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Based on record review, facility documents and interviews, the facility failed to ensure that a Medical Doctor reviewed and signed the records of all inpatients cared for by a physician assistant (PA #1) for 4 of 8 active and discharged sampled inpatients (#1, 4, 6 and 8). The findings are:
A. Review of the "Medical Practice Act," Chapter 61, Article 6 NMSA 1978 revealed the following: "61-6-10. Supervising licensed physician; responsibility A. As a condition of licensure, all physician assistants practicing in [name of state] shall inform the board of the name of the licensed physician under whose supervision they will practice. All supervising physicians shall be licensed under the Medical Practice Act and shall be approved by the board."
B. Review of the completed delineation of the clinical privileges form for PA #1 dated 02/06/06, under the supervising physician, revealed the following: "Initial assessment of Acute Care patient's medical, physical, and psychosocial status, including perform history and physicals, and medical screening exams ...Initial and continuing assessment of Long Term Care patient's medical, physical, and psychosocial status, including perform history and physicals, and medical screening exams. Attending physician will cosign within 72 hours. Write admit orders to acute care with countersignature by attending physician within 12 hours. Round on patients for supervising physician after supervising physician has assessed patient within 12 hours & supervising physician's countersignature within 4 hours ...Give discharge instructions to in-patients and family with attending physician's co-signature prior to patient leaving hospital. Patient has to be physically assessed by supervising physician prior to discharge ... "
C. Review of Patient #1's medical record revealed the following:
1. Physician's Orders dated 10/19/10 at 8:10 am and Progress Notes dated 10/19/10 at 8:30 am, signed by PA #1. As of 11:30 am on 10/20/10, there was no evidence that the supervising physician had reviewed and signed the Physician Orders or the Progress Notes.
D. Review of Patient #4's medical record revealed the following:
1. A History and Physical (H&P) dated 10/19/10 from the supervising physician's office, indicating PA #1 as the Attending Provider and signed by PA #1. As of 11:30 am on 10/20/10, there was no evidence that the supervising physician had reviewed and signed the H&P.
E. Review of Patient #6's medical record revealed the following:
1. Physician's Orders dated 08/09/10, not timed, signed by PA #1. Progress Notes dated 08/09/10 at 7:10 am and at 3:30 pm, there was no evidence that the supervising physician had reviewed and signed the Physician Orders.
F. Review of Patient #8's medical record revealed the following:
1. Progress Notes dated 08/08/10, not timed, indicating the patient is going to be discharged. There is another entry dated 08/08/10 at 12:00 pm, indicating that the discharge summary has been dictated by PA #1. There was no evidence that the supervising physician had reviewed and signed the Progress Notes.
2. An H&P dated 08/05/10 from the hospital, indicating that the Dictating Physician is PA #1. There was no evidence that the supervising physician had reviewed and signed the H&P.
3. A Discharge Summary dated 08/08/10 from the hospital, indicated that the Dictating Physician and Primary Care Physician as PA #1. There was no evidence that the supervising physician had reviewed and signed the Discharge Summary.
G. On 10/20/10 at 10:30 am, during interview, the Director of Nursing stated that she was not aware that PA #1 is writing orders, writing in the progress notes, dictating history and physicals and writing discharge orders and discharge summaries without the supervising physician reviewing or co-signing these documents in a timely manner.
H. On 10/20/10 at 11:00 am, during interview, the Director of Medical Records stated that she was not aware that PA #1 is writing orders, writing in the progress notes, dictating history and physicals and writing discharge orders and discharge summaries without the supervising physician reviewing or countersigning these documents in a timely manner.