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Tag No.: C0241
Based on interviews and record review, the Governing Body failed to appoint a Medical Director for the hospital. The Governing Body is responsible for all medical appointments. The findings are:
A. On 08/16/17 at 9:15 am during interview, the Hospital's Chief Executive Officer stated, "I have reviewed the Governing Body Meeting minutes for the last few years and I cannot find where the Governing Body confirmed our current Medical Director. The last CEO should have done that and I cannot find where he did."
B. Record review of the Governing Body's monthly meeting minutes for 2016 and 2017 revealed no physician appointed to be the Hospital's Medical Director. The current Medical Director has been in job just over a year without formal nomination.