Federal Funding for Parkland Threatened after Staff Calls Cops on Homeless Patient

Categories: Healthcare

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The homeless man identified only as Patient No. 5 was in a wheelchair, recovering from a suicide attempt and three broken bones when Parkland Memorial Hospital staff discharged him to a homeless shelter. He didn't want to go. "The patient stated he did not feel safe going to the shelter with three casts on," says a social worker's note.

An unnamed doctor gave the staff permission to call the cops if he didn't comply. "Dr. ... says that if patient refuses shelter and transportation, that we can call the police," say notes written by a hospital nurse last month. So when the patient "stated he wanted to file an appeal on his discharge" and refused to get in a van that would take him away, the staff took the doctor's advice. "Police called," conclude the hospital staff notes detailing that episode. The cops seemed to do the trick, with the hospital somehow finally getting him off the property. But now Parkland's treatment of Patient No. 5 is coming back to bite the hospital.

Centers for Medicare and Medicaid Services sent a letter to Parkland, made public last week, saying the hospital risked to lose $400 million in Medicare funding because it had placed a patient in "immediate jeopardy."

In a more detailed report, the CMS gets specific about all the things Parkland did to place him in jeopardy.

The man was hospitalized after a suicide attempt and seemed to exhibit more self-destructive behavior while there. He was supposed to stay off of his feet so his fractures could heal, but at one point, "patient jumped out of bed onto both feet stating, "See what you made me do are you happy now?" according to progress report notes from the hospital. After jumping up, "patient returned to bed screaming for therapist to leave the room."

Despite all that, the hospital never gave him a psychological or psychiatric evaluation. The CMS interviewed hospital staff afterward to find out why. One of the unnamed hospital personnel (the report keeps everyone anonymous) told the CMS that another hospital staff member said he didn't need one. Other staff said they didn't realize he had any mental health issues or insisted that the homeless shelter was safe.

But an employee of a homeless shelter told the CMS that all of its residents "would have to be independent and able to care for themselves as the facility did not provide any physical assistance." And buses that all the residents have to board each night to go to another shelter are old and not wheelchair accessible.

Last year, the federal government determined that Parkland "has caused or is likely to cause serious injury, harm, impairment or death to a patient." Investigators reviewed cases involving a death, a sexual assault and "hygiene lapses," covering just about everything that could possibly go wrong during a hospital stay. Then, a year ago, the CMS had some good news, announcing that Parkland Hospital "put themselves in a position to provide sustainable safe care."

Now that the CMS is mad at Parkland again, the hospital promises to fix its errors. In fact, CMS spokesman Bob Moos says his agency has already approved Parkland's plans. At some point before September 6, the CMS will make an unannounced visit to Parkland "to ensure that the hospital's planned corrections have indeed been implemented," Moos says in an email. So if you need to go to Parkland soon and want top-notch treatment, it sounds like between now and September 6 is the time to do it.

The CMS' report about Patient No. 5 is below:

Parkland Hospital CMS 2567 POC 8.2014.pdf



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56 comments
madiak47
madiak47

Why is it parkland hospital and the tax payers responsibility to tale care of tis person beyond stabilizing his medical treatment. Society did not force him to do drugs as his brother admits his usage in the comments below. Nor did we cause his injuries. He did this to himself. Why as a society do we continually allow people to male poor judgement call then it is our responsibility to clean up their mess or take carenso them. People need to have some sort of accountability for self. Parkland did their part should they have rented him an apartment and given him food and clothes as well. He made his choices and he should have to reap the consequences of his actions.

cptan7
cptan7

Parkland is full of incompetent Indian nurses who covers each other's detrimental errors. I have made several complaints to Parkland administrators in the past. Evidently nothing has been done. The nursing staff should be diverse to mirror the diverse patient population. This would lead to more whistle blowers and less cover ups.

STANDUP4PARKLAND
STANDUP4PARKLAND

For everyone who is passing judgement on Parkland after reading this article, please consider what would happen to the 400+ patient that are seen in the ER ALONE each day at Parkland if we did not have it. Then what happens to the patients after the ER visit:  hospital admission, clinic follow up, social placement... etc. Sure it might be a long wait time for the ER or clinic visits, but trust me there are A LOT of patients in the system and not enough providers.  


Many of the patients in the Parkland system  have no insurance or have "insurance" provided by Parkland (called Parkland Health Plus, basically a income tiered payment plan: i.e. free for people without income). Most of these patients would NOT be able to afford or receive long term health care without Parkland. 


