HospitalInspections.org

Based on staff interview, contract review, policy review, family interview, email and letter review, document review, and Emergency Room (ER) record review, the facility failed to ensure that the contract services provided to Patient #1 were provided in an environment that a reasonable person would consider to be physically and emotionally safe, in an effective manner, with respect, dignity and comfort.


Findings include:


The State Agency received the following complaint on 6/19/18:
"On Monday, June 4, 2018, at approximately 0800 hours (8:00 a.m.), my wife and I brought our 9-year-old daughter, (Patient #1) to (Hospital #1) ER to seek medical attention for an injury she received to her left toe. The care she received was less than poor and negligent. The attitudes displayed by the hospital staff was very unprofessional and distasteful by those that the community trusts to provide the necessary attention one needs when he or she is hurt, sick, or injury.
(My daughter) was seen by (Physician #1). Upon entering the room, (Physician #1) appeared to be aggravated. He did address (my daughter), but he snarled at me, her father, and told me that I should go get in "time out" and motioned for me to go stand in a corner of the hospital room. I did not ask what he meant by this comment, as my attention was more so on what my daughter needed at the time. However, as he examined (my daughter), his attitude was not empathetic, nor did he display any courtesy to her at all.
(Physician #1) referred to (my daughter's) injury as a scratch on her toe and insisted that it was not a cut or laceration despite what it look like to us. He also repeatedly stated that he would be treating the matter as a scratch. (Physician #1) explained that (my daughter's) foot would be soaked for 10 minutes and that he would put glue on her toe "to seal the scratch". Once (my daughter's) foot had been soaking for 10 minutes, (Physician #1) returned to the room, tossed two white towels to (my daugher's) mother, and told her to clean her up. By this time, we both were livid, as any parent would be. (Physician #1) was obviously aggravated by the concern we had for our daughter's injury and the care he was providing for a visibly open wound. He was rude and acted very aggressively. He did not want us to ask any questions, and at one point he yelled out that he had been a Surgeon for 25 years and he knew what he was doing. No one was questioning his authority.
We attempted to ask questions. (Physician #1) became hostile and refused to answer any questions. He also threatened to call the police. This is after he was allowed to be rude, throw towels, and act as if he was aggravated that my child was brought in for a "scratch". No matter how big or small an injury may seem, each one should be approached by the doctor as such. We were handed instructions on how to care for a laceration, but he continually referred to my daughter's injury as a scratch. (Physician #1) told us that we should have never come to the ER in the first place and there were 3 other facilities we could have chosen.
After listening to him rant and rave, we left upset and unsatisfied with services (Physician #1) and (Hospital #1) provided. After taking (Patient #1) to (Hospital #2) where she received professional and fair care, (Patient #1) did in fact need Stitches."


An unannounced visit was made to the facility on 7/16/18 at 10:30 a.m. The nature of the visit was discussed with the Registered Nurse (RN) ER Director. At 10:40 a.m. he stated "I am aware of the complaint. The doctor in question is no longer with us due to the hospital doing away with the contract emergency room physicians because we are going to tele-medicine with (an area medical center. The Chief Clinical Officer investigated the complaint. I do not know why there was no disciplinary actions taken against the physician. The Chief Clinical Officer was the ER physicians' boss at that time, however she is no longer here. She wrote a letter to the patient's parents stating that we have utilized contract physicians to staff our emergency room for years. After tracking and trending our patients' complaints, I found that 80% of our complaints come from the emergency room. Therefore, we began making changes. We changed the contract staffing company and quickly found no improvement. We are currently in the process of replacing the contract physicians with employed professionals, so we can better control the quality of staff, and increase our customer service. We are striving to be completely staffed with our own hospital employees by the end of June (2018). As we continue to use contract physicians, we will continue to educate and even replace physicians who do not meet our standards."


Review of Patient #1's ER record revealed the nine year old female child arrived to the ER on 6/4/18 with her parents with the "Chief Complaint: Laceration toe". Triage decision urgent. She was seen by Physician #1 who ordered "Soak foot in normal saline with 2 ounces of H2O2 and 2 ounces of betadine....skin affix closure with 1 inch of tube gauze dressing." He also documented, "Parents upset because (1) I asked them to dry foot rather than nurse. (2) I concluded superficial lac (laceration) of 4th toe - no need to repair... Family felt like it should be repaired and made a big issue. Addressed there were other ERs in the area. (3).... Became disruptive... told I would call PD (police department)."


