HospitalInspections.org

A. Based on record review and staff interview it was determined that the Critical Access Hospital (CAH) failed to ensure compliance with CFR 489.24.

Findings include:

1. The CAH failed to comply with it's responsibilities as a recipient hospital by denying admission to patients needing psychiatric treatment within the CAH capabilities.

See deficiency cited at CFR 489.24 (f) Recipient Hospital Responsibilities

A. Based on record review, phone interview and staff interview, it was determined that in 4 of 4 records reviewed with referrals for psychiatric treatment within the capabilities of the facility, the Critical Access Hospital (CAH) failed to accept patients for treatment.

Findings include:

1. The medical record of Pt. #1 was reviewed on survey date 9/13/10. Documentation indicated a referral from Gateway Regional Medical Center was received on 8/15/10 at 1530 PM. Documentation on the "Inquiry/Assessment Form" indicated Pt. #1's "presenting problem" was "delusional, Mom brought. Walking around with knives in her hand. Conversing with hallucinations, manic, racing thoughts." Documentation under "Part C: Disposition and Status" indicates, "Denied, Admission criteria not met, reason: needs long term care."

2. The medical record of Pt. #2 was reviewed on survey date 9/13/10. Documentation indicted a referral from Gateway Medical Center was received on 8/16/10 at 0130 AM . Documentation on the "Inquiry/Assessment Form" indicated Pt. #2's "presenting problem" was "BAL (blood alcohol level) 179, suicidal thoughts. No plan, heard voices. Paranoia, auditory hallucinations, conflict with counseling center- Mood labile, unkept- poor insight and judgement." Documentation under "Part C: Disposition and Status" indicates, "Denied : Other: Not appropriate for us, needs long term care as need and we don't have the facilities in our areas to care for."

3. The medical record of Pt. #3 was reviewed on survey date 9/13/10. Documentation indicated a referral from Gateway medical Center was received on 8/16/10 at 0130 AM. Documentation on the "Inquiry/Assessment Form" indicated Pt. #3's "presenting problem" was " Feeling depressed and suicidal-conflict with sister, patient states hasn't taken psych meds x1 week, feels depressed- no medication for 1 week-says sister threatened to stab him with a knife-police called, way to get back to Missouri." Documentation on "Part C: Disposition and Status" indicates, "Denied: Other: Not appropriate for us, needs long term care as need and we don't have the facilities in area to care for."

4. The medical record of pt. #4 was reviewed on survey date 9/13/10. Documentation indicated a referral from Gateway Medical Center was received on 8/16/10 at 0550 AM. Documentation on the "Inquiry/assessment Form" indicated Pt. #4's "presenting problem" was"'Homeless-shot at- no support- increasing depressed and anxiety for 3 days after being attacked/shot on streets... Command hallucinations to kill self..." Documentation on "Part C: Disposition and Status" indicates, "Denied: Other: Not equipped to care for in our area- No facilities in area."

5. During a phone conversation with the Psychiatrist (E#4) on 9/14/10 at 11:30, it was reported that he could not recall specifics of these referrals. During the conversation, E #4 reported that it was "not possible to make a decision" regarding the need for Long Term Care, even though this was the reason documented for denied admission in 3 of the 4 cases.

6. During an interview with the Program Director on 9/13/10 at 2:30 PM, the above findings were confirmed.