DECH receives extension to meet guidelines

The future looked bleak for Downeast Community Hospital (DECH) on June 25 when the Centers for Medicare and Medicaid Services (CMS) terminated the hospital's eligibility for federal funding, with an effective date of July 10. But late in the day on July 8, CMS extended the deadline to September 30 for DECH to comply with federal quality guidelines. The announcement capped 13 days of rapid fire events that began with the enforced leave of CEO Wayne Dodwell, followed by the naming of interim CEO Craig Jesiolowski, a petition to place the hospital in court-ordered receivership, the appointment of Eastern Maine Healthcare Systems (EMHS) as the receiver, and the installation of a new interim CEO, Doug Jones, to replace Jesiolowski.

Since January 1, 2008, DECH has been under virtually constant scrutiny by the state and federal agencies that are responsible for monitoring the 25-bed critical access facility. The investigations, or "surveys," were triggered by a total of 43 complaints, some including multiple allegations, of which 22 were substantiated and 21 were not. For each complaint found valid, the survey team from Maine's Department of Health and Human Services (DHHS) issued a "statement of deficiencies," and the hospital responded with a "corrective action plan." Over the 18 months, the documents totaled literally hundreds of pages, perhaps thousands – the printouts related to only two of the complaints that were recently reviewed by The Quoddy Tides exceeded 300 pages.

The substance of complaints that surveyors confirmed ranged from patient care issues in the emergency and obstetrical departments to conditions that failed to comply with standards for building safety. In February, the state downgraded the hospital's license to "conditional" and in April CMS categorized DECH as in "immediate jeopardy" of losing its eligibility for federal funding. CMS notified the hospital and the public that funding would cease on April 15, but rescinded the order only a day before the deadline when DECH came up with an acceptable plan to deal with identified deficiencies.

On June 25, CMS notified the hospital's president and CEO, Wayne Dodwell, that DECH was finally out of options – there would be no reprieve from the order to terminate the hospital's eligibility for Medicare funding on July 10. DECH had failed to meet four specific "conditions of participation," each one a statutory requirement under the Social Security Act: Emergency Services, Organizational Structure, Provision of Services, and Periodic Evaluation and Quality Assurance Review.

The letter to Dodwell declared that regulators had "discussed these requirements with you on numerous occasions." Based on the surveyors' visits, findings and recommendations, CMS "determined that the requirement is not met and is not likely to be met within an acceptable time period."

Spokespersons for CMS and DHHS would provide little elaboration beyond the letter's content, except for a statement from Catherine Cobb of DHHS that the action was taken because the hospital administration was "unable to implement their corrective action plan." Asked if she meant "unable" or "unwilling," she responded emphatically, "unable."

Within hours of the notification, Dodwell was placed on administrative leave, presumably by Quorum Health Services, the firm that provides management services to the hospital, although a Quorum spokesperson, Susan Hassell, would not comment on the company's involvement in Dodwell's separation. In a press release, Hassell appeared to distance Quorum from the hospital's board of trustees, stating the board "has developed a clear preference in how they desire to manage the hospital, particularly in relation to regulatory compliance. In some instances their preference differs from our company's approach to hospital management." She added that the board had "made numerous decisions inconsistent with" Quorum's recommendations.

Meanwhile, the state joined with DECH to file a petition in Kennebec County Superior Court to place the hospital in receivership. Hassell issued another press release to announce that Craig Jesiolowski, a Quorum vice president, had been appointed as interim CEO. She added, in an email response to a query from The Quoddy Tides, that his tenure would last "until the negotiations between Eastern Maine Medical Center, the courts and the state are finalized," the first confirmed indication that EMHS was in contention to serve as receiver.

On July 1, hospital spokesperson Julie Hixson issued a press release stating that DECH was in receivership to EMHS. The statement alluded to the broad powers conferred upon the receiver, explaining that EMHS "will have the authority to review and set aside any hospital contracts." Since the shake-up in hospital administration, Hixson has assumed the public relations role that had been handled by Robin Popp, a DECH vice president who is reportedly "on vacation." As of July 8, press releases have been jointly issued by Hixson and Suzanne Spruce, director of community relations for EMHS.

Hixson's July 1 statement pledged that the hospital would "address the corrective action plan," take steps to comply with "CMS requirements for licensing," and "assure CMS that the deadline for termination of DECH's Medicare participation should be extended." The receiver appointed Doug Jones, the recently retired CEO of Maine Coast Memorial Hospital in Ellsworth, as the new interim CEO for DECH. Jones was on site in the CEO's office as of Monday, July 6, but has not been available to reporters as of press time.

The receivership agreement does not affect Sunrise Care Facility in Jonesport or the Maine Veterans' Home on the DECH campus in Machias, according to Hixson, and the operations of both facilities are not affected by the changes in governance at DECH. The hospital's acquisition on June 30 of the Machias Medical Associates Building to provide additional office space for physicians is also unrelated to the receiver's role, Hixson said.

Walter Plaut, chairman of the board of trustees, says he spent "several days" at the hospital after the CMS announcement of the July 10 funding termination, speaking to key employees to reassure them of the board's efforts to cooperate with CMS requirements, the receiver and the new CEO. Other sources on the board would not speak for attribution as they face uncharted territory. "We don't know what receivership means. Even our lawyers don't know. This has never happened in Maine before," one said.

Those who would talk with a reporter "off the record" expressed surprise that "things got this far," voicing their belief that "things weren't really as bad" as portrayed by some in the press and some in the community, that, in the end, the regulators would value the dedication of the staff more highly and "see through anonymous and disgruntled" complainants. One recalled that some "anti-hospital" activists held a public rally where they "set up a table to solicit people to file complaints."

One official wondered, somewhat bitterly, "Why haven't we heard that the community bears some responsibility for this?" Then, more positively, the speaker added, "We've got to get the community to embrace the hospital, to recognize what a precious commodity it is."

Speaking of the CMS decision to extend federal funding for DECH through September, Michelle Hood, president and CEO of EMHS said in a prepared statement, "There is still much work to be done, and we continue to investigate deficiencies. However, in order to continue serving patients and operating a viable business, we must also have revenue. Without our largest client (Medicare/Medicaid) providing payment for services, our corrective efforts would fall short."

Commissioner Brenda Harvey of DHHS, the Maine agency that has conducted surveys at DECH on behalf of CMA, commented in a press release, "We are very pleased with CMS' decision to extend the deadline. It is important that the receiver have a reasonable amount of time to address the deficiencies identified and align with federal standards. The ability to continue to receive federal reimbursement will help the hospital continue to serve the people of Washington County while EMHS continues its work to achieve federal compliance."

Concerning the July 8 announcement, State Senator Kevin Raye of Perry commented, "The decision by CMS is a clear indication that the important steps taken by Commissioner Harvey and Eastern Maine Healthcare Systems to put the hospital on the right track are already bearing fruit. The healing process is under way at DECH, and I'm confident that the combination of dedicated staff and new leadership will secure the future of this vital institution."