Federal and state officials are moving to cut off government funding to patients at Tulsa’s Shadow Mountain Behavioral Health System following a critical inspection of the facility.
The Oklahoma Health Care Authority, in a June 1-dated letter, advised officials at the youth psychiatric hospital that it intended to terminate three of its SoonerCare contracts with the facility on July 31. The four-sentence letter indicates that the 60-day notice is not subject to appeal.
Shadow Mountain officials, in a statement, called the action “unwarranted.”
Oklahoma Health Care Authority officials declined to comment about the reasons for the contract termination.
However, the notice comes five weeks after a state Health Department survey identified numerous issues at Shadow Mountain, including:
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• On April 24, allowing a 12-year-old patient to grab a bottle of antipsychotic medication from a cart and ingest some of them. State surveyors attempted to review the incident on the hospital’s video recording system, but it could not be found in the archives.
• A review of video footage from April 18, showed one staff member grabbing a female patient and “driving her backward over a stool onto her back and the back of the head … when no imminent danger was present.” The staff member left the area while a nurse attended to the patient but then “quickly returned” and placed the patient in a headlock and wrestled her to the floor.
• Video footage from April 27 showed a staff member, after a brief verbal exchange with a patient, grabbing the female patient and “spinning her around, and holding her arms behind her back.” The surveyors indicated in their report that the patient displayed “no physical act of aggression or attempt to harm self or others” prior to being placed in the restraint.
• Shadow Mountain’s governing body failed to be informed of serious events that occurred at the facility and the development of “nebulous action plans” when discussing staff use of restraints and seclusion upon patients.
Asked for comment, Shadow Mountain Chief Executive Officer Mike Kistler provided the following statement:
“We were extremely disappointed to receive the notice from the Oklahoma Health Care Authority and believe the action is unwarranted. We are hopeful that we will be provided the opportunity to open a dialogue with OHCA which will allow us to demonstrate the quality of the care and treatment provided to our patients as well as the vital role we play caring for the residents of Oklahoma with significant mental health issues.”
In addition to action by the Oklahoma Health Care Authority, officials with the state Department of Human Services have indicated that they will no longer be routinely sending foster children and youths to the hospital.
Also, the U.S. Department of Health & Human Services Centers for Medicare and Medicaid Services has indicated that it will terminate its Medicare contract Aug. 24 unless the hospital takes corrective action.
“We have determined that the deficiencies substantially limit your hospital’s capacity to render adequate care and prevent it from being in compliance with all the applicable Medicare Conditions of Participation for hospitals,” states a May 26 letter from the federal agency to Shadow Mountain.
Problems at Shadow Mountain, whose main campus is at 6262 S. Sheridan Road, were revealed in April after an eight-month BuzzFeed News examination found possible systemic abuses of patients who receive mental health services at the facility, owned by Universal Health Services.
In May, an accreditation agency downgraded the psychiatric hospital’s status after its investigators found “an immediate threat to life” there.
The Joint Commission changed the hospital’s status to “preliminary denial of accreditation” following an unannounced visit to the facility May 9-10.
Preliminary denial of accreditation comes after a facility is found to have one or more of the following: an immediate threat to the health or safety of patients or the public; submission of falsified documents or misrepresented information; lack of a required license or similar issue at the time of survey; failure to resolve the requirements of an accreditation; or significant noncompliance with Joint Commission standards.
Shadow Mountain is licensed to operate by the Oklahoma Department of Health. The Oklahoma Health Care Authority has a contract with the facility for SoonerCare, which covers care for Medicaid-eligible children.
This is not the first time the Oklahoma Health Care Authority has moved to terminate a SoonerCare contract at Shadow Mountain.
OHCA terminated a SoonerCare contract for one of Shadow Mountain’s facilities in November due to noncompliance with minimal staffing requirements, but the contract was renewed in December, according to BuzzFeed’s investigation.
Meanwhile, Oklahoma State Department of Health spokesman Cody McDonell said the agency is reviewing a Shadow Mountain “plan of action” that addresses the deficiencies in the Health Department survey.
The deficiencies also include:
• Failure by the facility to protect and promote patient rights. The hospital failed to provide patients wanting to file a grievance contact information at the State Health Department. The hospital failed to protect patients from abuse or harassment and failed to utilize the least restrictive intervention to protect patients, staff or others from harm.
• Failure to follow hospital policy regarding use of restraints and seclusion. Records on April 27 noted that a patient awoke from a nap and immediately began threatening a staff member, swinging arms and spitting, resulting in the patient’s being restrained. However, Health Department officials reviewing video recordings from moments before the restraint indicated that the patient had “no swinging or spitting.”
• Failure to keep locked a room where electroconvulsive therapy was conducted.
• Failure by the hospital’s governing body to “grant privileges as part of the reappointment process of the medical staff.” Two of three members of the medical staff associated with the electroconvulsive therapy were not properly credentialed, a practice that “could potentially increase the risk of all patients receiving electroconvulsive therapy,” according to the inspection report.
• Failure to properly maintain patient medical records. Medical records for one patient file were said to be kept at a sister residential facility in Arkansas, while four other patient files were said to be kept at other residential facilities in the Tulsa metropolitan area.
On Friday, DHS told all Child Welfare Services staff to cease taking children and youths in state custody to any of four Shadow Mountain-operated facilities without approval from Child Welfare Services Director Jami Ledoux.
“If a youth is in need of assessment and the mobile response team is not available or able to deescalate the crisis situation, the youth should be transported to the next closest facility or emergency room, whichever is appropriate,” according to directive sent to DHS staff from Ledoux.
The directive outlines steps to take if no other facility is available and the situation is determined to be an emergency.
“An emergency would be considered if the child or youth is an immediate threat to themselves or others and no other placement is available to ensure their safety and the safety of others,” Ledoux states.
