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.

DECATUR COUNTY GENERAL HOSPITAL 969 TENNESSEE AVE S PARSONS, TN 38363 May 2, 2019
VIOLATION: CARE OF PATIENTS - PRACTITIONERS Tag No: A0066
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review and interview, the governing body failed to ensure all patients were under the care of a doctor for 4 of 4 (Patients #2, 3, 4 and 5) sampled patients admitted to the hospital.

The findings included:

1. Medical record review revealed Patient #2 (MDS) dated [DATE] with Suicidal Ideations. He was admitted and was seen by Physician Assistant (PA) #1. The patient was transferred to a psychiatric hospital on [DATE].
There was no documentation Patient #2 was under the care of a doctor/physician.

2. Medical record review revealed Patient #3 (MDS) dated [DATE] with complaints of Dyspnea, CHF and UTI. She was seen was admitted to the hospital and seen by Family Nurse Practitioner (FNP) #2. The patient was discharged home on 3/8/19.
There was no documentation Patient #3 was under the care of a doctor/physician.

3. Medical record review revealed Patient #4 (MDS) dated [DATE] with complaints of COPD, Edema and Dyspnea. She was admitted to the hospital and seen by FNP #1. The patient was discharged on [DATE].
There was no documentation Patient #4 was under the care of a doctor/physician.

4. Medical record review revealed Patient #5 (MDS) dated [DATE] with Chest Pain and UTI. She was admitted to the hospital and seen by FNP #2. She was discharged on [DATE].
There was no documentation Patient #5 was under the the care of a doctor/physician.

5. In a telephone interview on 3/18/19 at 2:46 PM Physician (doctor) #1 stated he does not see the patients in the DED or hospital, only signs behind the FNPs and PA.
VIOLATION: CARE OF PATIENTS - MD/DO ON CALL Tag No: A0067
Based on the hospital's bylaws and interview, the governing body failed to ensure a doctor was on duty or on call at all times to provide medical care and to provide over-site when necessary.

The findings included:

Review of the hospital's bylaws revealed, "...The hospital shall maintain and post a list of active staff members who are on back-up call for emergency service..."

In an interview on 3/27/19 at 10:30 AM in an empty room, the CNO verified there is no physician back-up call list and that Physician #1 keeps his own schedule.

In an interview on 3/27/19 at 11:20 AM in an empty room, Physician #1 stated he has no written agreement with the hospital.
VIOLATION: CARE OF PATIENTS - RESPONSIBILITY FOR CARE Tag No: A0068
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review and interview, the governing body failed to ensure a doctor was responsible for the management of patient care for 4 of 4 (Patients #2, 3, 4 and 5) sampled patients admitted to the hospital.

The findings included:

1. Medical record review revealed Patient #2 was admitted to the hospital 3/15/19 through 3/16/19 with Suicidal Ideations. The patient was seen and treated by Physician Assistant (PA) #1.
There was no evidence a physician/doctor was responsible for the management of the patient's care.

2. Medical record review revealed Patient #3 was admitted to the hospital 3/6/19 - 3/8/19 with complaints of Dyspnea, CHF and UTI. The patient was seen and treated by Family Nurse Practitioner (FNP) #2.
There was no evidence a physician/doctor was responsible for the management of the patient's care.

3. Medical record review revealed Patient #4 was admitted to the hospital 3/6/19 - 3/8/19 with complaints of COPD, Edema and Dyspnea. The patient was seen and treated by FNP #1.
There was no evidence a physician/doctor was responsible for the management of the patient's care.

4. Medical record review revealed Patient #5 (MDS) dated [DATE] with Chest Pain and UTI. The patient was admitted to the hospital and seen by FNP #2. The patient was discharged on [DATE].
There was no evidence a physician/doctor was responsible for the management of the patient's care.

5. In a telephone interview on 3/18/19 at 2:46 PM Physician (doctor) #1 stated he does not see the patients in the DED or hospital, only signs behind the FNPs and PA.

In a telephone interview on 3/20/19 at 1:30 PM the Chief Medical Officer stated Physician #1 reviews the medical records and signs behind the FNPs and PA.
VIOLATION: SUPERVISION OF EMERGENCY SERVICES Tag No: A1111
Based on medical record review and interview, the governing body failed to ensure Emergency Services were supervised by a doctor and failed to ensure a doctor was immediately available to provide direct care when necessary for 3 of 3 (Patients #1, 6 and 7) sampled patients seen in the emergency room .

The findings included:

1. Medical record review revealed Patient #1 presented to the emergency room (ER) on 3/17/19 with complaints of Abdominal Pain, Vomiting and Fever. The patient was found to have a Bowel Obstruction and transferred to another hospital. The patient was seen and treated by Family Nurse Practitioner (FNP) #2.
There was no evidence a physician/doctor was immediately available to provide direct care if necessary.

2. Medical record review revealed Patient #6 presented to the emergency room (ER) on 3/14/19 with complaints of Chest Pain. The patient had abnormal laboratory results and was transferred to another hospital. The patient was seen and treated by FNP #1.
There was no evidence a physician/doctor was immediately available to provide direct care if necessary.

3. Medical record review revealed Patient #7 presented to the emergency room (ER) on 3/17/19 with complaints of Anxiety. The patient was discharged home. The patient was seen and treated by FNP #2.
There was no evidence a physician/doctor was immediately available to provide direct care if necessary.

4. In a telephone interview on 3/18/19 at 2:46 PM Physician (doctor) #1 stated he does not see the patients in the DED or hospital, only signs behind the FNPs and PA.

In an interview on 3/27/19 at 10:30 AM in an empty room, the CNO verified there is no physician back-up call list and that Physician #1 keeps his own schedule.

There was no physician/doctor immediately available to provide direct care if necessary.