Md. Hospital Might Face Fines, Loss Of Medicare

A Montgomery County hospital where a 29-year-old patient suffered extreme malnutrition before his death could face steep state fines within weeks and even the loss of federal Medicare funding this fall because of serious failings in care.

Adventist Rehabilitation Hospital of Maryland, which has facilities in Rockville and Takoma Park, was notified recently by state health regulators that its efforts to remedy problems still fall short and that more improvement is required. The most alarming issues continued to relate to patients' dietary needs, with one woman in the end-stage renal disease repeatedly suffering severe drops in weight.

An administrator said yesterday that the Rockville facility was "making great progress" and would be ready when the state returns this month to review conditions. Regulators have put the facility on notice that it is on a critical timeline.

"We'll take a good, hard look," said Wendy Kronmiller, director of the state Office of Health Care Quality. "They'll have to satisfy us that they've fixed the systemic problems."

Officials began investigating in May after the 29-year-old patient's mother filed a complaint about the three weeks he had spent at Adventist Rehabilitation in Rockville. No one disputes that Julian Frazier was very ill when he was admitted Nov. 16, suffering from severe pancreatitis, chronic abdominal pain and nausea, and a host of complex diagnoses such as alcoholism and bipolar disorder.

The onetime math teacher was 6 feet tall and weighed 146 pounds.

But the state's findings, contained in a report to the federal Centers for Medicare & Medicaid Services, summarize a wrenching period of hospitalization marked by poor communication among those caring for him and a lack of cohesive evaluation, treatment and follow-up -- particularly as the patient's condition deteriorated.

By Dec. 7, Frazier was so "profoundly malnourished" that his body was fighting a massive buildup of fluid, his blood pressure was dangerously low and he was experiencing "visual disturbances." He was transferred at 2:30 a.m. to the emergency room at Shady Grove Adventist Hospital. Less than four hours later, he went into respiratory distress and cardiac arrest.

According to the health-care office's report, Frazier was "at a severe and unrelenting risk of starvation and the facility failed to weigh him, failed to do needed laboratory studies and failed to act on dire signs until it was too late."

Or, as Kronmiller elaborated yesterday: "It was a constellation of people not doing what they should have done or following up, from nurses to dieticians to the doc."

The hospital acknowledges that the patient's care fell short despite the large team assigned to his case.

"We could have coordinated our efforts better," said Aisha Bivens, the director of quality management, who cited privacy regulations as the reason she could not discuss the case in detail.

Bivens said the facility had begun assessing its procedures before the state contacted it about the complaint and had already revised how patients' weight should be monitored and documented and how medical and dietary staff should communicate across their departments.

Yet despite those steps, another visit by regulators, in July, identified continuing issues. A second report focused on three more patients with medical conditions that required careful dietary monitoring. With each, problems were found.

Bivens said yesterday that she thinks subsequent changes will satisfy the state's concerns.

"We're making great progress," she said. "We really are confident that these deficiencies will be successfully addressed."

If they are not, the state could levy fines of up to $10,000 a day for each violation. Continued troubles could result in federal termination of the hospital's participation in Medicare by mid-October.

The rehabilitation facility, which yesterday had 44 patients, is part of the Adventist HealthCare system. Hospital and state officials said it has had no significant deficiencies or accreditation difficulties in recent years.