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U.VA. INSTITUTES NEW SAFETY AND SECURITY PROCEDURES AT MEDICAL CENTER

University of Virginia officials today announced a number of actions designed to improve patient care and safety at the Medical Center.

These actions are the result of an extensive internal investigation conducted in the wake of allegations of sexual assaults and improper use of restraints on the psychiatric unit, said Leonard W. Sandridge, U.Va.'s executive vice president and chief operating officer.

We are deeply disturbed by the situations that have occurred, he said, and have investigated not only what happened, but more importantly, what we must do to restore the trust of our patients, their families and the community we serve. We all regret and apologize for what has happened.

Our patients deserve safe and effective care and we intend to provide it, consistently, in all units and departments, he said. With the leadership of Medical Center chief operating officer William E. Carter and his senior management team, we have moved with all possible speed, given that there are a number of complex medical and legal issues that required thorough and painstaking analysis.

Sandridge said the Health Care Financing Administration (HCFA), the federal agency that administers the Medicare program, notified the Medical Center yesterday that the institution was being placed in immediate jeopardy status, which could result in loss of Medicare reimbursement, due to situations on the psychiatric unit. HCFA reviewers will conduct a re-inspection within three to six weeks. Sandridge said he is confident that at that time, as a result of the actions announced today, this status will be rescinded.

Sandridge also announced that a review of the recent dismissals of nine temporary or probationary employees who had felony convictions and who also failed to provide complete information on their applications showed that three of them are eligible for rehire in appropriate positions. Medical Center officials will notify these employees individually.

The following administrative and operational changes have been instituted this week:

  • Tightening the management of the psychiatric unit. Pamela F. Cipriano, the Medical Center's chief clinical officer, will assume direct clinical and managerial oversight of the unit. In addition, Sandridge will appoint a team of outside experts, including national leaders of best practices for use of medical restraint. The team will work directly with Sandridge and senior management to review all clinical and managerial practices and policies.

  • Adding staff on the psychiatric unit to enhance round-the-clock patient monitoring. At night, two people, one of whom will always be a female, will conduct patient checks every 15 minutes. The additional staff also will allow more careful determination of when patients should be placed in or removed from restraints, Carter said.

  • Working with HCFA to finalize new policies and procedures regarding the appropriate use of patient restraints. A new set of policies and procedures was developed in January after HCFA ruled that the Medical Center was not in compliance with federal regulations. When HCFA reviewers conducted a site visit earlier this week, they noted that while progress had been made, there are still practices that need to be changed. The reviewers said that they had found no evidence of physical injury to patients with regard to restraints, Sandridge said, but there are still some issues that they would like us to refine before they approve our corrective action plan.

  • To address concerns about having a combined adolescent-adult inpatient psychiatric unit, for the immediate future the Medical Center will no longer accept adolescents for inpatient care, except on an emergency basis when they need to be medically stabilized. When this occurs, additional staff will be reassigned to increase monitoring of these patients. Once these patients are stabilized, they will be transferred to an inpatient adolescent care facility.

  • Strengthening the Medical Center's existing sexual assault reporting policy to better identify and investigate all allegations of any type of patient abuse, including assault. This includes guidelines for the clinical and psychological treatment of patients who are possible victims of assault at the Medical Center, and an official review mechanism for any sexual assault allegations.

  • Making permanent a policy that if an employee is accused of criminal or serious misconduct on the job, he or she will immediately be reassigned, suspended or put on administrative leave while a Medical Center and/or police investigation is conducted.

  • Increasing scrutiny in the hiring process. New hiring policies require criminal record checks to be completed before job applicants can be offered a position. Applicants with criminal records will be evaluated on a case-by-case basis and may be hired for appropriate positions, but those who falsify employment application information, including omitting significant events or providing inaccurate information about criminal convictions, will not be hired.

I believe that each of these actions is significant and will substantively improve patient care and safety at the Medical Center, Sandridge said.

On a longer-term basis, the Medical Center senior management team is evaluating all possible options to be able to provide psychiatric care for both adolescents and adults. Our ongoing goal has been to meet the needs of the community by providing inpatient psychiatric care for all patients who are referred to us, especially since Charter Hospital closed, he said. This is part of our role as the region's major medical facility and certainly is what families and medical professionals expect of us. However, there are many issues, including physical facilities, regulatory requirements and staffing constraints, that must be carefully evaluated before we make a final decision. We will work closely with regulators from HCFA and the state Department of Mental Health, Mental Retardation and Substance Abuse Services in evaluating these options.

Finally, I would like to extend my gratitude to the Medical Center employees, who are most distressed by these events. I hope that the issues we have been dealing with do not overshadow the dedicated and committed work of the thousands of employees who daily give their best, who put patients and families first, and who do all that they can to improve the health and lives of the people they serve.

June 7, 2001