Dallas hospital "no longer meets requirements to participate in Medicare program"

The county hospital, that primarily serves the local indigent population has flunked it most recent Medicare inspection. This is one of a long string of state and federal invesigations (including one of by the Dept of Justice that is ongoing). They get 10 days to try and convince federal regulators that they should not be kicked out of Medicare/Medicaid.

http://www.msnbc.msn.com/id/44098358/ns/local_news-dallas_fort_worth_tx/

An unannounced inspection of Parkland Memorial Hospital last month found a “serious threat to patient health and safety” that put the hospital in “immediate jeopardy” of losing federal funding.

The eight-day review by the agency that administers Medicare and Medicaid found “significant deficiencies” that must be corrected immediately or the hospital could lose its Medicare funding on Sept. 2.

Parkland -- the county’s only public hospital -- is operated by the Dallas County Hospital District. The hospital treats about 150,000 people a year in its emergency room and admits more than 40,000. It has 675 beds.

In unusually blunt language, the Centers for Medicare and Medicaid Services -- or CMS -- explained the violations in a letter to Parkland’s top executive Dr. Ron Anderson.

this is the same place that took care of a dying President

force the poor and indigent to go elsewhere?...

As in the states with no access to abortion clinics, if the hospital fails a Medicare inspection, they don't get to have Medicare patients?
So if the RW idealogogues don't want Medicare, they just fail Medicare inspections?

This is the most bizarre thing.
I can't even wrap my head around it.

Parkland is it. That's where indigent patients go and when I was a patient there 24 years ago it was a good facility. They may perform abortions there - I don't know but there are at least four other clinics that provide abortion procedures in the Dallas area.

LA county did this a while back with trauma centers... They just started closing them up..no more "free" treatment of gunshot wounds etc.

It's an old hospital, and the powers that be would probably like to get rid of it.. ending services needed most, will drop their patient count a LOT, and would provide the impetus to just close it up...

hospitals in rich areas are more "valuable"..:(

I really think this is about bringing the place up to code and not some nefarious plot. Parkland is a teaching hospital and I am willing to bet they will correct their problems before the September deadline. There is literally, no other place for the poor to go.

without them...there'd be even MORE patients in the ER.

did this bond issue pass?

http://www.healthleadersmedia.com/content/FIN-215835/Memo-to-Voters-Go-Tax-Yourself

Memo to Voters: Go Tax Yourself

Philip Betbeze, for HealthLeaders Media, July 28, 2008

In a way, Dallas's Parkland Hospital is running out of time. But it doesn't have to be that way. Its day of reckoning is coming now that the hospital's leadership won approval from its board of managers to ask the county commission to allow a bond election this fall. The election, which commissioners are expected to approve, will ask Dallas County voters to tax themselves to the tune of up to $747 million—60% of the estimated cost of building a $1.3 billion replacement hospital.

Yikes. Good luck with that.

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But the current Parkland is old and decrepit.

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Is the replacement being built in the same place?

Considering the new hospital isn't open, I doubt this is a ploy to get the old one shut down. Parkland has been plagued with issues for years. Parkland is a teaching hospital and one of three Level 1 traumas in the DFW area. Parkland is the only county hospital, and one of the issues is that people in other counties use Parkland.

We don't know what exact violations they incurred, they won't release it until after 20 August.

Looks like they're already building and transitioning to the newer facilites.