Also consider this: CMS intervened last year to "improve" Parkland. What ended up occurring was a massive scramble by Parkland which included millions of dollars paid to an outside consulting firm, which one of the biggest emphasis was that patient safety was compromised by not enough hand washing. I am all about infection control, but did the tax payer need to give millions of dollars to a private firm so Parkland can install hand sanitizer stations every 5 ft? Be careful when doling out generalized "love" by the public towards CMS as the police of big bad Parkland. 


I am a previous resident at Parkland, and in the past few years I've "lived at" Parkland. I've seen Parkland and it's hard working staff dragged through the ringer by the Dallas media and CMS. I agree there are many thing which can improve in this hospital system. But starting a witch hunt to "close down Parkland" or stating "Parkland kills patient", is unfair to what the hospital AND it's staff considering what it brings to OUR community. 


So before judging Parkland's value to the greater DFW area, please do not SOLELY rely on these types of media portrayals. Because there are so many sides to Parkland, whether good or bad, which people who have not worked there or have not received healthcare there can not even begin to imagine.

If even a fraction of people who have REAPED the benefits of Parkland through getting healthcare, training, or anything else would speak up, the general public, most who have been LUCKY enough not to need any county based healthcare, might realized Parkland's importance to everyone in our community. 

STANDUP4PARKLAND
STANDUP4PARKLAND

For everyone who is passing judgement on Parkland after reading this article, please consider what would happen to the 300+ patient that are seen in the ER everyday at Parkland? Then after the ER visit, patients needing admission get admitted, and patients needing follow up get some sort of appointment (it might be a long wait time, but hey there are A LOT of patients and not enough providers). Many of the patients in the Parkland system  have no insurance or have "insurance" provided by Parkland (called Parkland Health Plus, basically a income tiered payment plan i.e. free for people without income). Most of these patients would NOT be able to afford or get long term health care without the Parkland system. 


Also consider this. CMS stepped in to "improve" Parkland in the past couple years by threatening to shut Parkland down. What ended up occurring was a massive scramble by Parkland which included millions of dollars paid to an outside consulting firm. 


Before  judging Parkland's value to the greater DFW area, please do not only rely SOLELY on media portrayals, because there are so many sides to Parkland, whether good or bad, which people who have not worked there or have not received healthcare there can not even begin to imagine. 

2damicos
2damicos

I will confirm this was not a need to get out of the heat. There were multiple errors on Parkland and Green Oaks park. This is my brother and he was not homeless prior to this suicide attempt nor has he ever been homeless. He has worked hard all his life and has never been a burden on the gov system. He was familiar with a homeless lifestyle but he knew there was no way he could defend himself or take care if himself with one good arm! He has struggled with mental illness and drug use for most of his entire life but has always made ends meet. Parkland knew of his psychiatric history and recent suicide attempt because I told many of the staff at Parkland including social workers and the VP of care management.

It is not right that people such as my brother have no rights when in a facility such as Parkland. They used their influence to threaten him and force him to do what he did not feel comfortable or safe doing. I want to make sure that others don't go through something as horrific as this.

sbristow15
sbristow15

Parkland's guilty, again. Case closed.

russell.allison1
russell.allison1

According to weather.com the high temp on the day listed in the document (7/21/14) was 98 degrees.  The next day was 99 degrees. 

If one has had any exposure to the public mental health field around Dallas, one would have encountered a fair share of chronically homeless people who will feign mental illness during the hot and cold months to get themselves a warm or cool place to stay.  Some of those I'd encountered had a good "crazy" act that was sufficient to get them into Terrell for a week or two and then onto an outpatient facility.  Some who were well known to the system (I can recall 3 off the top of my head that fit this description) as malingerers would have to resort to some drastic measures to gain entry at times, suicide attempts being one option;  threat of violence was another. 

Given the lack of detail, I don't know if the case at Parkland was a case of suicide or just a case of "air conditioning by any means necassary" but based on the scant details I'm not sure I'd completely comdemn the staff at Parkland. 

Myrna.Minkoff-Katz
Myrna.Minkoff-Katz topcommenter

Not being from Dallas originally, Myrna doesn't understand the hostility people in this area have towards Parkland.  I've heard a couple people say anywhere but Parkland.  Can someone explain? 

sbristow15
sbristow15

Parkland is completely in the wrong on this one. 


There is no responsible hospital in world that kicks a suicidal person to the curb without any treatment, especially if that person makes such a serious attempt causing serious injuries to himself like this case; however, Parkland repeatedly discharges most its suicidal patients on the same day of their suicide attempts.


