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Based on review of the hospital's policy and procedure, open and closed medical records, observations, and staff and patient interviews, the hospital failed to allow the patient the freedom to choose the post hospital care provider of their choice for 1 of 6 patient's requiring post hospital services (patient #3).

The findings include:

Review of Policy & Procedure "Referrals to Other Agencies" effective date 07/01/96 revealed "the patient or his/her representative will make informed decisions regarding his/her care planning post discharge from (Name of facility). He/she will be given a list of health care providers who offer the services needed in the community in which the patient lives ...6. Choice forms for Skilled Nursing Facilities, Assisted Living Facilities ...and other specialty providers are maintained and are made available..."

Review of the choice form "Customized Orthotic/Prosthetic Center Providers" revision date 04/16/2013 revealed the names and phone numbers of three orthotic companies. The form did not contain the name of the orthotic company that Patient #3 had requested.

Closed Medical Record review of Patient #3 History and Physical revealed a 69 year old male admitted on 04/05/2013 with Lumbar 1 (lower back) compression fracture after a motor vehicle accident. Continued review of the medical record revealed a TLSO (total lumbar support orthotic) had been ordered prior to discharge to home.

Review of the Case Management progress notes dated 04/09/2013 at 1130 revealed "DP (discharge planner) spoke with patient and wife regarding TLSO brace. Family wishes to use a provider that is not on the provider choice list. Patient then chose to use (name of a provider on the list). (Name) faxed referral to company. Pt (patient) then fitted by (Name) from (name of company on the list). DP spoke with (name of physician) to inform him of fitting. (Name of Physician) informed DP that patient may be d/c (discharged) home w/o (with out) brace. Brace should arrive tomorrow and will be delivered to home by (name of company on the list). Patient d/c home ..."

Continued review of the medical record revealed the choice form "Customized Orthotic/Prosthetic Center Providers" with two provider names and phone numbers (the provider the patient was requesting was not on the list). One of the providers had been check marked and the form signed by Patient #3 dated 04/09/2013.

Interview on 07/31/2013 at 0930 with manager of case management revealed "...we provide a choice letter for Home Health agencies, DME (durable medical equipment agencies) and Orthotic Companies ...orthotics are separate from DME because not all DME's will do orthotics and braces ...at the time this patient was in the hospital we had only two orthotic companies on the list because that's all we had contracts with. To be on the list for orthotic services the hospital requires a contract ...the patient can only choose one of the two companies on the list ...this patient (patient #3) and his spouse requested to use an orthotic company that we (the facility) did not have a contract with. They had to select one of the two companies on the list. The patient was measured for the brace on the day of discharge then the brace was to be delivered to the patient's home the next day. The brace was not delivered to the hospital before discharge. I do not see a note in the chart that the patient was given the choice of being measured for his brace at home by the company he was requesting ....We would not have called the company the patient was requesting to make any arrangement because they were not listed on our choice form as a provider". Interview confirmed the patient's choice of post discharge orthotic provider was not honored and no reasonable effort made to coordinate the request.

Interview 07/31/2013 at 1209 with administrative staff revealed a grievance had been filed on 04/22/2013 by the spouse of Patient #3 regarding the hospital not allowing them to choose the orthotic company they wish for continued medical needs. Investigation was conducted and a follow up letter sent on 04/29/2013. Review of the letter revealed "... (Name of the company the patient requested) has not requested a renewal of their contract with us which expired in 2009. A contract with the hospital is necessary for this service to be recommended to our patients..."

Interview on 07/31/2013 at 1209 with administrative staff revealed "if we do not have a contract set up with the company they can not come in and provide the service ...it is a liability concern we have since they are coming to the hospital and seeing patients ...you can only choose the orthotic providers that are on our list ...no one calls and makes allowances if they (the one the patient is choosing) are not on the list they have to choose one that is on the list. I do not know if Case Management attempted to make any arrangements on an outpatient basis with the vendor they (patient #3) were requesting. You can only choose the vendors on our approved list". Interview confirmed the patient's choice of post discharge orthotic provider was not honored.

NC00089590