HospitalInspections.org

Based on review of medical records, policies/procedures and staff interviews, it was determined that the hospital failed to comply with the provider agreement as defined in ?489.24 related to EMTALA (Emergency Medical Treatment and Active Labor Act) requirements.

The findings were:

Refer to findings for Tag A 2409 - Appropriate Transfer:

The facility failed to ensure that Sample Patients #13 and #20 had a physician's certification countersigned by a physician within the hospital's defined time frame of 14 days.

Based on review of medical records, policies/procedures, and staff interviews, the facility failed to ensure that a physician countersigned physician certifications in three (Sample patients #9, 13, and 20) of nine transfer records reviewed. Two of the three records (Sample Patients #13 and #20) had gone beyond the 14 days allowed by the facility's policies and procedures. This failure could lead to a negative patient outcome.

The findings were:

1. Medical Record Review:

On 1/20/2012, the medical record of Sample Patient #9 was reviewed and revealed the following, in pertinent parts:
The patient presented on 1/12/2012 to the facility's Emergency Department with the complaint of a foreign body in the esophagus. The patient was stabilized and transported via ambulance to an acute care hospital for specialized care. The physician certification for transfer was signed by a Physicians' Assistant on 1/12/2012. The physician certification had not been countersigned by a physician as of the time of the review on 1/20/2012. However, the facility's policy allowed for 14 days for physician countersignatures.

On 1/20/2012, the medical record of Sample Patient #13 was reviewed and revealed the following, in pertinent parts:
The patient presented on 12/14/2011 to the facility's Emergency Department with the complaint of abdominal pain and was diagnosed with a transmesenteric hernia. The patient was stabilized and transported via helicopter to an acute care hospital for specialized care/surgical treatment. The physician certification for transfer was signed by a Physicians' Assistant on 12/14/2011. The physician certification had not been countersigned by a physician as of the time of the review on 1/20/2012. This was beyond the time allotted of 14 days by the facility's policy for physician countersignatures.

On 1/20/2012, the medical record of Sample Patient #20 was reviewed and revealed the following, in pertinent parts:
The patient presented on 11/1/2011 to the facility's Emergency Department with the complaint of pre-term labor and was diagnosed with preeclampsia. The patient was stabilized and transported via ambulance to an acute care hospital for specialized care. The physician certification for transfer was signed by a Physicians' Assistant on 11/1/2011. The physician certification had not been countersigned by a physician as of the time of the review on 1/20/2012. This was beyond the time allotted of 14 days by the facility's policy for physician countersignatures.

2. Staff Interviews:

An interview conducted on 1/20/2012 at approximately 8:45 a.m., with the facility's Chief Nursing Officer revealed the following findings:
S/he confirmed that Sample patients #9's, #13's, and #20's records did not contain a physician countersignature on the physician certification sheets that had been signed by Physicians' Assistants.
A subsequent interview on 1/20/2012 at approximately 9:45 a.m., with the facility's Chief Nursing Officer revealed the following findings:
S/he stated that the facility's policies/procedures allowed 14 days for countersignature by the supervising physician. S/he confirmed that both Sample patient #13's and #20's records should have contained the countersignature by the date of review. S/he stated that both Physicians' Assistants had the same supervising physician who was "bad at signing things" and that the facility had been trying to obtain his/her cooperation with regulatory requirements.

3. Review of Facility Policy/Procedure:

Review on 1/20/2012 of the policy/procedure "Physician Supervision", last revised 01/08, revealed the following, in pertinent parts:
"...The direct supervision or collaboration of the mid-level provider with the attending physician will be dictated by hospital policy, along with state and federal laws...
Procedure...
All orders and progress notes written by a mid-level provider must be co-signed by the attending physician no later than 14 days after the patient encounter..."