As of Tuesday, Kanakanak Hospital, which is run by the Bristol Bay Area Health Corporation, is no longer in immediate jeopardy with the Centers for Medicare and Medicaid Services.
“Immediate jeopardy” is a CMS designation for facilities that place patients at serious risk of death or injury. If a hospital is placed in immediate jeopardy and does not remedy the situation, then it loses its Medicare and Medicaid funding.
After Kanakanak Hospital was removed from immediate jeopardy status on Tuesday, BBAHC president and CEO Robert Clark said, “We are pleased that CMS has recognized the good progress underway to quickly but effectively bring the pharmacy to full compliance.”
Kanakanak Hospital was first placed in immediate jeopardy on Sept. 27. After a complaint was made, a CMS investigator conducted a three-day survey and noted a wide range of serious deficiencies in the hospital’s pharmacy.
The survey concluded that medications were being mishandled, that serious medication errors had occurred, and that hospital leadership was aware of a rise in medication errors and had not responded appropriately.
In mid-October, the hospital submitted a corrective action plan to CMS. The plan was accepted, and the hospital had 90 days to enact the plan. But implementation was rocky.
When CMS visited on Oct. 23, it extended the hospital’s immediate jeopardy status because key elements of the plan were not implemented.
BBAHC said that the immediate jeopardy status was extended due to problems with staffing.
It explained in a statement, “Due to the qualifications needed and BBAHC’s remote location, it has always been difficult to find the right pharmacy personnel with appropriate training and experience for the scope of services BBAHC provides. Hiring highly qualified and appropriately licensed personnel for remote, Alaska health care facilities is a lengthy process, and is challenging to complete in a matter of a few short weeks.”
A former Kanakanak Hospital pharmacist who worked there at the time said that problems also included insufficient training for pharmacists.
In the meantime, serious medication errors were still occurring. Dillingham resident Alannah Hurley is a caregiver for her 97-year-old grandmother. She said she has encountered numerous mistakes at the pharmacy.
“Over the course of the last eight months or so, we’ve noticed multiple errors, not only in packaging, but in dosage and medications being in the wrong bottles with the wrong labeling. We’ve put in multiple complaints and have only seen those errors get worse,” said Hurley. “One hundred percent, these are life-threatening mistakes.”
Hurley said some of the most serious errors occurred in October, when the pharmacy was supposed to be implementing its corrective action plan. She said she believes the medication errors began after the hospital administration fired or forced several longtime pharmacists to resign.
“Before longtime dedicated pharmacists were fired or resigned due to the toxicity of the environment out there, we never had problems like this,” said Hurley. “We had pharmacists like Evelyn Olson who cared, who worked with us to make sure that we were receiving the best care possible, people who really, really care about our people in this region.”
Olson was born and raised in Dillingham. Between attending college and then pharmacy school, Olson has worked at Kanakanak Hospital in various capacities since 2005. In 2013, she became a staff pharmacist at Kanakanak Hospital, and her husband, Kane Olson, became the pharmacy director.
The couple bought a house in Dillingham and planned to stay, but Evelyn said Kane was fired in Sept. 2017 and wasn’t given a reason. She resigned in January.
State law requires that every pharmacy designate a pharmacist-in-charge (PIC) to ensure compliance with all regulations. Evelyn Olson said Kanakanak Hospital administration had not designated a new PIC by the required deadline in late January. Olson said she requested direction from hospital administration, but did not receive any. Unsure if it was legal to operate, she and the other pharmacists closed the pharmacy until administration identified a PIC.
The pharmacy reopened hours later after hospital administration named a new pharmacist-in-charge, but Olson says the hospital took action against her.
“My boss at the time and a representative of HR essentially handed me a piece of paper that accepted responsibility for the pharmacy closing … and I would be placed on immediate administrative leave without pay,” explained Olson. “So I said, ‘I’m not going to sign this.’ I wasn’t going to accept responsibility. It was up to them to work with the state to work out the new pharmacist-in-charge situation.”
At least three community members wrote letters to the BBAHC board in support of Olson after she resigned, and the state Board of Pharmacy found she did not violate any statutes or regulations.
Despite the rough ending, Olson praised Kanakanak Hospital medical staff and employees.
She said, “I really, really love my job there. It was so important to me, as a lifelong Dillingham resident, to give back to my community, the community that always supported me through all of school, whether that be high school, undergrad or pharmacy school. So it was really important for me to return.”
Both Evelyn and Kane Olson now work as pharmacists in Anchorage.
After Evelyn left, at least three full-time, permanent pharmacists have left or resigned and two spots continue to be filled by temporary duty pharmacists. In October, no pharmacist working at Kanakanak Hospital had been there longer than four months.
The CMS survey only illustrates deficiencies. It does not suggest possible causes. However, it does note that medication errors rose sharply in the first half of 2018.
It reads, “There were 29 medication errors from January to July 2018 compared to six during this same time frame in 2017. The (Executive Committee meeting) minutes did not reflect the significance of the medication events and the lack of investigations, or action plans to be implemented.”
The CMS survey also found that hospital “leadership staff” took no actions on the increase in medication errors prior to being placed on “immediate jeopardy” status.
So what is next for the hospital as it works to improve patient safety and keep its CMS funding?
Because CMS lifted the hospital’s immediate jeopardy status after a site visit on Tuesday, the hospital will keep its Medicare and Medicaid funding as long as it successfully completes its plan of correction.
BBAHC said that plan includes working with the Indian Health Service to hire qualified pharmacists. The Alaska Native Tribal Health Consortium has also deployed a team to assist Kanakanak Hospital in training pharmacy staff and addressing deficiencies.
The new deadline for BBAHC to bring the pharmacy into compliance is Jan. 11, 2019.