.
Many of the violations alleged in a 79-page DPHHS report involve the failure to report to doctors numerous cases of elevated blood pressure and the improper administration and documentation of medications.
The state says, for example, that on June 12, staff failed to notify the attending physician about nine of 15 residents with issues including abnormal blood pressures, missed doses of medications, low heart rates, a choking incident and the refusal to take their medications.
Other incidents involve matters such as improper feeding techniques and removal of uneaten food.
In one case, residents wanted to change the television channel from the “The Lawrence Welk Show” to NASCAR, but were not allowed access to the remote control. A center staffer told investigators the Welk show was a planned activity and weekend staff were instructed to make sure it showed.
Davis, who has led the facility for about a year-and-a-half, said she resigned because of long-standing “systemic problems” that called for different leadership, although she said major improvements have been made. She called the closure a “huge wake-up call.”
“It took something major like this to get everyone’s attention,” she said.
On June 28, the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, told the center it found substandard quality of care at the nursing home and that it would be cut off from those two federal programs after Friday.
Carlton said she was surprised by the closure notice, but said the DPPHS findings were valid.
Both the hospital and the nursing home had received notices of immediate jeopardy to patients and developed plans to correct the problems. The state had approved those plans as recently as Friday; but on Monday, the state identified new issues in the nursing home, Carlton said.
“We failed as a facility to ensure that those policies and our plan of correction was enacted,” she said Thursday, “And there is no one more sorry than I am to our patients, those 30-some people who, this is their home. It’s a tragedy.”
Some of the patients are moving to other area nursing homes. Others are staying with family members. A few — among those not on Medicare — are able to transfer to “swing” beds within the hospital portion of the facility.
It was not immediately clear Thursday what problems at the hospital were alleged by the state, but the board has taken some action.
June 27, in a 4-1 vote, the board removed local family practitioner Dr. Nick Campbell from his role as medical director.
“I think he had done a very poor job as medical director,” said Hugh van Swearingen, who raised the motion against Campbell.
Monday the board suspended Campbell from practicing in the hospital’s emergency room for 60 days, citing violation of a policy requiring on-call physicians to report to the emergency room within 30 minutes of being called.
Campbell could not be reached by telephone Thursday.
The board appointed as interim chief of medical staff Dr. Terry Jones, based in Missoula, who is now the supervising physician for the two physician assistants who staff the Broadwater Wellness Clinic, which is part of the center.
State Rep. Kelly Flynn said he was concerned about the very short timeframe residents are being given to move and the turmoil it would create in their lives.
The facility was notified about the problems it needed to correct just 23 days before the recent notice, he said.
He said he met with state officials seeking some kind of extension before removing residents.
“They do have a lot of violations, but a lot of them could be corrected with stern enforcement,” he said. “I’m not condoning what’s gone on as far as serious mistakes being made. I just think there got to be a better way than the way it’s being done there.”
But, he said, the state was very firm about closing the facility.
A dPHHS spokesman said under federal law, once the facility has patients in “immediate jeopardy,” it has 23 days to fix the problems.
“They are some serious violations,” Flynn said. “The fault’s going to lie with somebody, whether the administration, the medical director or the board, somebody has to answer that things aren’t getting done.”
Beyond the impact to the residents and the dozens likely to lose their jobs, Flynn said closing the nursing home could make it harder for the remaining services, including the hospital, to survive.
“It really has broad ramifications over the long haul,” he said.
The center has 30 days to appeal the department’s decision, but Davis and Carlton were not optimistic about that option. It can apply for recertification in three to six months,
“We need to change our culture to a culture of unification, where everyone is working together,” said Carlton. “We have a large challenge ahead of us.”