HospitalInspections.org

Based on a review of facility documentation and interviews with staff, the governing body failed to be responsible for contracted services furnished in the facility.

Findings were:

Patient #1 was discharged on 9-27-17 to an MHMR [mental health/mental retardation] facility with whom prior arrangements had not been made.

Facility document titled "Heart of Texas Region Mental Health Mental Retardation Center Community-Based Services Agreement" contained the following language (page 16):
"11. Discharge planning must include, at a minimum, the following activities:
...
b. The name of the individual or entity responsible for providing or paying for the medication needed after discharge or transfer until the patient is evaluated by a physician; and
c. Development of a transportation plan."

In an interview with staff #5 on 12-13-17 at 8:51 am, staff #5 stated that she had been a Clinical Case Manager at the time of patient #1's stay at CC.

When told that the Heart of Texas (HOT) MHMR contract language stated that discharge planning needed to include addressing the responsibility of paying for or providing the patient's medication needed after discharge, staff #5 stated "usually [staff #7] just takes care of all that". When asked about the contract language stating that discharge planning needed to include development of a transportation plan, [staff #5] stated "that's why we send them [patients] back to her [staff #7]".

In an interview with staff #7 on 12-13-17 at 9:54 am, staff #7 stated that she was a Registered Nurse with the Mobile Crisis Outreach Team for HOT MHMR in Waco, Tx.

When told that the HOT MHMR contract language stated that discharge planning needed to include addressing the responsibility of paying for or providing the patient's medication needed after discharge, staff #7 stated "Um ...I don't know how we would have paid for it". When asked about the contract language stating that discharge planning needed to include development of a transportation plan, staff #7 stated "Well, the hospital ...Cedar Crest develops that plan". Staff #7 further stated that she gave CC staff 3 telephone numbers (for Bluebonnet MHMR in Marble Falls) to call but that she did not personally call Bluebonnet MHMR to let them know the patient was coming to their facility.

Facility policy 1000.86 titled "Discharge Planning" states, in part:
"Policy: Discharge planning, or transition planning includes the process of determining the appropriate post-hospital destination for a patient, identifying what the patient requires for a smooth and safe transition from the hospital to his/her discharge destination, and beginning the process of meeting the patient's identified post-discharge needs. The Discharge planning activities are initiated at the point initial assessment and continued throughout the patient's episode of care. The primary responsibility for development of the discharge plan rests with the attending physician and Interdisciplinary Treatment Team.

Procedure:
...
4. Discharge planning and coordination includes contact with necessary agencies and other providers to make needed arrangements, follow-up appointments and to forward necessary treatment data in anticipation of the patient's follow-up appointment. Staff will document actions in the medical record."

The above was confirmed in an interview with the CEO and other administrative staff the afternoon of 12-13-17.