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Citing patient safety, federal officials recently said that they would terminate payments to two Louisville health care facilities, including one — Signature HealthCARE’s Jefferson Manor Rehab and Wellness Center — whose procedures harmed a patient and whose conditions posed an immediate threat.

The Centers for Medicare & Medicaid Services said that it would cease payments to Jefferson Manor on April 5 “as a last resort after all attempts to remedy the deficiencies … have been exhausted.”

CMS gives facilities time to correct deficiencies before termination, and steps taken by Signature prompted the agency to rescind its payment termination plans on April 16.

Separately, CMS said on April 18 that it would terminate some Medicare payments for a Norton Healthcare facility because of two incidents in which an employee in the nonprofit’s mental health unit used “potentially harmful, unnecessary force” while managing patients. It later rescinded those plans as well.

The agency had said in a letter dated March 19 that the Signature facility, which has 100 certified beds at 1801 Lynn Way, was “out of compliance with CMS basic health and safety requirements.”

“We are closely monitoring the relocation of Medicare and Medicaid patients to other facilities,” the agency wrote in a public notice.

Signature HealthCARE told Insider via email that it did not receive a termination letter, but said that even if it had, such a notification “is a standard CMS letter issued to facilities within 30 days of the 180-day survey cycle end.”

However, CMS told Insider that such a letter is standard only “when a state survey identifies immediate jeopardy that could cause harm to patients’ safety and welfare.”

In a health inspection from Dec. 14, CMS noted five deficiencies for Jefferson Manor, including one that caused actual harm to a patient.

In November, after tests indicated that a patient’s blood wasn’t clotting in a normal amount of time, the facility did not notify a physician until three days later, “when the resident became unresponsive,” according to CMS.

Scans in the hospital showed the patient had suffered bleeding in the brain, according to the report.

Signature, a private for-profit that operates in 118 locations in 10 states, told Insider via email that “the facility has cleared ALL deficiencies — which means the state came back, reinvestigated, and determined that the facility had implemented an appropriate plan and had corrected ALL cited deficiencies. Again, this is routine or standard survey practice, and as previously mentioned, the facility remains in compliance with all state and federal regulations.”

Since April 2015, CMS has noted 19 deficiencies at Jefferson Manor in three standard health inspections, including some that posed immediate jeopardy to patient health and safety, according to the agency’s website. Signature was assessed a $40,000 fine after a report in 2015 found that a resident had left the facility without staff knowledge until an employee at the end of his shift noticed the resident in a wheelchair trying to cross a busy two-lane road about 0.4 miles from the facility.

The facility has one-star rating — the lowest possible on CMS’ five-star scale — based on health inspections, staffing and quality measures.

Of 66 nursing homes in Louisville, 17 have one star, including three from Signature HealthCARE. Fifteen nursing homes have four stars, which is above average, and 13 have five stars, which is much above average.

Two have a perfect score: Little Sisters of the Poor, at 15 Audubon Plaza; and Signature HealthCARE at Sts. Mary & Elizabeth Hospital, 1850 Bluegrass Ave.

Norton Healthcare

Norton Healthcare told Insider that the incidents cited by CMS involved one employee, who has been placed on leave, that no patient was injured and that the nonprofit has taken corrective measures including additional training for 4,000 employees and has returned to full compliance with CMS guidelines.

CMS said in its report that the hospital, at 200 E. Chestnut St., “failed to provide care and services in a safe setting and failed to ensure all patients were free from abuse.”

The agency said that around Jan. 30, an employee in the mental health unit used “potentially harmful, unnecessary force” to hold down a patient for an injection and, after the patient took an ink pen from staff, “tackled (the patient) from behind and used his full body weight to pin the patient to the bed until he/she dropped the ink pen.”

In late October, when a patient with bipolar disorder, psychosis and PTSD swung at nursing staff, the same employee “blocked the swing and pushed the patient toward the bed by grabbing the patient’s throat. (The patient) went down sideways on the bed … and (the patient’s) head hit the wall,” according to the report.

Matthew Ayers

Norton Hospital Chief Administrative Officer Matthew P. Ayers told Insider that Norton self-reported the incidents to the proper authorities.

“Ensuring the safety of patients is our most important responsibility at Norton Healthcare. We take all matters concerning patient safety very seriously,” he said.

Norton also said that if the employee, who is on administrative leave, returns, he will have no interaction with patients.

Ayers also said that Norton provided training for 4,000 employees at its downtown campus to make sure they understand the nonprofit’s policies, especially those relating to patient safety and reporting to supervisors. Fifty-five employees in the adult psychiatric unit and 42 in security also received additional training on restraints.

Ayers also noted that Norton had not received a termination notice in decades.

Based on Norton’s corrective actions, CMS rescinded the termination letter on April 25, and Ayers said that Norton is “in full compliance with all laws, regulations and certification requirements.”

Since early November, CMS has sent termination notices to 83 facilities in the nation, including eight in Kentucky. The agency also had sent letters to rescind the termination to about half the facilities, including all of the ones in Kentucky.

Boris Ladwig is a reporter with more than 20 years of experience and has won awards from multiple journalism organizations in Indiana and Kentucky for feature series, news, First Amendment/community affairs, nondeadline news, criminal justice, business and investigative reporting. As part of The (Columbus, Indiana) Republic’s staff, he also won the Kent Cooper award, the top honor given by the Associated Press Managing Editors for the best overall news writing in the state. A graduate of Indiana State University, he is a soccer aficionado (Borussia Dortmund and 1. FC Köln), singer and travel enthusiast who has visited countries on five continents. He speaks fluent German, rudimentary French and bits of Spanish, Italian, Khmer and Mandarin.


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