Springfield Hospital Center in Sykesville is scrambling to revamp treatment plans for its nearly 300 patients after federal regulators found lapses in care at the state-run facility for the mentally ill.
A team of inspectors from the Centers for Medicare and Medicaid Services, a federal agency that provides health insurance for more than 74 million Americans, interviewed staff and patients at the hospital this year before filing a 23-page report of deficiencies, obtained by The Sun under the federal Freedom of Information Act. Although the problems primarily involved recordkeeping, the team also found instances in which patients were left unmonitored and included in the report a patient's account of finding a nurse sleeping on the job.
Most notable among the problems was the lack of documented individualized plans of care, the surveyors wrote.
The inspectors criticized the hospital for its lack of written treatment summaries, for failing to track patients' mental status and for maintaining medical histories with missing information.
Paula Langmead, Springfield's superintendent, said she was initially "frustrated" with the accounts.
"But in reading it again in context of medical records, it took on a new meaning," she said in an interview last week. "Much of the active treatment that we provide was not being adequately documented."
The hospital is working to meet an August deadline set by the CMS to comply with federal standards and rewrite treatment plans for all 270 of its patients.
CMS sent a four-member team from its regional offices in Philadelphia to Springfield in January for an unannounced, routine survey. The inspection was the first there since 1995, said Carol Messick, a CMS spokeswoman.
"At psychiatric hospitals, the review specifically applies to staffing and medical records," Messick said. She said she could not comment on the specifics of the survey on Springfield until it becomes final, after the hospital has been given a chance to comply with recommended changes.
The CMS Philadelphia office inspects 530 hospitals - 59 are psychiatric facilities - in a region that includes Maryland, Delaware, Pennsylvania, Washington, Virginia and West Virginia.
Springfield had developed a care plan in anticipation of computerizing all patient records, but budget shortages have delayed that project, Langmead said. The system identified a patient's illness, treatment and therapy by number. Surveyors said that although the staff knew the diagnosis of each patient and where each was at any given time, many could not immediately translate the information associated with the numbers.
After receiving the survey results, Langmead composed a plan to correct the deficiencies.
"CMS thought we were too general. They wanted us to be more specific with each individual. Whatever we say on paper is what we should be doing," she said. "Our staff is traveling all over to see new concepts at other hospitals, and we have examples of what is working."
By last month, when a two-member CMS team returned for a follow-up survey, the changes were in place on three pilot wards and the staff was working to complete the task on the remaining areas, Langmead said.
"The surveyors expected to see total compliance, all wards using and progressing with the new plan of care," Langmead said. "Since we were not, we were again identified as out of compliance."
Although the bulk of Springfield's funding comes from the state, Langmead has stressed to her staff the urgency of making all the corrections. In the staff newsletter for May, Langmead told employees that it was imperative everyone "become familiar with and embrace" the new treatment plan.
"Is it time for panic? No," she wrote in the newsletter. "Is it a time for concern? You'd better believe it!"
CMS oversees annual payments of about $360,000 from Medicare and $1.5 million through Medicaid to Springfield, which has a $55 million budget.
"We give all hospitals an opportunity to correct in a reasonable time period," said Messick.
Springfield serves many uninsured patients, and many are referred from emergency rooms or other hospitals. In the past year, it admitted 600 patients who stayed an average of 30 days, but many remain longer. In addition, about 50 long-term patients reside in assisted-living settings on the campus.
CMS will conduct another survey after the deadline to make sure the hospital is in compliance, Messick said.