The fact that this man had a broken spine, and other broken bones from his nearly successful suicide attempt is proof enough that he is a threat to harm himself and should have been kept under psychiatric observation. Heck, he didn’t even feel safe leaving. (Maybe they should have taken this as a hint that they should have kept him under observation or maybe, god forsake, even treat him.)


The fact that Parkland is now just trying to make sure that local homeless shelters are “wheelchair accessible” only shows they would have done the same thing in kicking this guy to the curb and siccing the police on him if he protested.


What a bunch of monsters! Shut that place down already!

noblefurrtexas
noblefurrtexas

Why is in any business of the federal government what the staff at Parkland does about patients needing care but no home to go to?


Given how terribly the federal government has treated our veterans by running scam veterans hospital should disqualify them for making a peep about any other hospital until they clean up their own act!

annff69
annff69

Do you have an editor who could help you avoid publishing nonsensical bits like "the hospital risked to lose $400 million in Medicare funding"? 


whocareswhatithink
whocareswhatithink

I guess it just goes to show...when you don't do a job correctly the first time...everyone else around you suffers.

TheRuddSki
TheRuddSki topcommenter

So if they lose $400 million in Medicare dollars, who ultimately suffers?

Montemalone
Montemalone topcommenter

The people that didn't think a crazy homeless guy needed a psych eval need to be looking for other jobs.

And there's a "503 backend read error" where the report's supposed to be. Is that just me or is it related to "hygiene issues?"

unclescrappy
unclescrappy

UNBELIEVABLE. The Fed definetly needs to withold this money from them and tell them, show us how much better you can be and then we will dribble it out to you. Dr's, Nurses & anyone who works in a hospital like this needs to learn how to put Patient Care first & foremost. Maybe some of these so called professionals need to go to these Homeless shelters & stay for 24hrs & provide care so they better understand the issues.

sbristow15
sbristow15

@madiak47 This guy wasn't even stabilized to be discharged. He nearly successfully committed suicide. That shows he was danger to harm himself. That usually gets someone a psychiatric admission, and he didn't want to be unsafely discharged. Parkland kicked him to the curb with no means to fend for himself or tend to his injuries. It's heartless.

amy.silverstein
amy.silverstein

@2damicos I'd love to talk more, you can reach me at 214-757-9000 ext. 18430 or amy.silverstein@dallasobserver.com 

sbristow15
sbristow15

@russell.allison1 I don't think a guy coming in with a broken spine and broken limbs after his suicide attempt is a "malingering AC seeker," MORON!!!

ScottsMerkin
ScottsMerkin topcommenter

@Myrna.Minkoff-Katz Its kind of a local running joke but seriously, if you are burn patient or a gunshot victim, probably no better place to go in the area.  Just dont go there for your typical emergency room visit

sbristow15
sbristow15

@Myrna.Minkoff-Katz See the Dallas Morning News' four-year investigative series, "First do no harm," on Parkland's many many disturbing problems from 2010 to 2014 on the internet.

kyshaunique
kyshaunique

@sbristow15 forgot to add the man was caught by a police officer for speeding. SNF's are not made for individuals who are out seeking a new means of supporting their drug habit. Secondly, you stated you use to work for Parkland. So what I'm hearing from your displays of name calling you yourself know how demanding patient population are. You also know when it get too hot or to cold outside the drug addicts and homeless find all sorts of illnesses to come check in on. Secondly, being that you are no longer a part of TEAM PARKLAND it sounds if you yourself couldn't hang with the big boys who work at 100%  all the time and who are still there enduring. Third of all, Parkland receives more funding from private donations than CMS funding. Yes CMS funding is needed due to so many who are not insured, but at the end of the day Parkland can survive without CMS funding it. Furthermore, if CMS did pull funding than Parkland can choose to only serve the insured just as the other hospitals... Then where they go. Because pleases believe other hospitals not gonna put up with the things Parkland staff has to deal with on a daily basis. 

RTGolden1
RTGolden1 topcommenter

@annff69 Found someone they have. Apparently 600 years of training Jedi is not a good qualifier for news editors.

stevespouse
stevespouse

@TheRuddSki  Thank you so much for stating the obvious! All you critics do realize that parkland takes care of every patient that every other hospital in the state refuses to take care of! So where would you like these folks to go?


lebowski300
lebowski300

@Montemalone How could they possibly know he needed pysch eval when his recovery from the suicide attempt was super on track?

stevespouse
stevespouse

@unclescrappy  as a matter of fact, Parkland "professionals" donate their time daily to take care of our homeless in Dallas; How much time do the rest of you critics spend helping the homeless! Parklands employees have donated well over $1 million dollars that they have payroll deducted every single payday so that we can make the lives of these homeless people better! Any of the rest of you critics do the same?

noblefurrtexas
noblefurrtexas

@unclescrappy Given the scandal of horrible fraud and care for our veterans at federal hospitals, I'd say it's none of the business of the staff at Parkland how they handle patients needing follow-up care who have no home to go to. 


