Texas psych hospital loses Medicaid certification over patient restraint and seclusion

December 27, 2011

One of Harris County's major inpatient psychiatric hospitals has lost its Medicaid/Medicare certification in the wake of inspections that found "an immediate and serious threat to patient health and safety."

The Centers for Medicare and Medicaid Services has notified IntraCare Medical Center, a 148-bed acute-crisis care facility, that it is terminating its contract Dec. 23 because of the threat. The potential closing of the hospital represents a huge blow to the area's overburdened mental health-care system.

"This could be a devastating loss," said Andrea Usanga, director of policy and governmental relations for Mental Health America of Greater Houston. "We already have only about half the number of psychiatric beds recommended for our population."

Leaders of other Houston-area psychiatric hospitals said they have been contacted by physicians interested in admitting patients there and have told their emergency departments to brace for additional patients.

The IntraCare deficiencies, not corrected over a series of CMS inspections from July to November, mostly involved the improper use of restraints and seclusion, used to secure the safety of patients or staff. They also included a suicide attempt that was not investigated.

IntraCare CEO Terry Scovill said there are no plans to close the hospital, but he acknowledged it likely couldn't survive longer than 90 days without Medicaid/Medicare funding. He said IntraCare receives about 80 percent of its funding from Medicaid/Medicare.

State inspection

Because of the CMS action, the state health department will conduct its own unannounced inspection of IntraCare, said spokeswoman Carrie Williams. The department, which licenses IntraCare, this year fined it $6,000 after an investigation into a complaint about improper patient care and transfers in 2009.

IntraCare, near the Astrodome, is certified for the second most psychiatric inpatient beds in Harris County - behind only the Harris County Psychiatric Center - though it only has about 55 patients. Its patients - young children, adolescents and adults - are psychotic or pose a danger to themselves or others.

They include four foster care children taken from abusive or dangerous homes and placed there by the Texas Department of Family and Protective Services. DFPS Spokesman Patrick Crimmins said enough beds are available in the area to move those children to another psychiatric facility. "If we lose IntraCare we will be OK," said Crimmins.

Scovill said IntraCare plans to transfer staff to its North Houston facility, which is separately certified and not part of the termination action. The North Houston facility is licensed for 90 beds but only has about 35 in-patients and could accommodate another 30, said Scovill.

Bob Moos, a spokesman for the Centers for Medicare and Medicaid Services, said IntraCare will need to plan discharges in accordance with CMS regulations and ensure patients' rights are protected.

CMS summaries of three inspections at IntraCare Medical Center make frequent references to patients being secluded or restrained, physically and chemically, without doctor's orders. The two practices have become an increasing focus of debate in the psychiatric community.

The last CMS report, dated Nov. 17, notes that child and adolescent patients were restricted to the quiet room of their bedrooms with no physician orders, seclusion documentation or face-to-face evaluation thereafter. The report notes that an "IMMEDIATE JEOPARDY" was declared as a result of the "unsafe environment with potential for harm."

Scovill said IntraCare used the restraints and seclusion appropriately but failed to document doctor's orders properly. He said the person responsible for such documentation was fired. That the problems were still evident at CMS's third inspection was "a legitimate concern," Scovill said.

Problems fixed

Scovill said that the problems are corrected and that IntraCare is applying for re-certification. But he said didn't know if the process would occur fast enough.

Moos said a decertified facility would have to pass an unannounced inspection and "a period of reasonable assurance, which usually lasts a few months."

Although injuries and deaths have been associated with seclusion and restraint, these practices remain loosely and erratically regulated. Since 2008, the Texas foster care system has required residential treatment centers to document each time restraints are used.

A year ago the Houston Chronicle found that many don't do it diligently and some don't do it at all.

Source: Todd Ackerman, Terri Langford, "Psychiatric hospital loses Medicaid/Medicare contract," Houston Chronicle, December 15, 2011.