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.

EDWARD WHITE HOSPITAL 2323 9TH AVE N SAINT PETERSBURG, FL March 29, 2013
VIOLATION: MEDICAL STAFF Tag No: A0338
Based on record review, document review and staff interview it was determined the medical staff failed to enforce the Bylaws of the facility and failed to appropriately evaluate the credentials for one (#A) physician of one applying for reappointment to the medical staff. This practice failed to ensure the patients are cared for by properly credentialed and qualified physicians that would promote quality medical care.

Patient #1 was admitted to the care of physician #A on 12/24/12. The patient was discharged at 5:03 p.m. on 1/3/13 to an Adult Living Facility (ALF). Review of records obtained from the ALF dated 1/3/13 indicated the patient arrived at 5:25 p.m. The patient expired at 5:40 p.m., approximately 40 minutes following discharge from the acute care facility.

Physician #A was notified of the unexpected death of patient #1 by the police. Physician #A did not report the event to the facility's administration. This did not allow the facility to conduct an investigation regarding the unexpected death of the patient 40 minutes following discharge.

Review of physician #A's credential file revealed a copy of a letter dated 2/23/12 addressed to physician #A informing him he had been reappointed to the Medical Staff. An interview with the Vice President of Quality was conducted on 1/29/13 that revealed physician #A was suspended from the medical staff at the time he was reappointed without having remedied the reason for the suspension, in violation of the Bylaws. Physician #A had been suspended from the medical staff for a period of over 23 months. Physician #A had been notified of his suspension as recently as 11/29/12, approximately 25 days prior to the admission of Patient #1. Physician #A did not have admitting privileges at the time Patient #1 was admitted to his care. Refer to A0341.


A review of the Medical Staff Bylaws indicated when an individual has been suspended and the suspension continues for more than 60 days without verified evidence of reinstatement, then the individual shall be deemed to have voluntarily resigned from the staff, and have voluntarily relinquished all clinical privileges. The individual shall be notified of the automatic voluntary resignation and the need to submit a new application if reinstatement of membership for clinical privileges is desired. Documentation provided by the facility established physician #A had been continuously suspended since January 2011, a period of approximately 23 months prior to the admission of Patient #1. An interview was conducted with the Chief Executive Officer on 3/29/13 at approximately 1:30 p.m. She indicated she had no knowledge of and no evidence the Medical Staff had taken any action as required by the Bylaws with regard to physician #A's privileges. Refer to A0353.


Based on the cumulative effect of the Medical Staff failing to recognize ongoing and repeated violations of the Medical Staff Bylaws over a period of time exceeding two years and take appropriate action to enforce them, it was determined the facility was not in compliance with the Condition of Participation Medical Staff.
VIOLATION: MEDICAL STAFF CREDENTIALING Tag No: A0341
Based on credential file review and staff interview it was determined the medical staff failed to accurately examine the credentials of one (#A) of one candidate applying for medical staff membership. The Governing Body approved the reappointment of a candidate who had been continuously suspended from staff for violations of the Bylaws for a period of over one year at the time of his reappointment and continues to be in violation of the Bylaws following his reappointment, for a period of approximately 26 months. This practice fails to ensure the medical staff makes quality recommendations regarding the qualifications of candidates to promote safe medical care.

Findings include:

Patient #1 was admitted to the facility under the care of physician #A on 12/24/12.

A review of physician #A's credential file was conducted on 3/29/13 at approximately 9:15 a.m. The file contained a copy of a letter dated 2/23/12 addressed to the physician and signed by the Governing Body indicating physician #A's application for reappointment to the Medical Staff had been approved. He was granted active privileges in family practice.

An interview with the Vice President of Quality Management on 3/29/13 at approximately 11:30 a.m. revealed the Director of Medical Records indicated the physician had been on continuous suspension of his admitting privileges since January 2011. He confirmed the findings the Medical Staff recommended the reappointment of the physician while the physician was suspended from the staff for ongoing violations of the Bylaws. Physician #A remained on suspension at the time of the survey.
VIOLATION: MEDICAL STAFF BYLAWS Tag No: A0353
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on facility's Bylaws and document review and staff interview it was determined the Medical Staff failed to enforce the Bylaws for the attending physician (#A) caring for 1 (#1) of six sampled records. This practice fails to ensure physicians adhered to the medical staff bylaws to promote safe and quality medical care.

Findings include:

Patient #1's History and Physical dated 12/26/12 and signed by the attending physician indicated the patient was admitted on [DATE] to the physician care.

A review of the 2011 Medical Staff Bylaws page 37, paragraph 6.9 Automatic Resignation , Section 6.9.2 Failure To Be Reinstated Following Automatic Suspension, indicated a member of the medical staff who is automatically suspended due to failure to complete medical records, and the suspension continues for more than 60 days without completion of the medical records, then the individual shall be deemed to have voluntarily resigned from the staff, voluntarily relinquished all clinical privileges, and waived any rights to fair hearing or appeal process. The individual shall be notified of the automatic voluntary resignation and the need to submit a new application if reinstatement of membership for clinical privileges is desired.

A document provided by facility staff in response to a request for Rules and Regulations related to medical records completion was reviewed on 3/29/13. Section 14. indicated any physician not completing records within 60 days will have all admitting, elective surgical and consulting privileges suspended. Physicians remaining delinquent for 60 days will be sent a written notice informing him/her that he/she will be required to attend the next meeting of the Medical Executive Committee (MEC) if the delinquent records are not completed prior to the date of the meeting.