MOST homeless people are homeless out of choice.  That was established years ago.  So, there are frequently psychiatric issues as well as physical health issues. 


We used to say that the federal government should stick to things it does well; fairly taxing us, delivering the mail, and operating the military. 


Now that it does NONE of those things even marginally well, it seems a good time to take about 60% of the government's funding, and fire 2 out of every 5 employees.

RTGolden1
RTGolden1 topcommenter

@unclescrappy I'm guessing you don't reside and pay taxes in Dallas County.  If the Feds withold the money, it won't slow down Parkland or even hit them all that hard.  The county taxpayers will simply have to pick up the tab.

russell.allison1
russell.allison1

@sbristow15 @russell.allison1 After working in that system for 10 years, I've seen  worse than that.  One man burned himself to get readmitted to a hospital.  Another sliced himself open to get back in Terrell after his mother threw him out of the house.  One guy would bring a gun to the Parkland psych ER and demand admission.  He managed to get himself shot and killed by Dallas PD.  The attempt to inflict minor injury to oneself does sometimes result in significant injury.  As I mentioned, I don't know the details of this episode, but given my experience of this population, I have to leave open that the folks at Parkland weren't at any fault.

stevespouse
stevespouse

@sbristow15 @Myrna.Minkoff-Katz  whenever you read the Dallas Morning News series, try to remember they are after ratings...what they never reported is that every issue brought before the state was reported by Parkland employees! No hospital is perfect, but you have to give the employees the respect they deserve for recognizing there was a problem and going the extra mile to report the problems knowing that it was going to put a heavy burden on the staff to make the corrections.


sbristow15
sbristow15

@kyshaunique @sbristow15 Ma'am, I think when they said he was speeding, that means he was driving fast in his car and not "on speed," per se. Any way, that doesn't mean he should be denied medical treatment or be kicked to the curb, unable to defend or take care of himself.


Also a man coming in on a wheelchair with multiple broken bones and a fractured back after trying to hang himself should not be discharged on his own recognizance. That's irresponsible. Someone like that is not a "malingering A/C seeker" as you claim.


Secondly, I graduated from UTSW as a resident, so I'm very familiar with Parkland. And I don't want to hang with the big boys of TEAM PARKLAND (i.e., UTSW faculty) anymore as they never showed up for work and only gave 10% effort at best when they were present at the hospital.


Third, I would love to see Parkland try to "survive" without Medicare or Medicaid. Last time I heard, insured patients were leaving that hospital in droves from the lack of professionalism and courtesy from the staff there. Apparently, paying customers don't like to be treated like crap by uppity public hospital workers.

TheRuddSki
TheRuddSki topcommenter

@stevespouse

I have made no disparaging comments about Parkland, I was making a joke about Medicare paying for voluntary castration (sometimes wrongly referred to as "sex change") which has a resulting high suicide rate.

TheRuddSki
TheRuddSki topcommenter

@MaxNoDifference

So there won't be any cut-back at the patient level.

andypandy
andypandy

@noblefurrtexas @unclescrappyThe patient's problem wasn't that he needed follow up care it was that he needed a psych evaluation and inpatient monitoring.  The fact that they discharged him knowing that, that they released him into what they knew would be an unsafe environment given his condition, and that they used police to remove him from the premises does make it our business given that it is a public hospital.  Further, the doctor involved should if he has not already be brought before an ethic board.

sbristow15
sbristow15

@russell.allison1 @sbristow15  CMS and the state health agency disagree with you, but everyone would have to agree. You are a MORON!


Who thinks siccing the cops on a suicidal man with serious injuries without any means to fend for himself is responsible, let alone humane?

ScottsMerkin
ScottsMerkin topcommenter

@Myrna.Minkoff-Katz @ScottsMerkin lipstick on a pig, new digs, same people running it.  Look, there are some, actually a lot of  really good people who do really good work over there.  I happen to know a nurse who works some of the worst cases in the NICU, but with an organization that large, there are bound to be bad apples.

noblefurrtexas
noblefurrtexas

@andypandy @noblefurrtexas @unclescrappy Andy, If you're assessment is accurate, then I couldn't agree more that Parkland acted in the finest tradition of the VA. 

