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.

LAUDERDALE COMMUNITY HOSPITAL 326 ASBURY AVENUE RIPLEY, TN 38063 Oct. 1, 2018
VIOLATION: EMERGENCY SERVICES Tag No: C0200
Based on policy review, medical record review and interview, the facility failed to provide the supplies necessary to meet the needs of the patients who present to the Emergency Department for treatment.

The findings included:

Due to financial restraints, the facility could not provide emergency medical care to potential patients with alcohol or drug abuse concerns which resulted in the emergency department being placed on diversion.

Refer to E-202
VIOLATION: EQUIPMENT, SUPPLIES AND MEDICATION Tag No: C0202
Based on policy review, medical record review, and interview, the facility failed to ensure supplies were readily available for laboratory testing for 2 of 9 (Patients #3 and #9) sampled patients seeking treatment in the Emergency Department.

The findings included:

1. Review of the facility policy, "Blood Cultures Collection by Nursing Services" documented, " ...Most cases of bacteremia are detected using two-three sets of separately collected blood cultures. More than three sets of cultures yield little additional information. Conversely, a single culture may miss intermittently occurring bacteremia and make the interpretation of clinical significance difficult when certain organisms are isolated ..."

2. Medical record review for Patient #9 revealed the patient was admitted to the Emergency Department (ED) on 9/13/18 with complaints of abdominal pain.

Review of physician orders dated 9/13/18 at 10:30 AM revealed an order to do blood cultures times 2.

Review of the blood culture report revealed the specimen was collected on 9/13/18 at 12:14 PM. The results of the blood cultures were faxed on 9/19/18 to the facility and documented as follows:
"TEST STATUS: Final; SPECIMEN SOURCE: Blood; SPECIMEN QUALITY: Adequate; RESULT: No growth after 5 days; TRANSPORT MEDIA: Aerobic bottle only received." There was no documentation why the Anaerobic specimen was not colleted and sent to the laboratory for results.

In an interview in the conference room on 10/1/18 at 9:36 AM, the Chief Executive Officer (CEO) stated, "We could not pay the bills ...very tight on budget. Lab is one we are tight on. We ran out of supplies. For example if we pay our bill on Friday, which is usually when money is release, cannot get supplies until Monday ..."

In an interview in the conference room on 10/1/18 at 2:06 PM the Director of the Laboratory stated, "Normally we do both [anaerobic and aerobic] blood cultures but we were transitioning through labs and had limited supplies of only aerobic bottles for cultures ..."

3. Medical record review for Patient #3 revealed an admission to the ED on 9/4/18 for history of depression and suicidal ideation.

Review of the physician orders dated 9/4/18 at 5:35 PM documented a Tylenol (Acetaminophen) level was ordered.

Review of the facility lab results revealed the Acetaminophen level was sent to another local hospital to be completed.

In an interview in the conference room on 10/1/18 at 9:34 AM the Director of the Laboratory stated, "We were out of reagents to test for salicylate and acetaminophen for 2-3 days and out of reagent to test for Oxycodone for 2 weeks."

In an interview in the conference room on 10/1/18 at 9:35 AM the Chief Nursing Officer (CNO) stated, "When out of supplies we will divert patients to [Name of hospital #1] ...To be admitted to our Medical Stabilization Unit, must have a urine drug screen. Psych doesn't have the means to do medical clearance\medical stabilization because must do urine drug screen. We call EMS [Emergency Medical Services] and divert but cannot divert police or walk-ins. When those come in, the doctor screens and if urine need drug screen, send to another hospital ..."

In an interview in the conference room on 10/1/18 at 10:23 AM the Director of the Laboratory stated, "On 8/31/18 we ran out of reagents [materials required to test for presence of drugs] for acetaminophen/salicylate's/Oxycodone. We received reagents on 9/8/18."

In an interview in the conference room on 10/1/18 at 2:00 PM the CNO stated, "From 8/31/18 through 9/8/18 we could not admit psych [psychiatric] or alcohol [abuse or intoxication] because we could not do a urine drug screen. We notified EMS."

4. In an interview with this surveyor regarding financial stability, the hospital revealed the following:

When asked by the surveyor if supplies were ever lacking, at 9:15 AM, the CNO stated, "We have been down to the wire. This past Friday waiting on a shipment which did not come in until Saturday. We ran out of CO2 reagents-used to test for Troponin's. Had to send test to [Name of town where another local hospital is located]...We are financially burdened but I don't let patients suffer...We were out of reagents for drug screens-we did not admit psych-we were out for 2 days. We notify HRTZ [Healthcare Resource Tracking System] part of TN EMA, our local EMS that we cannot accept patients with suspected drug/alcohol issues..."

In an interview in the conference room on 10/1/18 at 9:35 AM, the CNO stated, "When out of supplies, will divert to [name of local hospital]..."

In an interview on 10/1/18 at 9:42 AM, the CNO stated, "To be admitted to our Medical Stabilization Unit, must have urine drug screen. Psych doesn't have a means to do medical clearance (medical stabilization) because must do urine drug screen. We can call EMS and divert but cannot divert police or walk-ins. When they come in, the MD screens and if need urine drug screen, send to another hospital."

In an interview in the conference room on 10/1/18 at 2:00 PM the CNO stated, "From 8/31/18 through 9/8/18 we could not admit psych or alcohol because we could not do a urine drug screen. We notified EMS."

In an interview in the conference room on 10/1/18 at 2:55 PM, the CEO stated he reports on the financial status in the Governing Board (GB) and Med Executive committee meetings. He stated he reports if there's been a problem such as with lab, but the minutes don't reflect it...just had GB meeting last week and it was discussed. No minutes have been approved yet. He further stated there is nothing in the minutes where the board is notified of financial issues, ..."tell them about paying ED doctors, lab bills ect..." He further stated the quality of care is not affected.