AUGUSTA – The state downgraded the license of Inland Hospital in Waterville last month after finding serious procedural deficiencies in pharmacy, patient care and other services.

The 46-bed hospital, owned by Eastern Maine Healthcare of Bangor, will have to make improvements on a timetable that extends to one year under a “conditional license.”

The problems found as part of the state’s regular three-year survey of the hospital were significant violations of hospital standards and must be remedied, said Sandra Bethanis, assistant director of the Department of Human Services’ Division of Licensing and Certification.

Typically, only one or two of the state’s 41 hospitals are downgraded each year, Bethanis said. Currently, Bangor Mental Health Institute and Goodall Hospital in Sanford also are operating under conditional licenses, which carry increased regulatory scrutiny and the threat of loss of license or extension of the conditional license.

The public’s best interest would be served by giving the hospital a chance to remedy the problems under the conditional license, wrote Eugene I. Gessow, director of the Department of Human Services’ Bureau of Medical Services, in a Nov. 8 letter to Inland Hospital President Wilfred Addison.

Gessow wrote that the hospital’s pharmacy had numerous deficiencies related to “staffing, control and security of medications, adequate and proper supply of emergency medication, distribution and safe use of pharmaceuticals, and dispensing of drugs.”

The survey also found regulatory violations in the use of restraints for medical and psychiatric patients.

These violations related to a lack of documentation of the proper assessment of patients before the restraints were used, Bethanis said. “When there’s a lack of documentation we have to make the assumption that [the assessment] was not done,” she said.

In addition, the process used by the hospital to investigate serious “patient occurrences” was incomplete and in violation of regulations. Other problems included inadequate policies and procedures in patient-care units and the nursing department, according to Gessow’s letter.

The state set 15- and 30-day deadlines for immediate improvements in some of the areas cited. Bethanis said the hospital is on track with the quick-fix remedies. Longer-term remedies also are required.

“Obviously, we were not happy with some of the state’s conclusions,” said Addison on Friday. He said the hospital was surprised when confronted with the findings because it has had few problems in recent years. He said some of the deficiencies cited may be attributable to changing standards. The hospital didn’t dispute the findings.

“The only thing you can do is move quickly,” he said. “We’re going to put in place what they want to see.”

Addison said it is a mantra in health care that if something isn’t documented it may not have happened. So there should have been documentation for assessment of patients for restraint use, although that’s not to say one wasn’t done.

The positive aspect of being given a conditional license is that it will allow Inland the opportunity to work closely with regulators to improve over the year, he said.

“We’ll end up at the end of the process being very compliant with the state standards,” Addison said.

Inland Hospital was founded in 1948 by a group of osteopathic physicians. Eastern Maine Healthcare acquired Inland about five years ago.