The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

MARION COMMUNTIY HOSPITAL 1431 SW 1ST AVE OCALA, FL 34478 July 18, 2013
VIOLATION: PHYSICIAN REQUEST FOR A DISCHARGE PLAN Tag No: A0819
Based on record review and interview the hospital failed to ensure that 1 (#12) of 10 discharged patients sampled of a total sample of 20 patients received the services ordered by her physician at discharge.

Findings:

During record review for Patient #12 revealed that on 5/27/13 she was admitted to the hospital after a motorcycle accident. Review of the physician ' s orders dated 6/14/13 the patient was discharged home with home health services, physical therapy, occupational therapy and speech therapy. Review of the case management notes dated 6/14/13 at 2:55 PM revealed that no home health agency had accepted the patient at the time of discharge. The patient was discharged in the company of her daughter on 6/14/13 at 4:09 PM.

Review of the discharge summary dated 6/14/13 the physician documented that the patient was unable to be placed in rehabilitation. All arrangements have been made for outpatient therapy, home health therapy, speech therapy, follow-up with Neuropsychiatry, and occupational therapy.

Interview with the case manager on 7/17/13 at 10 AM stated that she made several facility and home health referrals on Patient #12 ' s behalf. She stated that none of the providers would accept the patient ' s insurance. She stated that Patient #12 did not qualify for indigent care services as she had insurance. She stated that she felt that the patient was discharged to a safe environment as she had a daughter and a significant other to care for her. She stated that the daughter and the patient ' s significant other were to provide 24 hour supervision when she was discharged home as she continued to suffer the effects of her traumatic brain injury.

There is no documentation in the medical record that the patient ' s physician was notified that the home health and therapy services were not arranged. It is noted that the patient did not appeal discharge from the hospital as she and her daughter accepted discharge based on home health and therapy ordered services in the home.

Review of the hospital policy titled "Discharge Planning" reviewed and revised on 1/2013 revealed on page 2 #G. "The case manager or social worker will arrange for the implementation of the discharge plan." The policy does not address notifying the patient's physician if the ordered services cannot be provided.