HospitalInspections.org

Based on document review and interview, it was determined that the Governing Body failed to demonstrate it is effective in carrying out the responsibilities for the operation and management of the hospital. The Governing Body failed to provide necessary oversight and leadership as evidenced by the lack of compliance with the following Conditions of Participation:

CFR 482.13 Patient Rights
CFR 482.22 Medical Staff

Based on medical record review, review of facility policy and staff interview, it was determined that the facility failed to ensure that all patient rights are protected.

Findings include:

1. The facility failed to ensure that care was provided in a safe setting. Refer to Tag A-144.

2. The facility failed to ensure all patients are kept free from all forms of abuse or harassment. Refer to Tag A-145

An Immediate Jeopardy was identified on 5/19/15 related to the conduct of the anesthesiologist towards the surgeon and the patient during a surgical procedure.. The Immediate Jeopardy was removed on 5/19/15, upon receipt of an acceptable Plan of Correction (PoC).

Based on medical record review, review of facility documentation, and staff interview, it was determined that the facility failed to ensure all patients are cared for in a safe setting.

Findings include:

1. Documentation on the Operative Report Results in Medical Record #1, dated 5/3/15, states, "During the procedure Dr. (Staff #6) (Anesthesiology) became argumentative and disruptive. I advised him to stop this behavior however he persisted. I will report this incident to hospital administration post op." This was written by Staff #7.

2. Documentation in the post-operative report of the incident, by Staff #7 concerning Staff #6, stated, "...I performed a diagnostic laparosocopy and found approximately 500cc of bright red blood in the abdomen. I could not find the source of bleeding and as such made a decision to convert to laparotomy. I informed the OR staff to prepare for laparotomy. At this point Dr. (Staff #6) loudly insisted that I should not open the patient. I explained again my reasoning and that I was going to proceed. He became increasingly irate and argumentative. I asked the circulating nurse to call Dr. (Staff #8) of general surgery to assist in searching for the bleeding source. Dr. (Staff #6) stated: 'Why the f--- are you calling him? He's only a f---ing resident! Why do you need him?"

3. Documentation of an interview with Staff #9, conducted by Staff #4 concerning an incident that occured on 5/3/15 in the operative suite, was provided by the facility.

a. The documentation indicated that Dr. (Staff #6) was threatening Dr. (Staff #7) throughout the laparotomy.

4. Based on the above the patient was not provided care in a safe setting.

5. Staff #3 confirmed the above.

Based on medical record review, review of facility documentation, and staff interview, it was determined that the facility failed to ensure that all patients are kept free of abuse or harassment.

Findings include:

1. Documentation of staff interviews conducted by Staff #4 concerning the incident that occurred on 5/3/15 in the operative suite, was provided by Staff #4 and revealed the following:

a. Interview with Staff #9 indicated the patient was brought into the operative suite. Dr. (Staff #6) who was still mumbling about surgery, asked the patient if she speaks English. The patient looked at him and did not answer. Staff #9 asked the patient in Spanish if she spoke English. The patient said "no". Dr. (Staff #6) said "f---ing great, this is the USA and she didn't [SIC] speak English, you should learn how to speak English." Staff #9 went on to report that Dr. (Staff #6) was yelling at the patient to stop biting the ET tube. Staff #9 indicated that she looked up to see Dr. (Staff #6) rip the ET tube out of the patient's throat. Staff #9 indicated that the patient was moving and became somewhat combative and Dr. (Staff #6) hit the patient on the face at least 2 times and pinched her cheek while still yelling at the patient, violently pulled the patient's jaw back and screamed "...stop f---ing moving."

b. Interview with Staff #8 indicated that Dr. (Staff #6) pinched the patient's cheek aggressively on the left side. Staff #8 also indicated that Dr. (Staff #6) hit the patient in the back while transferring her. Staff #8 stated that Staff #6 was "...Extremely violent and aggressive..."

c. Interview with Staff #5 indicated that Dr. (Staff #6) was yelling at the patient, was aggressive with the patient's face, slapped the patient, and did a sternal rub.

d. Documentation also indicated that all staff involved in the incident were interviewed by Staff #10 (Acting CMO) and revealed the same information as in the interviews conducted by Staff #4.

2. Staff #4 stated that this incident was reported to the police and to the Department of Health, but was not reported to the Board of Medical Examiners.

3. Staff #4 confirmed the above.

Based on medical record review, review of facility policy and bylaws, and staff interview, it was determined that the facility failed to ensure all medical staff bylaws are followed.

Findings include:

1. The facility failed to ensure the medical staff bylaws were followed. Refer to Tag A-353.

Based on medical record review, review of facility policy and bylaws, and staff interview, it was determined that the facility failed to ensure all medical staff bylaws are followed.

Findings include:

Reference #1: Facility Policy; Disruptive Physician, under Standard of Conduct, states, "...Medical staff members who engage in unacceptable disruptive conduct shall be subject to disciplinary action in accordance with the corrective action procedure set forth in the Palisades Medical Center Staff Bylaws."

Reference #2: Medical Staff Bylaws; Section 1-Summary Suspension, b. states, "The clinical practitioner shall be sent via regular, certified mail or a hand-delivered written notice when feasible which includes: (1) the terms of his or her suspension; (2) reasons therefore; and (3) the affected Clinical Practitioner's right to have a summary suspension review before ad hoc committee...This summary suspension shall stay in effect at least until the requested review."

Findings include:

1. Documentation in Medical Record #1, on the Operative Report Results written by Staff #7, dated 5/3/15, states, "During the procedure Dr. (Staff #6) (Anesthesiology) became argumentative and disruptive. I advised him to stop this behavior however he persisted. I will report this incident to hospital administration post op."

2. Documentation in the post-operative report of the incident by Staff #7 concerning Staff #6, stated, "...I performed a diagnostic laparosocopy and found approximately 500cc of bright red blood in the abdomen. I could not find the source of bleeding and as such made a decision to convert to laparotomy. I informed the OR staff to prepare for laparotomy. At this point Dr. (Staff #6) loudly insisted that I should not open the patient. I explained again my reasoning and that I was going to proceed. He became increasingly irate and argumentative. I asked the circulating nurse to call Dr. (Staff #8) of general surgery to assist in searching for the bleeding source. Dr. (Staff #6) stated: 'Why the f--- are you calling him? He's only a f---ing resident! Why do you need him?"

3. Documentation of a staff interview conducted by Staff #4 with Staff #9 concerning the incident that occurred on 5/3/15 in the operative suite, was provided to this surveyor by the facility.

a. The documentation indicated that Dr. (Staff #6) was threatening Dr. (Staff #7) throughout the laparotomy.

4. The facility failed to follow the policy (Reference #1), regarding a disruptive practitioner.

5. Staff #4 indicated that Staff #6 was not suspended as indicated in the bylaws (Reference #2), as Staff #6 was going on vacation for two weeks following the incident.