At the risk of painting with a broad brush, I had an older doctor at Presbyterian lament that today's interns were largely less intelligent than doctors 20 years ago, and that they were constantly distracted by their cell phones, social media, and iPads. 

Perhaps he was more right than he knew. 



stevespouse
stevespouse

@sbristow15 @russell.allison1  you are placing judgement when you only have a small fraction of the real story! Do you work @ Parkland? Have you ever been to Parkland? Don't place judgement on people you know absolutely nothing about.

russell.allison1
russell.allison1

@sbristow15 @russell.allison1 What course of action would you think appropriate for someone who refuses to leave an acute care facility when their need for such an environment has ended?  Some of what I read mentioned that may not have been given referral to SNF's, but even if he had been given such information and was refusing to leave, what recourse is available for Parkland?  People refusing to leave a hospital setting after their condition has improved to a point that they are no longer in need of such care isn't at all uncommon. 

stevespouse
stevespouse

@ScottsMerkin @Myrna.Minkoff-Katz  who the heck are you people! "lipstick on a pig"???? we have worked tirelessly to make corrections that we ourselves reported! Its hilarious how uneducated people try to make comments and make it sound like they really know what they are talking about


TheRuddSki
TheRuddSki topcommenter

@MaxNoDifference

So the castration of males can continue uninterrupted.

fyador
fyador

@noblefurrtexas @andypandy @unclescrappy 


This sounds like sour grapes from an old doctor. I'm a physician / professor at an enormous academic medical center like UT Southwestern/Parkland, and interns and residents today see more patients with more medical complexity (plus 100 times the bureaucracy) than what he saw in his internship. At least on my service, no one is "constantly distracted by social media," but we have an emphasis on evidence-based medicine, and using digital resources is the best way to ensure that kind of care is delivered.


Parkland likely sees an enormous burden of challenging patients: lowest incomes, least access to primary care, poorest health education, highest volumes. Unless you've worked at a place similar to Parkland, it's folly to paint it as bad doctors and nurses at a bad hospital. Akin to calling teachers who work in the poorest school districts "bad teachers" because their students don't perform as well as Highland Park. I assume they're good people trying to work in a war zone. Dallas is a better place because of Parkland.

sbristow15
sbristow15

@russell.allison1 @sbristow15 Why not treat him and hold him since he nearly succeeded in committing suicide? Isn't that their F'in job?

Most hospital hold people who try to commit suicide for 48 hours for observation. Responsible ones treat them. Parkland has a record of kicking them to the curb on the same day as their suicide attempts. 

Parkland is supposedly a public, taxpayer supported, safety-net hospital for the uninsured and indigent. What business do they have of kicking sick and injured patients out on the street without treatment?

They are just wasting our tax dollars, pretending to be a public, not for for profit institution.

Chattering_Monkey
Chattering_Monkey

@stevespouse @ScottsMerkin @Myrna.Minkoff-Katz Apparently you need to make more corrections.  You continue to repeat history over and over.  Enjoy this latest CMS visit.  Im sure its not the last.  Explain how come I never hear about CMS over at JPS or any other large hospital in the area.  It seems to most people in the area that these are more educated comments than the one you make.  

JustCommenting
JustCommenting

@fyador @noblefurrtexas @andypandy @unclescrappy

Bullshit. My husband is a resident at Parkland now and he doesn't have time to eat or pee during the day, much less play on his phone. And he has told me about more than one malingering (some drug seeking) patient who just didn't want to leave and pulled all sorts of crap to avoid being discharged. Not that this was necessarily the case here, but Parklands patients aren't exactly angels.

stevespouse
stevespouse

@sbristow15 @russell.allison1  Bristow, what do you do for a living? do you have any idea what it is like to work in a huge county facility such as parkland? do you have any medical experience whatsoever or do you just like to curse and shout obscenities about something you know very little about?

russell.allison1
russell.allison1

@sbristow15 @russell.allison1 Unfortunately, we don't know the circumstances to enough detail based solely on this story and even the CMS and state survey would necassarily (and rightly so) favor the patient. A sincere attempt at suiciide would likely result in one being "OPC'd" (order of protective custody, a 72 hour commitment) to a psychiatric facility after he or she were medically cleared.  I didn't see any reference in the story to such a step so I can only conclude that none of the physicians involved were sufficiently moved by this pateints mental status to initiate such an order. 

In general, I'm with you on Parkland-it's a mess.  That said, there are a lot of people who work awfully hard in a thankless setting and in a most cases, do a hell of a job for the people they serve.

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