See post #37 for more details. One thing I didn't add to the list was Parkland and Southwest Medical School (their partner) allowing medical school residents to perform surgeries...by law, they cannot bill for those surgeries unless a faculty member participates in those surgeries.
But they have found an illegal loophole. Hospital and med school policy says that the attending faculty surgeon only has to be ON CAMPUS and only has to be present for what THEY deem as "critical parts" of the surgery.
So that means, if the faculty member says "hey, the critical part of the surgery is when they are closed up, I can sign some papers saying yes, I was there for the critical part.." and still bill Medicare. So these faculty surgeons are allowed to decide on their own how long they should be at a surgery and still bill for the entire surgery. Medicare reimbursement says otherwise.
Surgery patients were signing blank consent forms. The "doctor doing the surgery" line would be left blank and filled in afterwards. So the patient would have NO idea who was doing the operation. Or the faculty member's name would be on there when, in fact, it was a 1st, 2nd, or 3rd year resident doctor doing the surgery. Or, the 1st year resident student who was "supervised" by, say, a 2nd year resident. Again, not billable. But both the hospital and the medical school were billing Medicare for those services.
Hospital/medical school policy also allow for the faculty surgeon to be available electronically for the surgery...meaning as long as they were on campus (which is a HUGE ASS campus) and electronically available, it would count as the faculty being allowed to bill for the surgery. So if the resident doctor decides things are going terribly wrong, as long as they can, oh, send a text message or dial up the faculty member who is on the other side of campus, all is good.

None of the above was "caused" by an old building. It is the criminal activity by the executives of BOTH institutions who have been getting away with this for years. YEARS. And it has finally caught up with them.

Yesterday, Parkland's CEO gave a list of "reasons" for these criminal happenings and everything else that has caused CMS to threaten to pull funding. He said "we are having to provide 21st century care in a 57 year old building". As someone on another website said, there are multiple hospitals around the country ALOT older than Parkland and they don't seem to have CMS or billing violations. The building has nothing to do with it. It is the greedy execs who are running the place. They are essentially trying to put lipstick on a pig by claiming that a new facility will solve their problems.

I was the assistant head nurse of the MICU for 5 years.interns and residents DID do procedures,did intubate,did insert central lines. They are a teaching hospital... as opposed to the other hospitals.I know,because I work for the "other" hospital.The residents and fellows supervise at night.We also taught a lot of OB interns in my unit,as Parkland has a very high-risk pregnancy population.

Sure,shut down Parkland.Watch half of Dallas die due to lack of healthcare and medicine.Parkland has a pharmacy that supplies medications to the uninsured.Let's shut those down,too.Let's shut down the physical and occupational therapy,and especially, let's shut down Parkland's Burn center.It's mostly poor people who get burned.

Old buildings, carefully tended, do just fine:)

I don't doubt that there are probably grave problems at Parkland. I agree the facility is old but I don't subscribe to the belief that old = bulldozer. I would imagine there is likely some administrative drama and probably corruption. Dallas is a major US city, there's always political intrigue and buzzing around its workings.

I don't live in Dallas and haven't for 23 years. All I do know is that if Parkland were closed down or even razed to build an shiny new facility, that would be very bad. What I do know is that the wealthy of Dallas live nowhere near Parkland. It doesn't sully their view. The sirens and traffic there do not disturb their blissful peace.

around here, when a new anything is built, they tear down the "old" one.. I'm hoping the new one will also be a county/charitable one..

It just wouldn't make sense. There would literally be no place for the poor to go - in a city of over a million people. Turning Parkland into a private facility would be a blunder of insane proportions.

Looking at the page link tammywammy provided, the new buildings are going up practically adjacent to the old ones.

"The hospital treats about 150,000 people a year in its emergency room and admits more than 40,000. It has 675 beds."

Holy shit! 40k a year with 675 beds... Damn.

What needs to happen here is to find out why they have violations. Is there some type of fraud going on? Prosecute the thieves and get some else more qualified to run the place. Is it because they have a large numbers of people who cannot pay? Well... For fucks sake, cutting funding is not the way to fix that.

WTF?

Multiple agencies are now investigating both Parkland as well as UT Southwest Medical school for Medicare fraud. Two days ago, the Texas Board of Regents, which oversees the UT system, held a unexpected, urgent, closed door teleconference so they could vote to pay a million dollar+ fine to the federal government to settle the federal investigation/charges being brought againt UT Southwest medical school in Dallas.
How does this involve Parkland, also? Parkland and UT Southwest are partners, the medical residents train there. It is UTSW teaching partner/school.

