A rural, county-owned hospital in Kansas barely escaped a devastating blow earlier this month after officials from HCFA threatened to revoke its Medicare and Medicaid certification.
Ransom Memorial Hospital in Ottawa, Kan., the only hospital in Franklin County, Kan., was declared in "immediate jeopardy" of losing its ability to collect Medicare payments because of quality-control problems. After HCFA and the Kansas Department of Health and Environment conducted a complaint validation survey at the end of March, they gave the 45-bed hospital until May 5 to fix the problems.
"They found several deficiencies," said Robert Bregant Jr., the hospital's administrator. "We submitted a plan of correction to them. They resurveyed the hospital. We have only three minor nonpatient-care issues that we need to deal with."
He said everyone at the hospital was relieved that it will not lose its Medicare eligibility.
"At the same time, I believe the entire organization was unfairly cast in a negative light when the concerns that HCFA brought forward were systems issues that we corrected," he said. "We don't believe patients were put at risk coming to our hospital."
Meanwhile, a doctor on the hospital staff has filed suit against Ransom Memorial and Franklin County, its owner, alleging they suspended his hospital privileges without due process on April 1.
Bregant confirmed that internist David Edalati, M.D., had sued the hospital but said he could not address the physician's allegations. Edalati does have certain privileges at the hospital now, Bregant said. "He can order tests."
Edalati referred questions to his lawyers, Diana Breneman and Rick Lombardi, in Kansas City, Mo.
"The hospital has used Dr. Edalati's name in connection with certain patient issues," Breneman said. "They have not published the patient's name, but they have talked about Dr. Edalati's medical care." The hospital also told the local newspaper that its quality problems were attributable to Edalati, she said. "They told the media it was a one-patient issue and one doctor, and that's not correct. You can look at the HCFA report and see it refers to various problems. They have defamed him."
The lawsuit also says Edalati has not been allowed to defend himself, as required by the hospital's bylaws. "We believe you can't deprive someone of their property, their right to practice medicine, without a fair hearing," Breneman said.
Edalati also claims in his lawsuit that he was suspended because of prejudice against his Iranian ancestry.
The HCFA probe followed the deaths of two patients under questionable circumstances. One patient died in December 1998 after a delayed blood transfusion. Another patient died of respiratory failure after receiving a medication overdose. The HCFA survey doesn't identify patients, physicians or nurses by name.
The state of Kansas does not regulate hospitals directly but accepts the surveys of the Joint Commission on Accreditation of Healthcare Organizations as evidence that the facility meets quality-of-care requirements. The Joint Commission accredited Ransom Memorial on Dec. 11, 1998, with recommendations for improvement.
HCFA found, among other things, lapses in documentation of medical credentials, insufficient internal quality controls, a lack of medication protocols and delinquent medical recordkeeping. In addition, medical records were not secure. Hospital employees were concerned about these issues but got no response from the medical staff or the hospital administration, HCFA reported.