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.

GOOD SAMARITAN HOSPITAL OF SUFFERN 255 LAFAYETTE AVENUE SUFFERN, NY 10901 July 6, 2011
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
Based on observations and staff interviews, it was determined the facilty does not maintain a central log for all patients that present to the facility for emergency care.

Findings include:

During interviews conducted on June 27, 2011 at 10:15 AM, the administrative staff stated that obstetric patients in labor, bypass the ED and are sent to the Labor and Delivery Unit (L&D unit) and that those patients are documented in a log on that unit. At 11:00 AM that morning, the Manager of the L&D Unit stated that the unit's log is separate from the ED log. A review of the OB and ED log for June 27, 2011 revealed the OB patients are not documented or incorporated in the ED. Similar findings were noted on 7/6/11 when the OB and ED logs for July 4, 2011 were reviewed.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record reviews and staff interviews, it was determined the facility failed to ensure that patients were informed of the risks and benefits of transfer for 5 of 6 patients transferred from the ED. In addition, there was no documentation in the medical records to indicate what aspects of the medical record, if any, accompanied the patients when they were transferred to the other facilities. This was found in MR#s 4, 6, 11, 22 and 23.

Findings include:

1. Patients that were transferred from the ED were not informed of the risks and benefits of transfer. MR #4 is a forty-eight year old patient who (MDS) dated [DATE] after intentionally ingesting 5+ Tylenol. The patient stated she had only taken 5 but the family stated the patient had taken more. The patient reported feeling depressed after gallbladder and fibroid surgery. The patient believed that part of her uterus was removed. The patient was alert and oriented x 3. The patient was transferred that night for inpatient care at another facility due to her Depression and Suicidal attempt. There was no indication in the medical record that the patient was informed of the risks and benefits of the transfer. This finding was verified with the administrative staff on 6/30/11 at approximately 3:30 PM who also stated that the facility does not keep a copy of the risks and benefits of transfer in the patients medical records.

2. In MR #23, the patient presented at the ED on 4/8/11 via EMS for Depression because he had recently lost his job and home. The patient was alert and oriented x 3. The patient "was disheveled, was not eating or sleeping and had begun to self medicate with beer." The patient was transferred to another facility for inpatient care that night but there was no documented evidence that the risks and benefits of transfer were explained to the patient.

3. Similar findings were noted in MR #s 6, 11 and 22.