HospitalInspections.org

Based on record review and interview, the facility failed to ensure compliance with 489.24 (d)(1),(2) and (3) Stabilizing treatment in that 1 of 1 patient (Patient #20) returned to the emergency department and the patient's wife asked for an appropriate transfer to another facility on 11/28/2016 and was refused a transfer.

Cross reference to A2407

Based on record review and interview, the facility failed to provide in good faith stabilizing treatment or transfer the individual to another medical facility in that, 1 of 1 patient (Patient #20) returned to the emergency department after he was discharged less than 24 hours prior due to progression of weakness and inability to walk. Patient #20's wife requested a transfer to another medical facility, but was refused that transfer.

Findings included:

Review of the Patient #20 medical record, Patient #1 was admitted on 11/23/2017 with what the facility diagnosed as fatigue. He was kept for 4 days and was discharged on 11/27/2017. On 11/28/2017, the wife could not take care of the patient #20 and patient #20 was brought back to the ER by EMS with the patient having left sided weakness and inability to walk.

A chart note from the Case Worker Personnel #5 on 11/29/2017 at 11:30 AM; Case Manager (CM) spoke with patient #20 at bedside RE: PT (Physical Therapy) Recommendation for rehab:
"Unfortunately, patient is uninsured, so there are no resources available to facilitate rehab. Patient states that he is currently enrolled in Parkland Health Plus and will speak with his wife regarding a F/U appointment and see what type of rehab they can provide to him. Patient has RW (rolling walker) at home."

11/30/2016 9:30 AM Case Manager Personnel #5, Spoke with patient #20's wife over the phone RE: Discharge planning "Wife states that prior to this admission she asked ambulance to transfer patient to Parkland where he is enrolled in the Parkland Health Plus plan, and could probably be set-up with rehab. Instead, the ambulance brought him here. She plans on having patient follow-up at Parkland upon discharge to see what resources are available to him."

An interview on 2/14/2017 Patient #20's wife was asked when her husband was discharged from Dallas Regional Medical Center, Mesquite on 11/30/2017, was he transferred or was he discharged home. Patient #20's wife stated that her husband had been in the hospital and they sent them home (11/27/2017). When she called the ambulance back the next day (11/28/2017), he was much worse and she told the emergency doctor that she knew he was having a stroke. She asked the emergency doctor (female) to transfer the patient to Parkland as her husband had been accepted in their Parkland system. The female emergency doctor told her "No." She continued to ask to be transferred to Parkland and the doctor finally stated he would discharge Patient #20 and and she could take him to Parkland. Patient #20's wife stated the nurses were so nice and got the Hoyer lift and loaded her husband in the wheelchair and took him downstairs. The nurses arranged for 4 orderlies to load the patient #20 in her car so she could take him to Parkland. She said they would not transfer him by ambulance and said the only way I could take him was in my personal vehicle. At this point, he could not walk.

Review of the hospital's policy on Discharge Planning last revised on 01/2017, states "Case management in Hospital/Health Care systems is a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self-determination."
...#3. "Individualized discharge plan is patient oriented, noting patient's preferences in treatment and treatment goals, maintains patient privacy and ensures patient access and choices of services during hospitalization and post-discharge., Collaboration between the community, facility and professional disciplines provide an invaluable health care link which safeguards the patient and professional by facilitating the process of informed-decision making by patients and families."