State health inspectors found that three patients placed in nonviolent restraints at Mount Carmel St. Ann’s hospital didn’t receive proper checks from a registered nurse and the hospital had conditions that violated national fire safety codes.

The in-depth survey was conducted in mid-March by the Ohio Department of Health on behalf of the federal Centers for Medicare & Medicaid Services.

This was the third round of inspections conducted at Mount Carmel Health System facilities since hospital officials announced in mid-January that they were investigating dozens of patient overdose deaths.

Dr. William Husel, 43, of Liberty Township near Dublin, is accused by his former employer of ordering excessive doses of pain medication for 34 patients at Mount Carmel West and one patient at St. Ann’s in Westerville over a span of about four years. All the patients died, and Mount Carmel has said the doses given were potentially fatal for 29 of them.

Husel’s medical license has been suspended, and law-enforcement authorities are investigating the deaths. At least 28 wrongful-death lawsuits have been filed, three of which have been settled.

The previous inspections at Mount Carmel facilities focused on pharmacy services and the access caretakers had to the drugs they were administering to patients. Federal officials say Mount Carmel has remedied deficiencies in its pharmacy services, but had to address shortcomings related to the facility’s physical environment.

Findings from the most recent federal survey showed St. Ann’s was not in compliance with Medicare standards related to the supervision of nursing care.

“Based on medical record review, policy review and staff interview, it was determined that the registered nurse failed to assess and monitor patients in nonviolent restraints every two hours per policy,” the survey states. “This affected three patients of three medical records reviewed with restraints. A total of 45 medical records were reviewed.”

The hospital’s policy related to the use of restraints requires registered nurses to check on and assess patients at least every two hours.

A review of the medical record for one of the patients showed:

• On March 8, the medical record lacked a two-hour check from 3:24 a.m. through 7:56 a.m.

• On March 8, the medical record lacked a two-hour check from 1:29 p.m. through 5:11 p.m.

• On March 10, the medical record lacked a two-hour check from 9:30 a.m. through 12:28 p.m.

• On March 11, the medical record lacked a two-check from 11:38 p.m. through 2 a.m.

Records for two other patients also showed gaps longer than two hours for nursing care.

The survey of St. Ann’s facilities also found problems with the physical environment including issues that did not comply with national fire safety standards. Among the problems were exits obstructed by boxes of air filters, obstructed exit signs and the failure to test all components of the fire alarm system.

Ed Lamb, president and CEO of the Mount Carmel Health System, said CMS has accepted the corrective action plan for St. Ann’s. They now are awaiting CMS’ response to a similar plan for Mount Carmel West based on findings from a March inspection at that facility.

As part of its corrective plan, St. Ann’s said it reviewed its patient policies and determined that it adequately addresses the requirements for restraint assessment every two hours. The hospital has also developed internal tools and educated nurses on using non-violent restraints.

“Nothing changes in our ability to treat patients covered by Medicare or Medicaid,” Lamb said in a statement. “Our top priority remains providing safe, high-quality care to our patients, and we are confident that we have processes in place to do just that.”

The federal agency requires hospitals to meet certain standards to receive payments from Medicare, which provides health insurance for people 65 and older. If Medicare payments cease, payments from the state-administered Medicaid program that provides insurance for people with low incomes also would stop.