HospitalInspections.org

Based on record review, and staff and patient interviews, it was determined that the hospital failed to ensure that patient rights were upheld related to a request for medical care, and failed to implement the hospital policy entitled "Financial Policy" for 1 of 10 relevant self pay sample patients (ID #1).

Findings are as follows:

During a telephone interview on 1/26/12 at 1:30 PM with patient ID #1, it was reported that this patient had presented to the Walk-In Clinic at the hospital on 1/3/12 requesting a blood pressure check for complaints of dizziness, and "not feeling well all morning". The patient had "run out of blood pressure pills", and could not afford to pay for refills. The receptionist asked the patient's name, and the reason for the visit. The patient made the receptionist aware of "problems with insurance". The receptionist then explained that the hospital had a new policy in place, and a $20.00 co-pay for this visit was requested, or the patient could not be seen. The patient did not have the money for the co-pay, and therefore proceeded to leave without being seen, without protesting the co-pay issue.

A review of the hospital's "Your Rights as a Patient", under item # 8 states:

"You have the right to expect that, within its ability, the hospital will respond to your request (or your doctor's) for medical care".

The hospital policy entitled "Financial Policy" under "3.0 Procedures" states:

Under "B. Self-pay, refers to patients without insurance coverage. For these patients several options are available - Care will never be denied due to the patient's inability to pay".

The policy also states that "Patients who are self -pay....who are seen in the Walk-In Clinic or Adult Primary Clinic will be asked to make a payment of $20.00. The remainder of the charges for the visit will be billed to the patient".

During an interview on 1/26/12 at 8:45 AM with the Administrative Director of Outpatient Clinic Operations, she reported that all patients are seen by a nurse for triage upon presentation to the Walk-In Clinic. The receptionist signs the patient in on a log-in sheet, noting the complaint. The nurse then calls the patient in for an assessment. It was reported that this is the clinic's "scope of practice". There was no evidence that the patient had been "logged in" by the secretary for the nurse assessment, and therefore the Administrative Director denied the patient allegation. She voiced concern that there had been no protest from the patient. She further stated that any patient discrimination would be cause for immediate corrective action.

It was further reported that a new financial policy was put into place by the hospital on 1/3/12. The hospital had previously not been collecting co-pays or down payments for services received. The hospital's ability to provide free care has since become limited. Letters were sent to all established patients in November and December of 2011, alerting them to the new policy for co-payments with visits if self-pay. An automated patient appointment reminder system was updated to also remind the patient of the co-pay requirement.

Patients are seen in the Walk-in Clinic for episodic care. This patient was not an established patient, as she had not been seen in the clinic since 2007. The Administrative Director reported that if the nurse had been made aware of the co-pay issue with this patient, she has the authority to waive this requirement. She reported that all patient's are seen by the nurse. There was no evidence that the nurse was made aware by the secretary of the patient's presentation.

During an interview on 1/26/12 at 9:45 AM with the Walk-In Clinic Charge Nurse, it was reported that this nurse had been on duty on the day that the patient allegedly presented to the area for services. The nurse reported no contact with this patient. The nurse also reported no knowledge of the patient or the co-pay issue. "The co-pay would have been waived with the patient's presentation".

During an interview on 1/26/12 at 10:15 AM with the Walk-In Receptionist, it was reported that all patients are signed in upon arrival. Although the receptionist could not remember this patient, it was reported that this patient had presented on the first day when the new financial policy went into effect, and "perhaps there had been some confusion". The receptionist indicated that she would have made the charge nurse aware if there had been an issue with the co-payment.

A review of 9 additional medical records of self pay patients treated in the Walk-In Clinic did reveal that 3 out of these 9 patients were seen for treatment without co-payments made.