HospitalInspections.org

The hospital's census on 4/14/12 was 21 with 1 ventilator-dependent patient and 2 patients , each with a tracheotomy who required routine suctioning to maintain their airways (i.e., and their ability to breathe). The natural gas-powered generator failed during a natural disaster (tornado) on 4/14/12 which lead to a total loss of power including power for the life support and life safety equipment for patients #1, 2, and 3.

Based on staff interviews and document review, the hospital failed to meet the Condition of Participation for Physical Environment when it:

- Failed to provide an onsite fuel source for life support and life safety equipment;
- Failed to provide emergency power and lighting (working flashlights, battery lamps and back-up batteries) in all other areas not serviced by the emergency supply source; and
- Failed to meet the applicable provisions of the 2000 edition of the Life Safety Code of the National Fire Protection Association (NFPA).

The cumulative effect of the failure to provide emergency power and lighting in the hospital resulted in the hospital's inability to ensure the health and safety for all patients of the hospital.

Findings include:

- The hospital failed to provide functioning battery lamps or flashlights and batteries in all areas not serviced by their emergency generator and power. See A-702, 42 CFR 482.41(a) (1). (CFR refers to the Code of Federal Regulations.)

- The hospital failed to provide an onsite emergency fuel source to ensure operation of the hospital's emergency generator during power failures. At a minimum, the emergency generator was needed to provide power to life support and life safety equipment needed for at least patients #1, 2, and 3. See A-703, 42 CFR 482.41(a) (2).

- The hospital failed to meet the applicable provisions of the Life Safety Code of the NFPA. See further evidence at A-710, 42 CFR 482.41(b) and K 106 NFPA 101 Life Safety Code Standard 42 CFR 483.70(a)

Based on staff interview and document reviews, the hospital failed to comply with the applicable provisions of the Life Safety Code, National Fire Protection Amendments (NFPA) 101 2000 Edition and applicable references, such as NFPA-99: Health Care Facilities, for emergency lighting and emergency power when the hospital did not provide functioning battery lamps or flashlights and batteries in all areas not serviced by their emergency generator and power. The failure to provide emergency lighting in all areas not serviced by the emergency generator placed all 21 patients in total darkness in their patient rooms after a natural disaster (tornado) on 4/14/12 and continues to create an environment where the hospital is unable to ensure the provision of health care to all patients in a safe environment.

Findings include:

- Interview with Registered Nurse staff E on 4/24/12 at 7:30pm about the natural disaster on 4/14/12, the emergency generator, storm response by employees of the hospital, and evacuation of the hospital revealed the following. The emergency generator functioned from about 10:15pm on 4/14/2012 until about 4:30am on 4/15/12. Staff E reported the emergency generator powered only the "red" (emergency) outlets and about every other light in the hallways of the hospital. The emergency generator provided no lightening in the patient rooms. Staff E reported staff located a "few" flashlights when the weather service issued a tornado warning. Staff E reported not all the flashlights functioned and there were no spare batteries to place in the non-functioning flashlights. There were not enough flashlights to place one in each patient room with each of the 21 patients, or for each staff member.

Staff E reported the emergency generator failed at about 4:30am and there was no power in the hospital other than the few functioning flashlights. Charge nurse staff E, Registered Nurse staff G, Director of Plant Operations staff C, and Administrative staff A and B all reported the surrounding area to the hospital sustained roof and structural damage with large power lines down and debris on the streets obstructing about a 12 block radius. Emergency management personnel limited access to the area because of the downed power lines. It took approximately 30 to 40 minutes minutes instead of the usual 5 to 7 minutes for emergency medical transport personnel to "work their way through the debris and downed lines" to transfer 3 high priority patients who required life-sustaining equipment. The hospital lacked emergency lighting and or functioning battery lamps or flashlights with spare batteries in all areas not serviced by their emergency generator and power.

Based on interview and document review, the hospital failed to provide onsite fuel readily available for the operation of the hospital's emergency generator during a power failure to provide power for life support and life safety equipment. The hospital failed to meet National Fire Protection Association (NFPA) 101 Life Safety Code Standard regulation at ) tag number K 106.

Findings include:

- Administrative staff A and B and the Director of Plant Operations staff C verified on 4/24/12 the hospital lacked onsite fuel to operate the hospital's natural gas-powered emergency generator if the natural gas from the city were interrupted. Observation of the emergency generator on 4/24/12 found it was powered only by a piped-in natural gas line.

On 4/14/2012 the hospital was in an area where tornado and wind damage occurred. The emergency generator functioned from 10:15pm until 4:30am, approximately 6 hours, then lost power and all 21 patients were evacuated to other hospitals. The facility and gas company provided conflicting information about the cause of the generator's failure. Refer to K 106 written by the State Fire Marshal for specific information about the NFPA requirements.

Base on interview and record review on 4/27/2012, the hospital failed to meet the applicable provisions of the Life Safety Code of the National Fire Protection Association (NFPA).

Findings include:

- The State Fire Marshal's office made an onsite complaint investigation visit to the hospital on 4/25/2012 and issued a deficiency citation on 4/27/2012 at K 106, NFPA 101 Life Safety Code Standard 42 CFR 483.70(a). (CFR refers to the Code of Federa Reluations). Refer to tag K 106 for specific information.

During interviews on 4/30/2012, Administrative staff A,B, and C all verified the hospital failed to comply with K 106.