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.

PARK ROYAL HOSPITAL 9241 PARK ROYAL DR FORT MYERS, FL May 11, 2016
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on medical record review, Inquiry/Referral information form review, policy and procedure review, and staff interview, the hospital refused to accept a patient for specialty care from a referring hospital after inquiring about the individuals insurance status, which caused an unnecessary delay in care for 1 (Patient #16) of 20 sampled patients medical records reviewed. Refer to Tag A-2408 for details.


Based on medical record review, Medical Staff Rules and Regulations review, bed census review, web site review, and staff interview, the hospital refused to accept from a referring hospital within the boundaries of the United States an appropriate transfer of a patient who required specialized psychiatric capabilities and facilities that were available, but was refused due to out of network insurance for 1 (Patient #16) of 20 sampled patients reviewed. Refer to tag A-2411 for details.

.
VIOLATION: DELAY IN EXAMINATION OR TREATMENT Tag No: A2408
Based on medical record review, Inquiry/Referral information form review, policy and procedure review, and staff interview, the hospital refused to accept a patient for specialty care from a referring hospital after inquiring about the individuals insurance status, which caused an unnecessary delay in care for 1 (Patient #16) of 20 sampled patients medical records reviewed.

The findings included:

Review of records from the medical center's emergency department revealed on 3/12/16 at 12:23 a.m. Patient #16 presented after he "broke a bottle and tried cutting his left wrist. The first listed diagnosis was "suicide attempt/self-injurious behavior lacerations left wrist." The physician documented "Patient will require Baker Act [involuntary psychiatric examination] and transfer to Baker [Act] receiving facility."

The medical record from the referring hospital's emergency department record showed on 3/12/16 at 7:09 a.m. the Medical Social Worker (MSW) documented "[name] called from Park Royal Hospital to inform MSW that the patient's insurance is out of network...they will not be able to take patient." At 8:10 a.m. Patient #16 was put in "observation" status in the medical center's emergency department. At 11:40 a.m. Patient #16 was transferred to another facility.

Review of Park Royal Behavioral Health Services Inquiry/Referral Information form from the Park Hospital Intake Unit revealed on 3/12/16 at 6:21 a.m. Patient #16 was referred to the hospital for psychiatric care related to suicidal ideation, depression and substance abuse. Documentation on the Inquiry/Referral Information form indicated that Patient #16 was not accepted because "insurance out of network." The hospital refused to accept patient #16 on 3/12/16 based on insurance status. The refusal delayed the services needed by the patient.

In an interview on 4/19/16 at 2:00 p.m., the hospital Director of Admissions said they check the patient's insurance when the referral was made, and if the insurance was not accepted by their hospital, they would refuse the patient.

The hospital's Pre-Admission Screening policy #AD1001, policy origination date: 1/1/12, Policy Review date(s) 1/23/14, 1/29/15 was reviewed. The policy revealed in part, Policy: Designated clinical staff complete pre-admission screening assessments on patients referred for psychiatric inpatient treatment to determine eligibility for admission ... Procedure... 2. If the patient does not meet the admission criteria or meets exclusionary criteria, inform the ... referring source of this result so that an appropriate disposition can be made." The hospital 's policy and procedure did not specify " insurance out of network" as an "exclusionary criteria" regarding not accepting a patient for psychiatric services.

.
VIOLATION: RECIPIENT HOSPITAL RESPONSIBILITIES Tag No: A2411
Based on medical record review, Medical Staff Rules and Regulations review, bed census review, web site review, and staff interview, the hospital refused to accept from a referring hospital within the boundaries of the United States an appropriate transfer of a patient who required specialized psychiatric capabilities and facilities that were available, but was refused due to out of network insurance for 1 (Patient #16) of 20 sampled patients reviewed.

The findings included:

Review of records from the medical center's emergency department revealed on 3/12/16 at 12:23 a.m. Patient #16 presented after he "broke a bottle and tried cutting his left wrist. The first listed diagnosis was "suicide attempt/self-injurious behavior lacerations left wrist." The physician documented "Patient will require Baker Act [involuntary psychiatric examination] and transfer to Baker [Act] receiving facility." The medical center's emergency department record showed on 3/12/16 at 7:09 a.m. the Medical Social Worker (MSW) documented "[name] called from Park Royal Hospital name to inform MSW that the patient's insurance is out of network...they will not be able to take patient." At 8:10 a.m. Patient #16 was put in "observation" status in the medical center's emergency department. At 11:40 a.m. Patient #16 was transferred to another facility.

Review of Park Royal Behavioral Health Services Inquiry/Referral Information form from the Park Hospital Intake Unit revealed on 3/12/16 at 6:21 a.m. Patient #16 was referred to the hospital for psychiatric care related to suicidal ideation, depression, and substance abuse. Documentation on the Inquiry/Referral Information form indicated that patient #16 was not accepted because "insurance out of network." The hospital refused to accept Patient #16 on 3/12/16 based on insurance status. Patient #16 was not accepted for transfer on 3/12/16.

The Agency for Health Care Administration website shows the transferring medical center has no adult psychiatric or substance abuse beds. The same website showed the Park Royal Hospital is licensed for 103 beds for adult psychiatric and substance abuse services. Review of the bed census revealed that on 3/12/16 Park Royal Hospital ' s bed census was 79, when the referring hospital requested an appropriate transfer for Patient #16 on 3/12/2016.

Review of the hospital's Medical Staff Rules and Regulations section 2.3.1 titled " Transfers from Other Acute Care Facilities " revealed in part, " Transfers from other acute care facilities must meet the following criteria: a. The patient must be medically stable for transfer; b. The patient ' s condition must meet medical necessity criteria for inpatient admission; c. the patient must require, and [Hospital] must be able to provide, a higher level of care or a specific inpatient service not available at the transferring facility; d. Responsibility for the patient must be accepted by a physician with admitting privileges at [Hospital]; and e. The transfer must be approved by the Hospital representative with authority for accepting transfers. "

In an interview on 4/19/16 at 2:00 p.m., the hospital Director of Admissions said they check the patient's insurance when the referral was made, and if the insurance was not accepted by their hospital, they would refuse the patient.

Park Royal Hospital refused to accept a transfer of Patient #16 on 3/12/2016 who was referred for psychiatric treatment from a referring hospital emergency department due to out-of-network insurance. The referring medical center does not have psychiatric beds. Park Royal Hospital had specialized psychiatric beds/services (capability) and had the capacity to treat patient #16 on 3/12/16. The hospital also failed to ensure that their Medical Staff Rules and Regulations were followed as evidenced by the referring facility did not have psychiatric services available, and Patient #16 was Baker Acted and his condition met medical necessity criteria for inpatient admission at Parker Royal Hospital.