Initial results of an inspection of Grady Memorial Hospital -- following the death of a patient who fell from an 11th-floor window -- show the hospital must make building improvements but no patients are at risk.
Inspectors found no medical care issues while conducting an unannounced survey last month, according to preliminary findings from federal regulators, Grady’s new CEO John Haupert told corporate board members Monday. There are still some facility concerns, such as the placement of sprinkler heads, Haupert said.
It’s excellent news, but Grady must make sure its physical environment is safe, he said. “[There’s] more work to do, and we’ll get it done.”
That work will likely take a toll on finances at the safety-net hospital, which is facing a $20 million shortfall so far this year. As a result of the survey, Grady will be looking at increased staffing and maintenance in the next couple of months, said Sue McCarthy, the hospital's chief financial officer.
"It's not a pretty picture," McCarthy said.
Grady, which will receive the full, official report on the survey within the next week, must submit a plan to correct the problems to the Centers for Medicare & Medicaid Services, a federal health care regulator, within 10 days. Haupert said the hospital will be given a time line to fix the problems, which will likely be followed by another inspection. Meanwhile, its accreditation and Medicare payments are not expect to be affected.
An earlier report by regulators showed Grady didn’t have enough staff to provide the one-on-one monitoring a doctor had ordered for 60-year-old Gloria Shavers, who on Sept. 6 fell from a window that was supposed to be locked. The neurological unit Shavers was on also had 20 of 21 shifts understaffed from Sept. 1 to Sept. 7, according to the report.
A doctor had earlier noticed Shavers showing signs of confusion. She had been rushed to Grady two weeks earlier after having a seizure at a MARTA station.
The hospital’s problems were “determined to be of such serious nature as to substantially limit [Grady’s] capacity to render adequate care,” regulators wrote in a letter to board Chairman Pete Correll. Correll said Monday that he was encouraged by the preliminary results.
Following the incident, all of Grady’s windows were checked, closed and locked. Of its 566 operable windows, 21 were found unlocked.
In the most recent survey, inspectors didn’t find problems with any of the windows, Haupert said. The hospital went through four straight days with the nursing staff and five consultants to prepare for the survey, he added.
The hospital's financial picture fell into disrepair when it lost roughly $20 million in local and federal dollars to care for the uninsured this year. It has cut more than 200 jobs and consolidated two neighborhood clinics. Grady also faces a multimillion-dollar shortfall next year.
In an effort to increase revenue, the hospital is ramping up efforts to screen uninsured patients and identify those who may be eligible for Medicaid. The government health care program for low-income people makes up roughly 40 percent of Grady’s revenue.
About 45 percent of its patients are uninsured; of those, only a quarter apply for medical assistance, said Shaunta Vaughn, Grady’s senior director of revenue cycle.
A new automated process alone has generated $7 million from identifying low-income patients eligible for health coverage since May. The hospital is also focusing on better screening people who come into the emergency department.
“We just closed a big leak ... but there’s a lot of work left to be done,” McCarthy told board members.
At the same time, the state is experiencing significant delays in processing applications -- as budget cuts have led to fewer caseworkers, Vaughn said. In Fulton County, caseworkers have an average load of 1,400 cases but are required to process 200 a month.
“More applications are being submitted. More people are unemployed,” she said. “They just have more to do.”
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