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DESERT VALLEY HOSPITAL 16850 BEAR VALLEY RD VICTORVILLE, CA 92395 Sept. 16, 2016
VIOLATION: MEDICAL STAFF BYLAWS Tag No: A0353
Based on interview and record review, the facility did not ensure the Medical Staff bylaws were enforced when the attending physician did not ensure the Gastrointestinal (G.I.) and General Surgery (surgery specialist) consultations were obtained for the patient in a timely manner. This practice increased the risk of a delay in patient care and a poor health outcome. Findings:During a review of the clinical record for patient 23, the physician progress note written by MD 2, dated June 24, 2016, indicated "...Plan: The patient will be closely monitored. Obtain G.I., General Surgery as well as Cardiology (heart specialist) consults..."A review of the clinical record indicated no documented evidence that a G.I. consult was ever obtained for the patient. A review of the progress note written by MD 1 (surgery consult) for patient 23, dated June 27, 2016 (three days after the surgery consult was ordered) indicated "...Small bowel follow through (test for small intestine blockage) shows stasis (no flow) of contrast (liquid that shows up on X-Ray) and follow up KUB (abdominal X-Ray) shows persistence of slight distention (full of air) of a loop of bowel. She is not a very good candidate for an operation but she may have to have one. Will try some enemas in case stool inspissation (thickening or hardening) is contributing to her G.I. Symptoms."

Further review of the clinical record indicated the progress note written by MD 1 (surgery consultant) dated June 28, 2016, indicated "...I called the I.C.U. this morning at about 9 O'clock to check on the patient and was told she expired during the night..."During an interview with the acting Chief Nursing Officer (CNO) on September 15, 2016, at 10:20 AM, she confirmed that the patient's G.I. consult was never obtained. She also agreed there was no documented evidence that the surgery consultant saw the patient before June 27, 2016 (three days after the attending physician ordered a surgery consult). The acting CNO stated the Registered Nurse (RN) is responsible for ensuring the open orders are done. She agreed that all RN's that take care of a patient should check for open orders (physician orders that have not been done). She stated that once a physician has ordered a consult, the physician who was requested to come and consult on the patient was telephoned by the staff. The CNO produced a copy of the telephone log which had evidence that other consultants had been telephoned by the staff. The telephone log did not contain documented evidence that a telephone call was made to the G.I. consultant. Also there was no documented evidence that a telephone call was made to the surgical consultant. The facility policy titled "Consult Process" dated July 2015, indicated "Policy: Desert Valley Hospital patients shall have consults initiated to other disciplines/departments throughout their hospitalization in a timely manner and according to the procedure and criteria established for each consult by that discipline/department."The facility "Medical staff general Rules and Regulations" dated December 2014, indicated "...7.3. Request for consultation: The attending physician is responsible for securing a consultation..."