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Based on the review of 3 open and 7 closed medical records, 4 of which were Medicare recipients, staff interviews, policies and procedures, along with other pertinent documents, it was determined that the hospital failed to ensure that patients were informed of their rights when being transferred and discharged as evidence by 1 of 1 transferred patients lacking a transfer form and 3 of 4 recipients not receiving or signing the initial or discharge Important Message from Medicare (IMM), thus denying 3 Medicare recipients of the information necessary to exercise their discharge appeal rights.

Patient #4 was a 75+ year old alert and oriented patient. During hospitalization the patient's needs exceeded the capability of this hospital and patient #4 was transferred to a higher level of care. Medical record review showed that there was not a transfer form within the record. The hospital failed to ensure that patient # 4 was informed of the risks and benefits of the planned transfer.

Patient # 2 was a 90+ year old who was documented as alert and oriented on admission. The medical record lacked both an initial IMM on admission and lacked the discharge IMM which should have been furnished up to two days prior to patient discharge.

Patient # 3 was a 75 + year patient old alert and oriented throughout admission. The medical record showed that the initial IMM was not signed by patient #3 and no second IMM was provided. On admission the IMM for patient #3 was signed by a nephew, not the patient. Further review of the medical record showed that patient # 3 designated a sister and two nieces as the surrogate decision makers, not the person that signed the initial IMM. No second IMM was found on the medical record of patient # 3.

Patient # 5 was a 75+ plus year old alert and oriented patient that presented for an elective procedure and admitted to the hospital for a four day stay. Patient #5 medical record lacked a initial IMM on admission. Patient #5 did have the discharge IMM.

Based on the review of 3 open and 7 closed medical records, policies and procedures, and other pertinent documents, it was determined that the hospital failed to support the right of 1 of 10 patients to participate in their medical decision-making as evidence by the hospital's failure to have consents signed by the patient or determining capacity prior to going to surrogate decision makers.

Patient # 2 was a 90+ year old the presented to the emergency department due to coughing and shortness of breath, and was admitted with pneumonia. On admission, patient #2 was documented as alert and oriented x3. Medical record review found that the patient did have advance directives that identified an adult child as a decision maker; however, the patient was not documented as being in one of the three qualifying conditions that would have meant the adult child was authorized to make decisions, nor was there a capacity evaluation documented that would have indicated the patient could not make decisions.

There were two consents on the patient medical record signed by the daughter, a consent to treat and a consent for an invasive procedure.