LEWISTON — Central Maine Medical Center’s safety grade has dropped from a B to a C, making it one of the lowest-rated hospitals in Maine and one of just two in the state to receive a C.

CMMC has experienced problems with bloodstream infections from central lines inserted into ICU patients, urinary tract infections in ICU patients with catheters, dangerous bed sores and deaths from treatable complications – such as pneumonia or a heart attack – after surgery, according to the spring 2018 grades released Tuesday by the Leapfrog Group, a Washington, D.C.-based nonprofit that tracks health care safety, quality and value at hospitals with a minimum number of cases and/or procedures.

The infections were reported between 2016 and 2017. The bed sores and treatable-complications deaths were reported between 2014 and 2015. Leapfrog could not say Monday exactly how many incidents occurred during that time.

This is the third time in recent months that CMMC has been the subject of safety or infection concerns.

In December, CMMC’s accrediting agency said the Lewiston hospital was not doing enough in its policies and procedures to prevent infections, and it gave the hospital 30 days to improve or risk its accreditation. The hospital made some changes and the agency has since given its approval.

Also in December, Medicare announced it was penalizing CMMC for the second year in a row for high rates of infection and patient injuries.

CMMC President David Tupponce said the hospital is working on correcting the deficiencies.

“We take this seriously,” he said. “We know we still have work to do, but I’m confident we are making a lot of progress.”

Leapfrog releases safety scores every spring and fall. CMMC typically has gotten an A or B.

Leapfrog CEO Leah Binder said a C is below the national average and is particularly discouraging for a hospital in Maine, where a C has been uncommon.

“I don’t like seeing Central Maine Medical Center get this grade. They’ve had As before and this is a real disappointment,” said Binder, who is from Maine and served as vice president of the Franklin Community Health Network in Farmington before heading Leapfrog.

MaineGeneral Medical Center in Augusta also saw its grade drop, from an A to a B. Hospitals in southern Maine largely maintained their grades, with Mercy Hospital in Portland, Mid Coast Hospital in Brunswick and York Hospital earning As, and Maine Medical Center in Portland receiving a B. Southern Maine Health Care Medical Center in Biddeford was the lone exception, improving from a B to an A.

Leapfrog’s safety scores are based on 27 measures, including infection rates, staff behavior, patient injuries and surgery problems. The data largely comes from hospital surveys and the Centers for Medicare & Medicaid Services, the federal agency that administers Medicare. The information was reported between 2014 and 2017, depending on the measure.

Tupponce said the hospital has been making changes to improve safety, including requiring more training for medical providers who handle central lines and implementing a new nursing protocol for urinary catheters.

“I’m happy to report that we’ve had zero catheter-associated urinary tract infections since June of 2017,” he said. “That’s an example of current work that has already addressed some of the issues in the Leapfrog report.”

He noted that the bed sore data is more than three years old and since then CMMC has replaced a lot of its mattresses and has trained nurses on skin care. Over the past fiscal year, he said, the hospital has had no incidents of dangerous bed sores.

For deaths from treatable complications after surgery – a score that is worse at CMMC than the national average and has worsened since the last Leapfrog grading period – Tupponce said there may be little the hospital can do.

“Because we are a regional referral center for both trauma and a lot of the heart-vascular issues, we see some of the sicker patients in this area about that. I think we take some heroic steps to save some of the sickest of the sick in this situation. Unfortunately, we aren’t able to save everyone,” he said. “This is the important work that we do in this community and other communities, honestly, as a referral center.”

Maine Medical in Portland – the state’s largest hospital and a trauma center and referral hospital for heart-vascular issues in southern Maine – also saw a score that was worse than the national average for deaths from treatable complications after surgery. However, CMMC’s score was worse than Maine Med’s.

Tupponce said CMMC staff members are working every day on safety and quality, with daily safety reviews, daily operating room meetings and staff huddles three times a day to ensure the hospital has the appropriate staff for its patient population.

“This is important to us. We don’t wait for spring and fall,” he said, referring to when Leapfrog releases its safety grades.

CMMC wasn’t the only Maine hospital to see its grade slip Tuesday. St. Joseph Hospital in Bangor fell from an A to a C, the only other Maine hospital to get a C.

With five of the 14 hospitals reviewed slipping at least one grade, Maine has fallen from second best to seventh among the 50 states in six months.

That concerns Binder.

“I think that’s something people in Maine should be talking about. There’s an unmistakable pattern of a decline in safety that we see from these numbers and it is very disturbing,” she said. “I think there needs to be some effort made right away to reverse these numbers.”

She believes all hospital leaders need to put safety at the top of their priority list and keep it there.

Peter Hayes, CEO of the nonprofit Healthcare Purchasing Alliance of Maine, said his team is working to understand what’s caused the sliding grades. Still, he believes Maine hospitals have improved over the years and are still in a pretty good position, despite the current slip.

For CMMC in particular, Hayes believes its new health system CEO, who took over in the fall of 2016, is leading the hospital in the right direction.