TOPEKA, Kan. (CN) - A Kansas state hospital was kicked out of the Medicare program after a report revealed that a patient raped a staff member, another patient regularly assaulted her wheelchair-bound roommate and nursing staff failed to properly supervise patients.
The Centers for Medicare and Medicaid Services (CMS) terminated Osawatomie State Hospital's participation in the Medicare program on Dec. 21. It is one of two state psychiatric hospitals in Kansas.
The CMS in November found an "immediate jeopardy situation" at the hospital, according to the Kansas Department of Health and Environment.
"The cumulative effect of the systemic failure to supervise the provision of care, to perform required safety checks and to protect suicidal patients from hanging risks placed all patients receiving services at risk for harm," the CMS reported on Nov. 24.
Osawatomie, pop. 4,500, is 61 miles southwest of Kansas City. The hospital was founded in 1855 and for years was commonly known as the Kansas Insane Asylum.
The termination came after the hospital submitted a correctional plan, but the state found continuing deficiencies during an "immediate jeopardy" revisit that ended on Dec. 18.
The CMS deficiency report detailed staff's failure to properly monitor a psychotic patient, which allowed him to rape a mental health technician working the evening shift in October.
Federal scrutiny followed the rape, which was reported to police. The technician, referred to as T, was delivering linens to the patient's room at around 8:30 p.m. when the man grabbed her and put his hand over her mouth.
"I was trying to scream and was banging on the walls, and he raped me," she told investigators.
Two patients heard the woman's screams and burst into the room, where they found the technician on the bed with her pants pulled down. The patients threw the perpetrator against the wall and held him while another patient stood in the hallway screaming, "He raped her! He raped her!"
"They came before any staff did," the woman told investigators. Staff reported the rape to police, and the Miami County Prosecutor charged 42-year-old Aaron C. Goodman, of Hartford, with rape.
Hospital staff had placed Goodman -- who was diagnosed with psychosis and was admitted with a history of trying to strangle his wife on multiple occasions -- on unit observation status with 15-minute checks. A staff member logged that someone had checked the patient at 8:30 p.m. but video surveillance recordings revealed that no observation check actually occurred.
In addition, video footage from 8 to 9 p.m. revealed that security rounds staff failed to perform additional required 10-minute safety checks until 8:57 p.m. that night, according to the report.
Hospital administration had previously heard staff concerns that security round staff were "standing around talking with MHT staff, not performing their rounds, and leaving the unit before their replacement arrives" but failed to address the situation, according to the report.
More video recordings captured "an open and unsupervised bathroom containing ligature hazards" and staff members unlocking a bathroom for a patient and walking away, leaving the patient alone with hanging hazards.
A summary of findings from the Dec. 18 revisit also reported the hospital's failure to protect a female patient from self-harming behaviors and from assaulting other patients.
"On almost a daily basis, the patient participated in some sort of self-harm by placing objects like coins, pens, spoons, knives, and safety pins in her eyes, ears, and vagina," the summary stated.
The hospital assigned that patient, with a history of "aggressive/assaultive acts including choking and pulling out hair" as a roommate to another female patient confined to a wheelchair.
"On almost a daily basis, the patient participated in some sort of assaultive/aggressive act against another patient or staff including choking, pulling handfuls of hair out, kicking, and throwing coffee," according to the summary.
Hospital staff also allowed the violent patient to be near a male patient with a history of sexual aggression. When staff caught the two kissing, they admitted they had had sex that day, unnoticed by workers.
The already cash-strapped state must now take up the Medicare slack to fund Osawatomie State Hospital.
Kansas is suffering budget woes from Gov. Sam Brownback's massive tax cuts in 2012 and 2013. Brownback claimed the tax cuts would revive the economy, but that did not turn out to be the case. Facing a deficit estimated at $400 million to $600 million, and downgraded credit, Brownback agreed in August to $384 million in tax increases, including increasing the sales tax from 6.15 percent to 6.5 percent, and the cigarette tax from 50 cents a pack to $1.29 a pack. He also started looking for $50 million in spending cuts.
A hearing in Topeka is set for Tuesday, Dec. 29, scheduled with KanCare, a legislative oversight committee, to determine the hospital's future.
Osawatomie is one of only two state psychiatric hospitals. The other is Larned State Hospital in Pawnee County. "We're going to talk about where we go next," said Angela de Rocha, spokeswoman for the Kansas Department of Aging and Disability Services, which administers Kansas' four state hospitals.
Hospital administration can still take steps to meet Medicare participation requirements and establish Osawatomie State Hospital's eligibility to participate again by reapplying with the state survey agency.
Even without Medicare funding, "The hospital is not closing," de Rocha said. "We're still reviewing our options."
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