Every week there are new announcements about another federal and state agency that has started yet another investigation at Parkland.
The latest being the FBI. They are looking at possible fraudelent contracts that were given to local companies that are run by former members of the hospital's board of managers as well as the former head of their IT program. Contracts that are millions of dollars each. One guy left the board and within months that same board gave his "new" company a huge ass contract.
The FBI investigation started out as a raid/investigation into a Dallas county commissioner. The money trail has now led to Parkland.
Agencies actively investigating Parkland: DoJ, CMS (Medicare), FBI, State agencies like the pharmacy board (400,000 narcotic pills were stolen by pharmacy workers and sold on the streets of Dallas--took the hospital a YEAR to discover the thefts), OIG..

The list is never ending.


And, yes, the bond for the new hospital passed. One week before the election for it, yet another CMS inspection was done. Honchos at the hospital worked with the local CMS office to squash it. The initial report said, like this current one, that Parkland failed it. That report was illegally altered to show that Parkland passed it. They couldn't have a report like that surfacing so close to the bond election. The original CMS report at the time surfaced, it didn't match the altered one.


Oh, Joint Commission has also cited them recently. That report said that patients who entered their ER were risking their lives by going to that ER. You see, there was a well known local restaurant owner who died after waiting for 19 hours with abdominal pain. They never did reassess him, by the time he was brought in, he died of cardiac arrest. This happened a few years ago, Parkland was cited for that. His death sparked the Joint Commission investigation as well as (yet another) federal investigation and they recently were fined $50,000 for that. Drop in the bucket to them.


A month or so ago: Parkland lost a post brain surgery patient. He walked out of the hospital unit, no one saw him gone. He was confused and disoriented but the floor staff ignored the alarm system on the floor that was triggered by him walking off the unit. He was missing for 12 hours. Police finally found him 6 miles away from the hospital at some restaurant. Parkland never did make a public announcement about a missing patient. The family and the police had to do that.

A psych patient ran away from the Parkland ER not too long ago. Again, someone who should have been closely monitored. He ran out into the street and was killed by an oncoming car.

More recently, another psych patient with a history of cardiac problems was brought in to their psych ER. He was thrown into an isolation room and when he started gettng more restless and complaining of chest pain, he was tackled by some psych Er techs and held face down while he was give sedation injections. He was left there, alone, face down. They found him not breathing, he died despite resus attempts. His body had bruises and cuts on it that were not there when he arrived to the ER. They came from the rough handling of the techs.

Most important part about that last death. Parkland never reported it to federal agencies as they were required to do as it was a death that happened while they were giving care to the man. It should have been as it was what is called by the federal/health care regulators a "sentinal event". An event that you don't ever, ever, ever, ever, ever want to happen. It means that there was serious harm or a death from the care you gave/didn't give. The regulating agencies ONLY found out about that sentinal event when the local newspaper reported it. That is how they found out. Not because the hospital reported it to them. The event was hidden by Parkland.

The feds seem to be moving in highspeed now because the new articles/reports are coming out now faster than they have in the past few years.

and everything you say about that hospital rings true, sends shivers down my spine.

We have an old community hospital here, I was in and out of it for several days while a family member was a patient, and noticed a TON of routine violations of protocols,patient regulations, procedures, safety issues.
I have directed my family to take me to the nearest big city hospital unless my heart has stopped.
In which case, problem solved.

It seems that NOTHING works anymore, that we have lost the functionality of most of our systems.

They did a great job and took excellent care of me. It is where my neurosurgeon practices.
I have insurance.

I was the asst head nurse of the MICU at Parkland in the 90's. Parkland get the sickest of the sick. All surrounding hospitals can go on divert... not parkland. They get all the Burn patients in North Texas.They have a lot of complicated OB patients.....and they have an outstanding epilepsy/neurosurgery unit.

They are catching shit...but trust me, the other hospitals do NOT want to see them close. They won't have a dumping groung for thousands of very sick poor.

At least they did when I had blogslut jr. 24 years ago. Parkland save my life and the life of my child.

Have they ever figured out how to get the surrounding counties to contribute to Parkland/Dallas Co Hospital District? I remember reading many articles over the years about Parkland being crushed under the weight or out-of-county residents.... Is there any chance that those suburban counties can be made to pay a share for their residents now?

by ambulance.

