By Rick Harvey

Eureka Springs Times-Echo

Documentation that staff at Eureka Springs Hospital conducted required trauma-related meetings and education in recent years cannot be located despite recent extensive searches throughout the facility. 

That’s what registered nurse Velvet Shoults reported at the hospital commission’s monthly workshop held Monday, May 5. 

“If it existed, it does not live at the hospital,” Shoults said. 

The Arkansas Department of Health is scheduled to do a site visit at the hospital on Wednesday, June 4, and not providing the documentation will likely lead to a “deficiency,” commissioners were told. 

“When the department of health comes on the 4th, I expect them to find deficiencies,” Shoults said. “There’s no way around it. They’re going to look at 2022, ’23, ’24 and the first half of ’25. I don’t have any records for ’22 or ’23. I have a few chart reviews that I can find, but no education, trauma education, no trauma chart review, meeting minutes, anything like that.”

Commission chair Sandy Martin asked what that means for the hospital. 

“Well, it looks like they didn’t have any meetings,” Shoults said. “No physician peer review meetings, no operations meetings, no chart reviews, no trauma education, no process, really, for ’22 and ’23.

“Now, did they? I think they did. I just can’t show any record of it.”

Martin responded: “So, it wasn’t documented?” 

“There’s none,” Shoults said. “So, what the department will do is they likely will cite us with a deficiency for what we can’t show from the past, but they can’t shut us down because I can show it all exists now as of February 1st, roughly, mid-February. They’ll be able to see meetings and chart reviews and all the nurse education and physician education is all up to date, all the certifications. … All the practice management guidelines have been revised and updated, all the policies, pretty much the entire program, kind of put back together.”

While the main site visits from ADH typically happen every three years, Shoults said she expects a return visit next year to follow up regarding any deficiency. 

“They’re not critical deficiencies. They’re not shut-you-down deficiencies,” she said. “They are:  …  ‘You have an opportunity to show a track record of what you’ve built, and and we’ll be back in a year,’ is what I fully expect for them to do.”

“OK, basically like a slap on the hand,” commissioner Brian Beyler said. 

An unavoidable one, Shoults replied. 

“Yeah, because I can’t show it,” she said. “You have to have it. Like peer review meetings, you should have so many a year. That’s the physician peers looking at cases … and discussing different things in the cases, opportunities for improvement. I don’t have any record of any meetings ever prior to the ones we’ve had in the last couple months.

“Now, if they were there, I’ve been through every desk, every file cabinet, every notebook, everything, and I find nothing.”

Martin asked if there was an “electronic repository” of reports, “or anything that was going on?” 

“I’ve not found any record of anything electronic for the trauma program at all,” Shoults said. “It’s all paper, at least what I can find. And the things they got cited for the last time, they were easy things. They’re things we won’t get hit with again, education records … and we’re all good for those things. But, the past record of charts being reviewed, cases being discussed, and what they look for and it sounds very complicated and it’s really not. 

“So when we look at a chart, our whole goal is to find something wrong. Seems crazy, but find what’s wrong and make sure it never happens again. And then document the process that you’re trying to fix it.”

Moving forward, transparency is key, Shoults said. 

“I can see a trauma log, kind of, where they knew what cases were in, but I don’t know what they did with them,” she said. “So, there’s just not a lot to go by, but the department’s going to see it. And we’re going to be transparent. We’re going to tell them when they come. We’re saying: ‘Here’s what you’re going to see.’”

Commissioner David Carlisle asked for clarification on when the last citations happened for trauma infractions.

“You’re surveyed every three years, so it would’ve been three years ago,” Shoults said. “… So, May of 2022 maybe.”

“…. So it’s kind of like our records have disappeared?” Carlisle asked. “Is that a fair inference?”

Shoults replied: “I can say that I can’t locate them, and I’ve been through all of the offices and file cabinets. … I have some chart review sheets, so I can see where some charts were looked at, but as far as meetings and physician review of the charts and operations, the state programs mandate two meetings. 

“One is a physician peer review, so your physicians get together and discuss the decisions related to the care. And the other is operations, which is that patient’s journey through your facility. Lab, radiology, registration, nursing, and that’s where you decide, do we have the right equipment? Do we have the right supplies? Are we quick enough to CT and all the things that would happen?

“If it’s there, I’ve looked through every notebook that I can in the entire building, and I find none.”

It’s as if documents disappeared, Carlisle said. 

“Sitting as a commissioner … for some of those years, the idea that we’re not running records of the things you do to stay in compliance with all the various entities seems kind of impossible,” he said. “So, it just leads me to the personal conclusion that a bunch of stuff disappeared magically at the time when we’ve had our problems.”

“It either disappeared, I can’t find it, or they created it prior to the state’s arrival,” Shoults said. “… For me, honestly, it doesn’t matter. I mean, I can’t show it. All I can wow them with is we’re where we are now and what we’ve created going forward.”

Shoults said it appears the hospital got “provisional” approval during the last site visit. 

