It's been a bruising week for Health Management Associates and the Florida firm's two local hospitals, Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center.

In recent days, "60 Minutes" and the New York Times both ran stories that raised questions about the pressure from HMA on its doctors to improperly admit patients or administer tests, in an effort to increase profits.

And now a state report notes significantly high infection rates among certain patients at Lancaster Regional.

And a Pennsylvania insurance network announced this week that it was canceling its Medicaid contract with the two Lancaster HMA hospitals, as well as with a Carlisle HMA hospital. The move will affect about 3,000 patients.

In the wake of the developments, the head of the two local HMA hospitals said they remain dedicated to patient care.

"The associates and physicians at Heart of Lancaster Regional Medical Center and Lancaster Regional Medical Center are always focused, first and foremost, on providing the highest-quality care possible in our communities," said Bob Moore, market chief executive officer of the two HMA hospitals here.

"We stay focused on that goal no matter what happens in political debates about health care or in the media."

He also noted both hospitals were recognized as "top performers' by the Joint Commission, the federal government's national certification agency for hospitals.

HMA's most recent woes include:

• A new state report showed significantly higher than expected infection rates among some hospitalized patients at Lancaster Regional in 2011.

The higher rates were among patients with two types of infections: catheter-associated urinary tract infections and central line-associated bloodstream infections.

Those types of infections, along with six types of surgical site infections, were examined by the state in the recently released 2011 Healthcare-Associated Infections Report because they are good indicators of the quality of infection control in hospitals, state officials said.

Based on its size, location, numbers of patients and other factors, Lancaster Regional was expected to have about five of the catheter-associated urinary tract infections and actually had 13.

The hospital was expected to have about two of the central line bloodstream infections and actually had eight.

"What you want to look at is the number going down," said Kait Gillis, a state health department spokeswoman, referring to the infections. "And it's not at Lancaster Regional."

Marla Konas, infection control nurse for the two local HMA hospitals, said Regional examined the infection cases to see whether hospital policies were followed correctly and what it could do to improve its rates.

The hospital already follows evidence-based practices proven to reduce infections, she said. Officials looked to see if they needed to do more education with staff or take any other action.

Some of the patients who developed infections were very sick, Konas said, and so had to have central lines for longer periods of time, which increases the risk of infection.

This year, the infection rate has gone down, she said, noting, "We've seen improvement."

• Gateway Health Plan announced this week that it is terminating its contract with Lancaster Regional and Heart of Lancaster, as well as Carlisle Regional Medical Center, as of Dec. 31, after what it called "a year of failed contract negotiations."

Gateway is a health plan for Medicaid and Medicare clients. The termination affects only Medicaid patients.

Gateway has 2,957 Medicaid patients at the three hospitals. (It could not specify the numbers at the two local hospitals.)

A local HMA spokeswoman noted that the contract was terminated as Gateway's contract renewal would have "substantially" decreased rates to be paid to the hospitals, while hospital costs are increasing.

In a statement issued Wednesday, Gateway, which is based in Pittsburgh, said it was working with local doctors on the two hospitals' medical staffs about the continuity of care to Gateway members.

Gateway said members will be able to receive services from their current providers for up to 60 days, according to the statement.

Doctors who are affiliated with the local HMA hospitals will not be able to continue to see those patients after the interim period, because Gateway requires doctors to admit to an 'in-network" facility.

HMA said those patients do not have to switch providers, as it accepts other Medicaid health plans. If patients switch to another plan before Jan. 1, they can continue their care with their provider at the two HMA hospitals here.

For its part, Gateway said it would help find other providers in its network for patients, if they so desired.

The infection report and Medicaid contract cancellation were announced as HMA came under fire in two recent national news reports for its alleged admission policies.

"60 Minutes" on Sunday aired a story in which former doctors and hospital officials charged HMA with running unnecessary tests and admitting patients without cause, to increase its profits.

Former emergency room physicians who worked at Carlisle Regional Medical Center were interviewed for the report.

In a story published Friday in the New York Times, the newspaper reported that HMA disclosed it was the subject of federal investigations, specifically by U.S. Department of Justice and U.S. Attorney offices in seven states. The federal investigations are looking into physician referrals and the necessity of testing and admissions.

The U.S. Attorney for the Eastern District of Pennsylvania is one of the federal investigators.

Earlier this week, local HMA hospital officials shared a statement issued by HMA's corporate office in Naples, Fla., in response to the "60 Minutes" report.

The statement noted that no issues were found with the quality of care at HMA hospitals in the "60 Minutes" report. Nor did the report identify specific patients who had been "inappropriately admitted," the HMA statement said.

cstauffer@lnpnews.com