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.

CLEVELAND CLINIC MARTIN NORTH HOSPITAL 200 SE HOSPITAL AVE STUART, FL 34995 March 14, 2019
VIOLATION: SYSTEM MEDICAL STAFF NEEDS Tag No: A0352
Based on staff interview and clinical and administrative record review, the facility failed to ensure the contracted medical services for neonatology provided the required physician coverage as indicated by the Level II hospital certification for 1 of 3 sampled patients (Patient # 1).

The findings included:

The facility is identified as a Level II NICU (Neonatal Intensive Care Unit). Neonatal Intensive Care Service, 59C-1.042 document regarding Physician Staffing, " Level II Neonatal Intensive Care Services shall be directed by a neonatologist or a group of neonatologists who are on active staff of the hospital with unlimited privileges and provide 24-hour coverage and who are either board certified or board eligible in neonatal-perinatal medicine."

Review of the Professional Services Agreement made with the hospital for Neonatology coverage, the physician services provided by the provider stipulate that the provider "will provide 24/7 coverage (in house and on-call) at the hospital".

Review of the schedule for Neonatology covererage, revealed in January, February and March there was one neonatologist scheduled to provide 24 hour coverage at two facilities. Additionally, there are multiple days in March when there is no Neonatal Nurse Practitioner (NNP) assigned to cover the facility and the physician is assigned to cover two facilities. The March 2019 schedule does not have a NNP assigned to this facility on March 1, 2, 3, 4, 5, 8, 9, 10, 11, 17 and 29.

Review of the clinical record for Patient # 1 revealed the infant patient was born on 03/04/19 at 2:15 PM. The infant was delivered via an emergency Caesarean Section (C-Section) secondary to her mother experiencing Placenta Abruption. (Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. In some cases, early delivery is needed. Placental abruption (abruptio placentae) is an uncommon yet serious complication of pregnancy. The placenta develops in the uterus during pregnancy. It attaches to the wall of the uterus and supplies the baby with nutrients and oxygen. Placental abruption occurs when the placenta partially or completely separates from the inner wall of the uterus before delivery.) During the delivery, there was the Obstetrician (OB) physician, Midwife, three (3) Registered Nurses, Anesthesiologist and a Nurse Anesthetist. There was not a Neonatologist present at the time of the infant's birth at 2:15 PM to attend to medical needs of the infant. The infant immediately, "within 30 seconds", began to experience emergent medical issues, "not breathing and had no heart rate", which required the expertise of the neonatology specialist to provide the needed medical services to the infant. However, there was further notation that the emergency room physician had to be summoned to provide medical assistance to the infant and assisted with the resuscitation, "he intubated the infant" secondary to a neonatologist not being present. The neonatologist arrived later at 2:35 PM (20 minutes) after the baby's birth. After stabilization, the infant was transferred to another hospital for more intensive medical services.

An interview was conducted with the Medical Director of NICU on 03/13/19 beginning at approximately 1:15 PM, who reported that the facility changed providers for neonatologist coverage in January and the physicians cover two facilities. They currently have a staff of three physicians but have plans to get more physicians credentialed. She reported they are responsible to respond to calls, round daily with infants and prenatal consults. She further confirmed that they are currently providing on-call coverage to the facility. She further stated that the NICU nurses and Respiratory Therapists are trained for neonatal resuscitation and they are to stabilize the infant until the neonatologist arrives. However, it should be noted the NICU Nurses and RT certifications are limited and unable to provide the medical expertise, if the infant requires intubation and other specialty services needed for infant resuscitation.