An interview was conducted with the Vice President of Quality on 3/29/13 at approximately 10:30 a.m. He presented documentation from the Medical Records Director indicating the attending physician had been continuously suspended from the medical staff due to incomplete medical records for all of 2011, 2012 and continued on suspension as of the current date. He confirmed the finding that the Rules and Regulations state a suspended physician loses his/her admitting privileges for the duration of the suspension. He was unable to explain the manner in which a suspended physician without admitting privileges is able to admit patients.

An interview was conducted with the Chief Executive Officer on 3/29/13 at approximately 1:30 p.m. She stated the facility was unable to provide documentation related to the attending physician's notification of delinquency, notification of suspension, request to appear before the Medical Executive Committee or documentation of any action taken by the Governing Body as a result of the attending physician's appearance or failure to appear or his continued suspension of privileges for over two years. She indicated she had no knowledge or evidence of any action being taken by the Medical Staff or the Governing Body to enforce the Bylaws with regard to the attending physician.

A copy of a letter dated 11/29/12 addressed to the attending physician was submitted by the Vice President of Quality Management on 4/2/13. The letter indicated the attending physician had one or more incomplete medical records that would become delinquent in one week. The letter indicated if the attending physician did not complete his medical records within the specified time, his admitting, surgical and consultative privileges would be suspended per the hospital's Bylaws. The letter included a list of 29 delinquent records. The oldest delinquency was a record requiring dictation of the Discharge Summary for a patient discharged on [DATE]. The list of 29 delinquent records included multiple admissions for patients whose records were delinquent from a previous admission:

The review of the letter dated 11/29/12 indicated the suspended attending physician admitted and readmitted multiple patients throughout the time his admitting privileges were suspended, after the time he should have been considered to have voluntarily resigned all his clinical privileges per the facility's Bylaws.
VIOLATION: REASSESSMENT OF A DISCHARGE PLAN Tag No: A0821
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, policy review and staff interview it was determined the facility failed to ensure the discharge plan for one (#1) of six sampled records was reassessed in response to changes in the patient's condition to ensure the discharge plan met the needs of the patient following discharge. This practice does not ensure a safe discharge.

Findings include:

Patient #1 presented to the Emergency Department from an Assisted Living Facility (ALF) on 12/24/12 and was admitted . She remained hospitalized for 10 days and was discharged on [DATE] at 5:03 p.m.

The History and Physical dated 12/26/13 and signed by the attending physician indicated the patient was admitted for treatment of dehydration, increased white blood cell count and infection of the colon. She had a history of critical, inoperative [DIAGNOSES REDACTED]. The physician documented the patient did not have angina, Congestive Heart Failure (CHF) or syncope indicating the [DIAGNOSES REDACTED] was not symptomatic and the cardiac status was stable. The Physical Examination included documentation an oxygen saturation level of 97%.

Case Manager's notes dated 12/25/12 at 12:10 p.m. indicated the case manager interviewed the patient and determined the patient was expected to return to the ALF. The note dated 12/26/12 at 1:52 p.m. indicated the case manager had spoken with the ALF administrator regarding the patient's return to the ALF, possible transfer to a Skilled Nursing Unit or Home Health Care assistance following discharge. The note dated 1/3/13 at 4:32 p.m. indicated the case manager contacted the patient's son and the administrator of the ALF regarding the patient's discharge that day.

The Shift assessment dated [DATE] at 8:02 a.m. indicated the patient's oxygen saturation was lower than usual at 94%. Physician's orders form dated 1/3/13 at 2:00 p.m. included an order written and signed by the attending physician to discontinue the patient's oxygen that was being administered as needed at 2 liters per minute per nasal cannula. Review of the Medication Administration Record revealed the patient was administered Valium at 4:58 p.m. for anxiety. The Unit Log dated 1/3/13 at 5:03 p.m. indicated the patient was discharged to the ALF.

Review of the ALF documentation dated 1/3/13 revealed the patient arrived at the ALF at 5:25 p.m. The patient had shallow respirations, the lower legs were grossly edematous and the upper legs were mottled. The notes documented the ALF administrator was calling 911 to arrange emergency transport back to the hospital. The administrator then heard a family member state the patient was not breathing at 5:30 p.m. The patient was pronounced at the ALF at 5:40 p.m. on 1/3/13, approximately 40 minutes following discharge from the acute care facility.

A thorough review of the medical record failed to reveal any reassessment of the patient's discharge plan as a result of her change in condition. There was no evidence of reassessment of the patient's oxygen saturation level following the physician's order to discontinue the oxygen to determine if the patient was tolerating being without oxygen or would require it at home following discharge. There was no evidence the RN assigned to the care of the patient was aware of the mottling of the lower extremities. There was no evidence of the vital signs being assessed prior to the patient leaving or the patient's response to the Valium that was administered approximately ten minutes before discharge to determine if the discharge plan needed to be changed.

An interview was conducted with the Chief Executive Officer on 3/29/13 at approximately 1:30 p.m. She indicated she agreed with the finding that the mottled condition of the patient's upper legs would not have occurred in the short time between the patient leaving the facility and arriving at the ALF. She confirmed the finding that an appropriate reassessment of the patient's needs at discharge had not occurred.