“Now for your big visit, and just like what we’re talking about, if they find something that they want you to fix, they give you provisional, which means: ‘We’ll come back in a year,’ ” she said. “And then theoretically, you could get secondary provisional, they’ll come in another year, and then you’ll be due for your three-year. “But, it looks like they got provisional the last time for some things. And I mean, there’s quite a few things. But, we won’t have any issue with what they found prior. It’s just now I don’t really have a lot to show them for a program. If you said show me what this program has been doing in the last three years, I really can’t do that. Not to mention the medical director is different, program manager is different.”

ER VISITS ON RISE

Lana Mills, the hospital’s director of nursing and clinical services, updated the commission on a continued trend of increased visits to the emergency room. 

The hospital had 119 visits to the emergency room in January, 122 in February, 126 in March and 139 in April, Mills reported.

“And as of this morning we’re at 29 patients in the last four-and-a-half days,” she said. 

Martin then read a letter that was sent to Mayor Butch Berry from a recent patient at the hospital who complimented the care they received, both at the facility and in coordination of a transfer to Washington Regional Medical Center in Fayetteville. 

“Their professionalism and attentiveness were greatly appreciated during a stressful time,” Martin read from the letter. “What stood out most, however, was what happened next. When we arrived at the emergency room in Fayetteville for further evaluation, we discovered that Eureka Springs Hospital had already checked us in. As a result, I was seen immediately with no time spent in the waiting room at all. This seamless coordination between facilities was truly impressive, and a testament to the level of care and foresight shown by the Eureka Springs Hospital team. …”

Commissioner Kate Dryer said she had to reiterate a part of the letter.

“I want to repeat the phrase ‘seamless coordination,’ ” she said. “No hiccups is what that means.

“Also, I would like to point out for anybody who’s listening out there that seven patients a day right now sounds like is what the numbers are. So, the charge that nobody wants to come to our hospital is no longer valid.” 

Mills agreed.

“We’re making changes and we’re making positive changes,” she said. “The patients are seeing that, and the community will see that …” 

The word of mouth of positive experiences at the hospital will continue to spread, Beyler said later in the workshop.

“The number of visits is an obvious point, and whether it be tourism or local residents, it’s a good thing, period,” he said. “If anybody gets treated well, especially if they’re even visiting, they’re going to tell other people, and it’s just going to continue to multiply. 

“Yeah, we’re moving the right way.” 

IT NEEDS

Because of the frequency of the hospital’s need to have a representative from Pinnacle, the facility’s IT company, travel to Eureka Springs from Rogers to assist in technical issues, commissioners agreed having a Pinnacle employee in house full time was the better option.

Currently, the hospital pays Pinnacle $7,000 a month, and adding a full-time person to be housed at the facility would add $3,000 per month, Martin told commissioners. 

“We’ve been paying for their visits because we do have to pay for the mileage and time of them sending a tech over,” said Cynthia Asbury, the hospital’s chief financial officer. “We’ve had a lot of visits. I think it was 29 in the past … two months. 

“… We just have a lot of needs … just our day-to-day.” 

Paying the extra fee to Pinnacle would be less expensive than the hospital hiring its own employee, with benefits, to handle IT needs, Asbury said. 

“… We didn’t replace our IT people because of Pinnacle,” Beyler said. “I think it’s a win-win because I think we’ll get better results.” 

The full-time Pinnacle employee could start around the first of June, Asbury said. 

“OK, we don’t need a vote on that, that’s an administrative decision, but I just wanted to bring it up and discuss it,” Martin said. 

STAFFING UPDATE

Jodi Edmondson, interim CEO and human resources director, told commissioners that there have been paramedics hired recently to assist in the emergency room.

“One of our paramedics is updating and activating the emergency management procedures,” she said. “We’re now back in compliance with the Regional Emergency Management Committee. 

“All of our staff will be doing FEMA training online as a part of that, and we’ll be working with the local police and fire departments on some drills. We are meeting with the Rural Health Redesign Center this month to review our service line assessment.”

Edmondson said the hospital was on track to “have blood product back in house within seven to 10 days.” 

CEO UPDATE

Martin said she planned to have a conversation with the commission’s pick to be the hospital’s new CEO not long after the conclusion of Monday’s workshop.

“Our candidate of choice, that I got in trouble for using that, Tiffany Means, is back in the country,” Martin said. “She’s been in Peru and Japan and got back on Friday or Saturday. 

“We’re going to have a conversation this afternoon at 4, so we’ll get back to negotiating with her. I’ll keep you updated and we’ll take it from there.”

UPCOMING MEETINGS

Martin said the commission’s next regular meeting, scheduled for 2 p.m. Monday, May 19, will include a presentation from 360 Degree Medicine.

At its next workshop, scheduled for 2 p.m. Monday, June 2, the commission will likely continue to look at a recent proposal from Dr. John House to take over running hospital operations.

“We will workshop and look at Dr. House’s proposal in June and compare and contrast,” Martin said. “… There’s some legal issues and some question marks on that to get through, so we’ll probably revisit that in June.”