HospitalInspections.org

Surveyor: 10814

Based on complainant's interview, administration interviews and policy review, the hospital failed to send the required patient grievances response letter to the complainant. This was observed in 1 of 4 patient grievance records, noted in P1's complaint record.

Failure to send a grievance response letter to a complainant does not ensure the grievance
process is implemented according to the Patient Rights Medicare Regulations.

(This is a repeat deficiency noted in compliant #29757, written on 02/02/2011).

Findings:

1. On 09/06/2011, the investigator conducted a telephone interview with the complainant. The complainant reported that s/he requested a meeting with the hospital administration regarding concerns about the patient's hospital bill and how the patient fell on 12/29/10.

2. The complainant also reported the patient required surgery on 12/30/2010 to repair her/his left ankle fracture. This information was not shared with the complainant until s/he arrived to the hospital on 12/30/2010. The complainant claimed s/he was the Power of Attorney fore the patient.

3. The complainant made a request to meet with the hospital administration to discuss the patient's bill and what caused the patient to fall on 12/29/2011.

4. S/he reported that on 03/2011 the hospital administration did meet with her and with another family member. However, s/he reported the hospital had not sent a follow-up letter discussing the results of the grievance.

5. On 09/06-07/2011, the investigator reviewed the established written grievance policy. The policy was title, "Patient Grievance & Complaint Management." The policy was revised on 03/22/11 by the administration.

6. The policy documentation review revealed that on page 3 of 5, in section D read as follows:

A. Whenever a patient or patient's representative requests the complaint be handled as a formal complaint or grievance or

B. Makes a specific request from the hospital for a response. The complaint is then considered as a patient grievance and is handled as such.

7. During an interview on 09/06/2011 with the Risk Manager. S/he reported the complainant did contact the hospital to meet with the hospital administration. The Risk Manager set-up the meeting for 03/2011 to met with the complainant and family member. The Medical Unit Hospitalist, Risk Manager, Clinical Nurse Manager of the Medical Unit, met with the complainant and family member to discuss there concerns.

8. On 09/07/2011, the Risk Manager reported to the investigator that a grievance response letter was not sent to the complainant. The administration felt the meeting on 03/2011 answered the complainant's questions.

9. During the interview the Risk Manager reported the Corporate Risk Management Office informed the hospital administration to handle the patient's fall as an injury incident occurrence because it was not a
complaint based occurrence. This was the reason why a grievance response letter was not sent. Also, it was reported that 27 other hospitals follow this same procedure across the United States.

10. The hospital failed to:
1. Send a grievance response letter to the complainant identifying the changes that were discussed during the meeting on 03/2011; (after the complainant/Power of Attorney requested a meeting with the
administration to discuss her/his concerns) regarding patient's care).
2. The hospital failed to follow the written grievance policy.
3. Also, the hospital failed to meet the Medicare Patient Rights Regulations regarding the grievance
process.