The 140,000 ER visits are a higher level of acuity than the surrounding ERs.
The surrounding ERs know it's cheaper to pay for EMS to transfer than the 250K hospital bill the patient will accumulate.

I was just hoping beyond hope. Sigh

The Metroplex is where they invented the idea of the suburbs siphoning off money from the cities. Everybody who works in Dallas commutes from Grand Prairie or Rockwall or whatever -- you even have "inner city suburbs" now like Irving which aren't far enough out to attract wealthy commuters and so are becoming mini hellholes themselves.

In fairness I haven't been there in a few years and I hear there are some glimmers of gentrification in places like Deep Ellum, but the idea that Arlington or Denton would actually pay for their share of the services they use goes against the whole intent of what passes for urban planning around there.

Because they are allowed to make up their OWN definitions of "indigent". If the patient from one of those counties doesn't "qualify" as being indigent, the surrounding county doesn't have to pay Parkland.
Case in point. Collin C0unty. They define indigent as someone who makes around $1,200 a YEAR. Yes, a year. If that person "makes" more than that, the county refuses to pay Parkland for any healthcare provided because, in the county's defintion/eyes, the person is not indigent.
Other counties have much higher, more reasonable definitions but Collin is a heavily repub county who rarely will even admit that there is an indigent, homeless population in their county and if there is, they sure as hell are not going to help them get healthcare.

is the specific county I was thinking of when I asked. 1200 a year to be indigent there, in Plano/Frisco.... uh huh. The are a mean bunch up there. I hope Parkland can get it worked out. We love to hate Parkland here, but we couldn't do without it.

There is no where else in the Dallas/Ft. Worth area for her to go. She is without a job or a husband at the moment. This stinks. I don't know what she'll do.

Some do fail and must fix the problem. However all ER's are required by law to treat all patients regardless if they can pay or not. So yes this sucks but on an emergency situation the patient will still have access to an ER. The problem after that is if they must be admitted.

It was a piece of crap in the 1980s and I can't imagine it's much better. They used to joke that Sam Houston was born there, it's so old. (It's not actually that old but I know it goes back to the 19th century.)

...and didn't treat them like shit...let their extended families be with them until they died...and did a lot of research on HIV/AIDS.

And I have to say the staff were absolutely awesome (they had a program that let siblings be in the delivery room, so I got to see my brother be born -- it included a home visit from a nurse beforehand and three classes at the hospital). It's just that the physical plant was so run down it was kind of distressing.

They do desperately need the new facility. the staff is trying to care for patients in the 21st century with 20th century shit.

What worries me....there is an excellent nursing staff there.Too much negativity will run these very dedicated nurses off.

that JFK was taken to and died at.

The facility was six years old at that time and world-class. It's still a highly respected hospital but the bones of the buildings are getting creaky and thus, the county is constructing new buildings that should be ready to go in 2014.

This is very sad story. My mother worked there in the early sixties as a floor nurse.

Have gotten away with too much for too long.
And each year they awarded themselves bonuses..some getting tens of thousands of dollars each year, the CEO get over $100,000 in bonus money. They refused to call it bonuses, instead they called it an "incentive plan"--adding that it was tied to their job performances/results. Uh-huh. Judging by the mess that they are in now with the various federal and state agencies, I'd say their collective job performances have SUCKED, and now they are having to answer to multiple federal regulators.

Pretty much what the top execs do is find someone, ANYone, outside the executive suite to blame, all while claiming that they knew NOTHING about ANYthing.

It's a given that at the end of this year, despite all these federal investigations, those same execs and management WILL expect and WILL get these same bonuses.


One of the execs who has been second in command recently announced he is leaving...he is taking a job as CEO of Grady Hospital in Atlanta. Funny, I read some of the puff pieces in their local papers about him, and none of them seem to add he is leaving a facility that has multiple federal investigations and now is 10 days away from losing Medicare funding. Good luck, Atlanta, you will need it.