HospitalInspections.org

Based on record review and interview, the facility failed to ensure an effective process for resolving grievances which involved physician clinical issues. The facility failed to have an established grievance policy and process for evaluating grievances about physician clinical issues and therefore failed to fully analyze a grievance which included a physician clinical issue. (Patient ID # 1).

Findings included:
TX00463053

Record review of facility policy titled "Grievance Management Process", last reviewed 06/2018, stated in "This document described a grievance procedure that provides a framework for grievance investigation and resolution with multiple decision points to determine expected outcome." In the policy, a flowchart labeled "physician clinical issue? Refer to the Phys Code of Conduct Process/Policy." Then flowchart states "Talk to/share with Physician." The policy then stated "Physician responded and resolved, if not go to Chief of Service."

Record review of facility grievance documentation included statement from Physician Staff ID #57 restating clinical facts of case and decision making for Patient ID #1's case.
Record review of facility grievance documentation included email statement from Risk Management employee Staff ID #62 on 7/17/2023 at 10:41 am which stated "care was appropriate. His demand for compensation denied."

Interview with Accreditation specialist Staff ID #51 on 8/17/2023 at 1:30 pm, she confirmed that per grievance tracking documentation, Physician Staff ID #57 had reviewed his own care for clinical issues and confirmed there was no other medical or peer quality review performed.

Telephone Interview with Director of Medical Staff Office Staff ID #74 on 8/17/2023 at 2:43 pm. He stated that physicians "would not be allowed to review their own cases" for the purposes of a clinical issue review.

Telephone Interview with Vice President of Quality Staff ID #78 on 8/21/2023 at 1:09 pm, he confirmed that the facility failed to have a thorough policy which facilitated screening for physician clinical issue grievance investigations and stated the facility would need to create one.