HospitalInspections.org

Based on record review and interview, the Medical Staff failed to ensure the quality of the medical care, in that,

A) 3 of 3 consults (Patient #4/Gynecological Oncology - GYN/ONC & Surgical Oncology - ONC and Patient #6/ Pain Management) did not occur for the patients; and
B) the transfer/admission In Good Faith did not receive the required service. Patient #4 was accepted by the hospital designee for Oncology for Uterine and Cervical Mass and did not receive the service during the hospitalization.

Findings included

Patient #4:
The medical record for Patient #4 reflected, "4/10/18...Memorandum of Transfer - Medical Condition: Diagnosis: Uterine and Cervical Mass...Reason for transfer...Medically Indicated...Obtain level of care/service NA (not available)...Service: Oncology (ONC)..."

The 4/15/18 Discharge Summary reflected, "Large cervical mass with bladder invasion ...the patient was transferred here for a surgical evaluation; however, speaking with both Gynecology-Oncology as well as a Surgical Oncology given the patient's unfunded status, it was felt that she would best be served by being at (another county's Hospital)...she was advised to go directly to the Emergency Room at (Another county's Hospital) for admission and further work-up..."

Both hospital face sheets reflect Patient #4 lives in Grayson county, not Dallas county.

During an interview on 8/28/18 ending at 4:49 PM, Personnel #2 was asked if the hospital was aware of the multiple notes on Patient #4 about the GYN/ONC and Surgical ONC consults and no consults being completed. Personnel #2 stated, "No." Personnel #2 was informed the patient was accepted via the MOT for Oncology for uterine and cervical mass. Personnel #2 was asked if that was provided. Personnel #2 stated, "No." Personnel #2 was asked if the hospital had that service. Personnel #2 stated, "Yes, but they do not take call." A Doctor can choose whether they want to see a patient."

During an interview on 8/29/18 at 11:20 AM, Personnel #11 was asked about Patient #4's consult for GYN/ONC not being done. Personnel #11 was asked if there were issues with services completing consults at the hospital. Personnel #11 stated, "It depends." Personnel #11 was asked if the hospital had GYN/ONC and Surgical ONC services. Personnel #11 stated, "Yes." Personnel #11 was asked if there were issues getting those services to see patients. Personnel #11 stated, "Usually, the issue is time." Personnel #11 was asked if money or payment was an issue. Personnel #11 stated, "I can't say."

During a telephone interview on 8/29/18 at 12:22 PM, Personnel #23 was asked about Patient #4's case. Personnel #23 stated, "the note said Per (Attending) gyn onc has been consulted and will not see pt. If I remember right, she was supposed to be a direct admit and (Attending) spoke to them (GYN/ONC) and they said they wouldn't see the patient." Personnel #23 was asked about consults not being done with GYN/ONC. Personnel #23 stated, "It is often the case with GYN/ONC service. Meaning, they are not on-call and we have no binding agreement for the hospital line (service). Per my experience, they have not seen patients for a variety of reasons." Personnel #23 was asked reasons up to and including payment. Personnel #23 stated, "Yes."

During a telephone interview on 8/29/18 at 2:20 PM, Personnel #13 was asked about Patient #4's case. Personnel #13 stated she spoke with Personnel #24, GYN/ONC and Personnel #25, Surgical ONC by phone. They asked the funding status...told them she was unfunded and they chose not to take the patient...spoke to Personnel #9 (Chief Medical Officer) because I was not getting a normal response to consult requests for caring for my patient. Personnel #9 said no physician can be forced to take the patient."

Patient #6:
The medical record for Patient #6 reflected, "9/14/17...22:30 Consulting Physician: (Personnel #21) Reason for Consult: Chronic Pain...9/15/17...2:24 (AM)...(H&P addition) the patient is asking for pain medication to increase the dose...Discussed with family that (Personnel #21) will be there to discuss other issues..."

There was no Chronic Pain Consultation Note.

During an interview on 8/29/18 at 11:10 AM, Personnel #1 was asked for Patient #6's consultation note for Personnel #21. Personnel #1 stated, "There is no note."

The 3/29/17 MCP "Medical Staff Rules and Regulations" required, "Admission...the management of each patient's general medical condition...A physician for each service/speciality shall be oncall and immediately available...attending physician shall be responsible for coordination the treatment of the patient...the attending physician shall be responsible for consulting the appropriate specialists to evaluate and assist in the patient's care...regardless of the patient's social status or ability to pay...consultations shall be obtained and completed within 24 hours or sooner...any qualified practitioner can be called for consultation..."

Based on record review and interview, the facility failed to ensure appropriate discharge within the geographic area of the patient's residence, in that,

Patient #4's discharge plan referred the patient to (Another) County Hospital Services other than her county, Grayson County.

Findings included

The 4/15/18 Discharge Summary reflected, "Large cervical mass with bladder invasion ...the patient was transferred here for a surgical evaluation; however, speaking with both Gynecology-Oncology as well as a Surgical Oncology given the patient's unfunded status, it was felt that she would best be served by being at (Dallas County Hospital) ...she was advised to go directly to the Emergency Room at (Dallas County Hospital) for admission and further work-up ..."

Both hospital face sheets reflect Patient #4 lives in Grayson County.

During a telephone interview on 8/24/18 ending at 2:41 PM, Personnel #22 was asked if the patient needed a transfer to (County Hospital) versus Discharge. Personnel #22 stated, "No. She needed the outpatient clinic follow-up." Personnel #22 was asked if the discharge was appropriate given the geographic area of her residents. Personnel #22 stated, "No. We ID' d that as an issue/opportunity."

The 5/20/18 "Discharge Planning and Referrals of Patients to Post Discharge Providers" Policy required, "Before the patient makes his/her decision as to the provider of post acute services, a facility employee must provide the patient written notification, either on the list of all post-acute service/provider options in the geographical area or on the Patient Choice Letter..."