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.
|BOCA RATON REGIONAL HOSPITAL||800 MEADOWS RD BOCA RATON, FL 33486||Nov. 7, 2018|
|VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN||Tag No: A0820|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interviews and facility document reviews, the facility failed to ensure the patient's representatives were informed of the facility's intent to discharge the patient to a facility that was not agreed to by the patient's representatives for 1 of 3 sampled patients (Patient #1).
The findings included:
The Discharge of a Patient/Discharge Planning Policy and Procedure was last revised on 05/09/2018, and revealed the Patient Discharge Instructions are explained to the family at the time of the discharge.
On 08/10/18, this [AGE] year-old-man presented to the Emergency Department via law enforcement under a Baker Act with dementia and acute psychosis. While being examined, it was determined he had a first-degree Atrioventricular (AV) block. His Baker Act was placed on hold while they admitted the patient to treat his heart block.
This patient had been residing with his daughter, who told the staff her brother is the Power of Attorney (POA), and he lives in New Jersey.
The patient's daughter and his son, who is the Power of Attorney, informed the psychiatrist and the case managers, they wanted their father air lifted to a facility in New Jersey.
The case managers had contacted the Florida Memory Care Unit and had received acceptance of the patient, without the daughter and son, Power of Attorney, ever agreeing to the Florida Memory Care Unit. The record revealed the patient's daughter was approached by the case managers and asked to agree to discharge the patient to the Florida Memory Care Unit. The record failed to reveal any evidence where the daughter approved this or signed any paperwork for the Florida Memory Care Unit.
The patient's son and Power of Attorney, who lives in New Jersey, had communicated via phone with the case managers and the psychiatrist. Each time he explained that he and his sister were busy making arrangements to have their father air lifted to a facility in New Jersey.
On 08/21/18 at approximately 4:38 PM, the facility in New Jersey had notified this facility, "Yes, willing to accept patient."
On 08/21/18 at approximately 8:30 PM, instead of arranging for the patient to be air lifted to the facility in New Jersey, the facility discharged the patient to the Florida Memory Care Unit. They did this without first notifying the patient's son and daughter or obtaining their approval for this discharge.
On 08/23/18, according to the wishes of the patient's son and daughter, the patient was discharged from the Florida Memory Care Unit, via air ambulance, to the facility in New Jersey.
The psychiatrist confirmed he was fully aware of the wishes of the patient's son/Power of Attorney and daughter. He stated he knew they were arranging to have their father air lifted to a facility in New Jersey and he was ready and willing to lift the Baker Act so they could accomplish their goal.