Review of the ER Complaint Log revealed that Physician #1 had two other patient complaints as well as a physician complaint against him.


Review of credentialing files revealed that Physician #1 had temporary privileges for affiliate staff- emergency department physician.


Review of the ER schedule revealed that two RNs were on duty in the ER on 6/4/18 for the 7:00 a.m. to 7:00 p.m. shift. Both nurses were off duty the day of the survey. Both nurses were telephoned four times each during the survey. No answer to the calls or call backs were ever received.



Review of the Hospital Emergency Care Agreement with their contract physician provider dated February 28, 2018 revealed: "...3. All physicians furnished to Hospital shall A. Comply with the standards of professional practice and accept the duties as shall be determined by the medical staff of the hospital and shall abide by the by laws, the rules, and regulations set forth by the medical staff:... D. Comply with all laws, rules, and regulations of governmental authorities having jurisdiction over hospital..."



Review of a 6/5/18 letter written by the Chief Clinical Officer to the patient's parents revealed, "I would like to apoligize for the poor performance you experienced at (Hospital #1's) emergency room on June 4, 2018. We expect our staff to give 100% every day to ensure that our patient's needs are met. I understand that you did not experience that and I am sorry.
(Hospital #1) has utilized contract physicians to staff emergency room for years. After tracking and trending our patients' complaints, I found that 80% of our complaints come from the emergency room. Therefore, we began making changes. We changed the contract staffing company and quickly found no improvement. We are currently in the process of replacing the contract physicians with employed professionals, so we can better control the quality of staff, and increase our customer service. We are striving to be completely staffed with (Hospital #1) employees by the end of June. As we continue to use contract physicians, we will continue to educate and even replace physicians who do not meet our standards.
I want to thankyou for addressing your concerns with us. Without input from the community, we would not know the areas that need improving. Please continue to share any concern you have with us.
Again, I want to apologize for the inappropriate attitude and services you received. Please understand we are working to fix it and that the physician will be addressed. I do hope that we can regain your trust again one day"


Review of the email the Chief Clinical Officer sent to their contract physician provider on 6/6/18 revealed, "I have compiled a list of complaints we have had on (Physician #1)... His attitude and bedside manner is unacceptable. Within the last three months, he has told patients to go to other hospitals for treatment, he has told parents to sit in the timeout chair, and has written orders to override our primary physicians' orders. I know we are working together to make this happen during the transition, but his behavior is killing us. I have had board members approach me about stories they heard in the community. I do not know if there is anything we can do at this time, since you are providing us with limited coverage, but we need to discuss..."


Review of the facility's "Patient's Rights" policy, last reviewed 5/17/17, revealed: "... Respect and Dignity: Patients have the right to considerate, respectful care and the recognition of their personal dignity... Patient Safety: Patients have the right to expect reasonable safety insofar as the hospital's practices and environment are concerned. The patient has the right to express concerns about their medical care without delay. This right extends to family members or the respresentative of the patient, and will not change any current or future care....Free From Verbal Or Physical Abuse or Harassment: Patients have the right to be free from abuse. While the patient is under the hospital's care and on it's property, the hospital is responsible for ensuring patient's health and safety, his/her physical, emotional, and psychological well-being..."


Review of the hospital's "Bylaws" amended October 17, 2017 revealed: "...Purpose of the Institution...to provide high quality patient care to our patients and high-quality health care service to the community we serve... Objectives of the Institution:... Providing an atmosphere of dignity and compassion for the patients and their families... Accepting and maintaining nothing less than the highest possible level of ethics, professional standards, and competence from all who are assisting us in accomplishing our objectives..."


During the Exit Conference on 7/16/18 these findings were discussed. Nothing else was submitted for review.


On 7/24/18 at 10:50 a.m. an attempt was made to telephone Patient #1's parents. There was no answer. A voice message was left for them to return call. 2:10 p.m. Patient #1's father returned call. He stated he did not have anything to add to his complaint.

Based on staff interview, contract review, policy review, family interview, email and letter review, document review, and Emergency Room (ER) record review, the facility failed to ensure Patient #1's right to receive care in a safe setting.

Findings include:

Cross Refer to A084 for the facility's failure to ensure Patient #1 was provided the right to receive care in a safe setting.

Based on staff interview, contract review, policy review, family interview, email and letter review, document review, and Emergency Room (ER) record review, the facility failed to ensure Patient #1's right to be free from all forms of abuse or harassment.

Findings include:

Cross Refer to A084 for the facility's failure to ensure Patient #1 was free of all forms of abuse or harassment.