For the second time in six months, Durham Regional Hospital has failed to meet quality standards for federal Medicare and Medicaid funding, according to a 45-page list of problems from the state's Division of Facility Services.
Nine state officials completed a full survey of the facility between Aug. 6 and Aug. 9 as a follow-up to a similar investigation conducted in March that also cited quality violations.
Among the most serious claims in the report issued Sept. 4 to the hospital, which is administered by Duke University Health System, were insufficient management of a contract service providing kidney dialysis and problems with nursing care, a major issue in the last report.
"Based upon the survey, problems were found both with nursing services as well as the governing body," said Azzie Conley, assistant chief of licensure and certification of the state's Department of Health and Human Services and a member of the investigative team.
Conley noted several major problems with the hospital's dialysis services, which are contracted out to Biomedical Applications of North Carolina, Inc., but are the responsibility of the hospital. "There were indications of the [administration] not being knowledgeable of the contract," she said, indicating that the hospital staff was not overseeing the treatment correctly.
"The hospital failed to assume that the contracted staff coming to the dialysis center were properly trained," Conley said, pointing to findings that some contract nurses were working without valid credentials and without the required doctors' orders for flow rates of fluid during treatment. In some cases, she said, nurses were administering treatments in contrast to given doctors' orders.
The inspection report also cited nurses' failures to give blood transfusions correctly, again often contrary to orders. Conley noted one example in which a man was administered a blood transfusion exceeding four hours, putting him at severe risk. Failures to treat patients' pressure sores and to complete proper health screening were also included in the report.
Conley said flaws were found in the overall organizational structure of the hospital, including relations between medical staff and administrators, and that many of the problems involving nursing care were a product of lax management.
As required, Durham Regional responded with a plan of action Sept. 10, "outlining specific corrective steps for each of the complaints," said Katie Galbraith, director of marketing and corporate communications for Durham Regional. "We certainly take it very seriously."
The response was accepted by the state as a satisfactory plan to address the problems.
"Providing quality patient care has been and continues to be our top priority," said Durham Regional CEO Richard Liekweg in a statement. "We are confident that we have corrected the issues [the Division of Facility Services] identified and that they will find us in compliance when they return."
Hospital officials refused to allow doctors or nurses to comment.
A survey of the hospital in May confirmed that the faults found in the March investigation, which was conducted in response to numerous patient complaints, had been adequately addressed. The most recent inspection was a standard follow-up, known as a "validation survey," to make sure of continued compliance.
Although the state report comes less than a week after Durham Regional announced losing more than $2 million for the fiscal year ending July 2002, "[the problems] are not an issue of staffing or budget," said Galbraith. "These are issues that needed to be addressed."
The hospital has 45 days from issuance of the critical report to meet the required standards.
"If [Durham Regional doesn't] meet the requirements, we make recommendations to terminate them from the Medicare program," Conley said.
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