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Facing $19M accreditation threat, N.H. Hospital gets funding to fix doors

  • New Hampshire Hospital in Concord as seen on Tuesday, July 5, 2016. Elizabeth Frantz / Monitor file



Monitor staff
Wednesday, July 11, 2018

New Hampshire’s state-run mental hospital is set to move ahead on a $647,000 upgrade for its doors after the Executive Council passed an emergency motion to head off a mounting threat to its accreditation.

Now the hospital is racing against the clock to install the doors ahead of a crucial site review by inspectors from the Centers for Medicare and Medicaid Services this September.

Failure to pass that CMS review could cost the hospital $19 million in federal funding, officials said.

“Ordinarily I would be very reluctant to make such a recommendation, but in this case there are compelling circumstances that make this option the least-bad of uncomfortable choices,” wrote Department of Administrative Services Commissioner Charlie Arlinghaus in a request to the council last month.

An internal review in fall 2017 found that 324 doors in the hospital are designed in a way that could be used for self-harm, in violation of recent standards imposed by CMS, according to the request. Those doors will need to be replaced.

Specifically, CMS is seeking to address ligatures on door handles and hinges – joints that could be used to affix ropes or cloth to allow for suicide or self-harm. The new doors will include “anti-ligature mortise” locks and continuous hinges designed to minimize those risks.

If the replacements are not made at New Hampshire Hospital before its September survey, state officials said, the hospital could lose its accreditation, a possibility that carries dire consequences.

“Failure to mitigate the ligature risks in our environment, prior to the survey, will likely result in loss of accreditation which could lead to loss of all Medicaid and Medicare revenue, fines, suspension of admissions or closure of beds,” officials said in their request.

In their meeting Wednesday, executive councilors moved to allow the hospital to skip the involvement of the Division of Public Works Design and Construction team and expedite the replacements. But even with those barriers removed, Arlinghaus said the deadline remains tight.

“Any contractor selected will even with a waiver have only about two months to complete a portion of a task that may well take longer,” Arlinghaus wrote. “The potential loss of up to $19 million and the limited time argues for expediting the process.”

The crunch comes in response to a broader push by CMS to update regulations to address the risk of self-harm within psychiatric facilities, according to Jake Leon, a spokesman for the Department of Health and Human Services, which oversees the hospital.

While inpatient suicides at health care facilities represent a small percentage of suicides in the U.S., concern is growing.

Last October, responding to rising reports, nonprofit accreditation organization The Joint Commission issued new guidelines for hospitals to prevent self-harm, many of which directly addressed the issue of ligatures on doors. Those guidelines informed New Hampshire Hospital’s internal review, state officials said.

New Hampshire legislators had already addressed the door upgrades in House Bill 580, signed by the governor last month, which approved the use of capital funds for the project. But that bill included a provision that would allow the process to be expedited by the governor and council if need be, according to Arlinghaus.

Meanwhile, Leon said the Concord-based hospital, which holds 168 beds, is “moving forward and ordering replacement doors in time to be installed this fall.”

“While there may be some risk that the survey could cite NH Hospital if door replacements have not been completed in time, staff are working diligently to both complete the renovations and create mitigation plans for any replacements that have not been completed to comply with the new CMS requirements,” Leon said.

(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)