Feds: Central Maine Medical Center Must Fix Deficiencies Or Lose Medicaid and Medicare Funds

May 6, 2019

Central Maine Medical Center (CMMC) in Lewiston is at risk of losing federal funding after inspections identified several issues, including a case in which a patient was paralyzed. The Sun Journal first reported Thursday that the Centers for Medicare and Medicaid Services found CMMC deficient in safety and quality.

Central Maine Medical Center in Lewiston
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Maine Public reporter Patty Wight has been looking into this story. She spoke with Nora Flaherty on All Things Considered.

Flaherty: Patty, tell us about when issues at CMMC were first identified and what kinds of deficiencies we're talking about.

Wight: It was in January when the Centers for Medicare and Medicaid Services surveyed CMMC, and it was triggered by a patient complaint.

This case starts with the patient at a spine surgeon's office last October. They lost their balance, hit their head, and became unconscious. The patient was transported to CMMC's emergency department with a known spine fracture. At one point, the patient was lying down in bed, and a nurse came in and started to elevate the head of the bed to a 45-degree angle. The federal report say a family member questioned doing this, but the nurse said they were following doctor’s orders, and continued to move the patient to an upright position while the patient was screaming in pain. And afterward, the medical records say the patient lost motor function and was paralyzed.

What does the hospital say about this incident?

I spoke to Dr. David Tupponce, who is the president and CEO of Central Maine Medical Center. He said that the federal report doesn't capture the full context of what transpired and the underlying medical conditions the patient had. But he did also say that CMMC is not trying to dodge accountability, saying: "We take our responsibility very seriously to identify cases where we can improve and to immediately and very aggressively look for opportunities for process improvement."

And improvement is what the Centers for Medicare and Medicaid Services want to see. The report concluded that CMMC was deficient in three areas: in emergency services, quality, and hospital leadership. And if CMMC doesn't improve, it will lose its federal Medicare funding.

What do we know about the progress the hospital has made since January?

There have been two surveys since then that also found deficiencies. One survey in response to another patient complaint. This patient came to the ER in January with chest pain. They got an EKG and the results were normal. But protocol requires other tests, and those were not conducted. And after waiting for two hours, the patient left the ER without ever being seen by a doctor.

 It sounds like CMMC hasn't made much progress.

Dr. Tupponce would disagree with that assessment. He says fixing these issues is "not a simple one and done." He pointed out that despite these additional findings of deficiencies, the Centers for Medicare and Medicaid Services has seen enough progress to push back the deadline CMMC has to make corrections. That initial deadline was May 4, but now it's June 30.

So what is the hospital doing to improve?

According to Tupponce, the hospital is looking at several areas, from improving communication, to ensuring protocols are consistently applied. Really, he says, it all boils down to making sure that the processes the hospital uses are resilient and not subject to a single failure point.

We should note that this is just the latest debacle for CMMC. Last summer their federal funding was in jeopardy because the Centers for Medicare and Medicaid Services found they were turning away patients in mental health crisis from their ER without proper treatment. And there's been turmoil within the wider Central Maine Healthcare system, with some staff voting 'no confidence' in Central Maine Healthcare CEO Jeff Brickman last summer.

That's right. The Sun Journal also reported last month that a board member resigned because he wasn't happy with the direction of the organization, and he was concerned about his personal liability.

In the face of this latest challenge that CMMC is dealing with, Tupponce said the deficiencies found are not the full picture of what's happening at CMMC. He pointed out that, among other things, the hospital was awarded an A-grade from the Leapfrog rating group. Which was an improvement from the C-grade it received before that. He says, "the community needs to recognize that there are a number of other very objective indications that this organization is far better and stronger than it was a year or two ago."

How likely is it that CMMC will meet its June 30th deadline for improvements?

Tupponce says he is expecting the hospital will meet that deadline. There's likely millions at stake should CMMC lose its Medicare funding, but he says he's confident that won't happen.

Updated 4:40 p.m. May 3, 2019