HospitalInspections.org

Based upon record review and interview, the hospital failed to appoint a Medical Director that provided medical supervision over the Critical Access Hospital's health care staff. The was evidenced by identifying Hospital I's Medical Director (Staff J) due to an integrated Governing Body and Medical Staff. Findings:

Interview on 05/25/24 at 10:30 a.m. Staff B stated Staff J was Medical Director. Review of Medical Staff Physician list revealed Staff J was not identified. Further interview with Staff B revealed when asked about Staff J, he replied the Governing Body and Medical Staff were integrated with their sister hospital "Hospital I".

Review of the Governing Board and Medical Staff Meeting Minutes from 01/01/23 through 02/01/24 revealed there failed to be documented evidence a Medical Director from the hospital's medical staff had been appointed for supervision and direction of the health care staff.

Based upon record review and interview, the hospital failed to implement an appropriate transfer for 1 of 4 patients (#6) who required a higher level of care. This was evidenced by the failure to have a written certification that stated the reason for the transfer, the risks and benefits of the transfer and the patient's medical condition at the time of transfer. Findings:

On 02/02/24 at 10:44 p.m. patient #6, a 12 year old female, presented to the emergency department with the chief complaint of Suicidal Ideation with Intentional Overdose. According to the History of Present Illness, the patient had reportedly taken a combination of over the counter medications with the intent of trying to kill herself. Laboratory tests were obtained, monitoring for medication side effects, and Intravenous medications were administered. Review of the Medical Decision Making revealed "...Patient spoke with counselor on the iPad at (Mental Health Facility K). They are going to try and arrange an inpatient placement. Will continue to monitor the patient this evening." On 02/03/24 at 8:20 a.m. the Registered Nurse documented "Transport from (K) here to transport patient to (Psychiatric Hospital L) in Oklahoma City. Grandmother (legal guardian) to ride with patient and transport to receiving facility."

Further review of patient #6's emergency department record revealed there failed to be documented evidence an appropriate transfer certification was implemented. Interview on 03/26/24 at 1:50 p.m. with Staff B revealed facility K was used to conduct the evaluations on their psychiatric patients via iPad and then find placement for inpatient psychiatric care. When asked if the hospital completed any transfer certifications, Staff B replied "no" that everything was set up with Facility K and receiving hospitals.