HospitalInspections.org

Based on document review and interview, the facility failed to provide out-patient services for 1 of 20 (#4) patients that presented to the facility's urgent care. Findings include:

On 11/25/2014 at 0830 during a review of the medical record for patient #4, revealed that the patient presented to the facility's out-patient Urgent Care clinic on 09/20/2014 at 1421 after sustaining an injury while at work the previous day. Patient #4 was triaged at 1421 where a nurse tech took the patient's vital signs, documented the patient's chief complaint "upper left side chest/back pain-onset when lifting yesterday" and asked the patient to state his pain level on a scale from 0-10. The patient rated his pain level to be "8". The patient then waited in the waiting room until 1705 at which time he was taken back and placed into a room to wait for the provider to see him. Sometime between 1705 and 1753 (documented time of "check out.") the patient was informed by the midlevel practitioner, "that due to the fact that there is active complaint with the state medical board against the supervising physician today, the patient cannot be seen here at urgent care today. Advised to follow up with occupational medicine on Monday or to go directly to the emergency department if he feels he needs to be seen today." The note was electronically signed by the midlevel practitioner (Staff V), dated for September 20, 2014 and timed for 2153.

On 11/24/2014 at 1530 during an interview with the Urgent Care Manager (Staff R), she was asked to speak to what the provider staffing is at the facility for any given day, Staff R replied, "There is one doctor from 7:00-8:00 am, sometimes it is from 7:00-9:00 am, depending on the day. Then at 8:00 or 9:00 am a midlevel practitioner comes in, at 11:00 am there is another midlevel or physician that comes in. It just depends on availability if it is a midlevel or a physician. At 3:00 pm the morning doctor leaves and another doctor comes in." So when asked if the facility has at least two practitioners all day except for the first hour or two in the morning, staff R stated, "Yes, there are two the rest of the day." When asked if she was aware of any instances where a patient, that presented to the urgent care was refused treatment, she stated, "Not that I am aware of. Some patients may only be examined and then transferred but they are seen by a provider prior to the transfer."

On 11/25/2014 at 0830 during record review, revealed that on 09/20/2014 at 1500 staff S was the physician provider on duty on 09/20/2014 when the complainant was placed into a treatment room. There was also a midlevel (Family Nurse Practitioner [staff V]) on duty during this time. On 11/25/2014 at 1255 during an interview with Staff S, when queried as to why he did not see the complainant for his complaint of "chest/rib pain" staff S stated, "This person has an open complaint against me that he has filed with the state licensing board." When queried as to why then then the patient was not referred to the midlevel practitioner, he stated, "I have been advised that since there is a complaint pending against me by this individual that I should not have any association with the patient. That my name should not appear anywhere on the patient's medical record. "When queried as to who had advised him of this, he stated, "My attorney." When queried as to if he sees all the patients that are seen by the midlevel practitioners, he stated, "No." When queried as to when would you see a patient that had been seen by a midlevel practitioner, he stated, "If asked to see the patient, or if it was an acute emergency." When queried as to if he was aware that his name already appears on the patient's medical record due to the fact that he was the provider on duty when the patient presented, he stated, "I did not."

On 11/25/2014 at 1330 during an interview with the Vice President of Medical Affairs (staff T), when queried if he was aware that the patient had presented to the urgent care and was not provided treatment, he stated, "am now." When asked if it would have been appropriate for the patient to have been treated by the midlevel practitioner that was on duty, he stated, "That would have been the right thing to do."

On 11/25/2014 at 1340 during an interview with the Urgent Care manager (staff R), she stated, "The 'supervising physician' that is on duty reviews and signs off on the medical record." When queried as to if they are required to sign off on all records for patients that were seen by the midlevel practitioner, she stated, "No, they don't need to sign off on all of them."