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.

REGIONAL HOSPITAL OF SCRANTON 746 JEFFERSON AVENUE SCRANTON, PA 18501 April 30, 2020
VIOLATION: ORGANIZATION AND DIRECTION Tag No: A1101
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure a physician wrote a transfer order for a patient being transferred to another facility for a MRI and failed to ensure a transfer form was completed for five out of five medical records reviewed (MR1, MR2, MR3, MR4 and MR5).

Findings include:

Review on March 10, 2020, of the facility "Patient Transfer Policy," revised April 23, 2019, revealed "Purpose: Protocol establishes standards for interfacility patient transfer. Policy: Indications for transfer include medical necessity ... Transportation of the patient should occur in an ambulance that is staffed with qualified personnel and has appropriate equipment for the transfer, the provider at Regional Hospital in Scranton will determine the most appropriate EMS personnel to transfer the patient ... Procedure: ... Transfer of Stable Patient: ... 4. Appropriate arrangements are made for transport mechanism and treating provider will determine the staffing required to accompany the patient; ... For all patient transfers a transfer form is to be completed ..."

Review on March 10, 2020, of facility "COBRA/EMTALA Policy," revised February 22, 2019, revealed "... V. Transfer means the movement of an individual outside a hospital's facilities at the direction of any person employed by, affiliated or associated, directly or indirectly, with the hospital, but does not include such a movement of an individual who has been declared dead or who leaves the hospital against medical advice or without being see [sic], or movement of an individual to or from a hospital owned facility that is operating under the hospital's provider number, as long as all person [sic] with the same medical condition are moved to this location and there is a bona fide medical reason for moving the patient. ... 2. Medical Treatment The Hospital shall provide a medical treatment within its capacity to minimize the risks of transfer to the individual's health ... 3. Appropriate Transfer. The transferring physician will determine and order life support measures, personnel and equipment that are medically appropriate to sustain the individual during transfer. ... 4. Personnel and Procedures. The Hospital will provide that licensed nurses and other qualified personnel are available and on duty to assist with patient transfers, provide accurate information, and ensure that written protocols or standing delegation orders, as approved by medical staff, are in place to guide Hospital personnel when a patient is to be transferred to another hospital. ..."

A request was made on March 10, 2020 for a transfer order policy. None was provided.

Review on March 10, 2020, of MR1 revealed MR1 presented to the Emergency Department (ED) on January 25, 2020. MR1 reported falling two days prior from a ladder while hanging curtains on an 85-inch-high window.

Continued review of MR1 revealed an MRI was ordered on January 25, 2020. Continued review revealed MR1 was transferred to [Name of local hospital] for the MRI. Nursing documentation revealed MR1 eloped from [Name of local hospital] prior to the MRI being completed. MR1 had no documentation a transfer order was written by the provider or a transfer form was completed.

Interview on March 10, 2020, with EMP3 confirmed MR1 presented on January 25, 2020, after falling from a ladder while hanging curtains on an 85-inch high window. EMP3 confirmed MR1 was ordered an MRI by OTH1 and was transferred to [Name of local hospital] for the MRI. EMP3 confirmed MR1 eloped from [Name of local hospital] prior to the MRI being completed. EMP3 confirmed MR1 had no documentation of a transfer order written by the provider or a transfer form was completed.

Review on March 10, 2020, of MR2 revealed MR2 presented on January 25, 2020, after MR2 was walking with a walker at home and his legs were not moving well. Documentation revealed MR2 was ordered an MRI stat (immediately). Continued review revealed MR2 was transferred to [Name of local hospital] for the MRI and then returned to the facility. MR2 had no documentation a transfer order was written by the provider or a transfer form was completed.

Interview on March 10, 2020, with EMP3 confirmed MR2 presented on January 25, 2020, after MR1 was walking with a walker at home and his legs were not moving well. EMP3 confirmed MR2 was ordered an MRI stat and MR2 was transferred to [Name of local hospital] for the MRI and then returned to the facility. EMP3 confirmed MR2 had no documentation a transfer order was written by the provider or a transfer form was completed.

Review on March 10, 2020, of MR3 revealed MR3 presented on November 3, 2019, complaining of left buttock pain radiating down left leg. Documentation revealed MR3 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI and then returned to the facility. MR3 had no documentation a transfer order was written by the provider or a transfer form was completed.

Interview on March 10, 2020, with EMP3 confirmed MR3 presented on November 3, 2019, complaining of left buttock pain radiating down left leg. EMP3 confirmed MR3 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI and then returned to the facility. EMP3 confirmed MR3 had no documentation a transfer order was written by the provider or a transfer form was completed.

Review on March 10, 2020, of MR4 revealed MR4 presented on January 1, 2020, with a headache and visual changes. MR4 was ordered an MRI stat (immediately) and was transferred to [Name of local hospital] for the MRI and then returned to the facility. MR4 had no documentation a transfer order was written by the provider or a transfer form was completed.

Interview on March 10, 2020, with EMP3 confirmed MR4 presented on January 1, 2020, with a headache and visual changes. EMP3 confirmed MR4 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI and then returned to the facility. EMP3 confirmed MR4 had no documentation a transfer order was written by the provider or a transfer form was completed.

Review on March 10, 2020, of MR5 revealed MR5 was admitted to the facility on on [DATE], with a cerebrovascular accident (stroke). MR5 was ordered an MRI and was transferred to [Name of local hospital] and then returned to the facility. EMP3 confirmed MR5 had no documentation a transfer order was written by the provider or a transfer form was completed.

Interview on March 10, 2020, with EMP3 confirmed MR5 was admitted to the facility on on [DATE], with a cerebrovascular accident. EMP3 confirmed MR5 was ordered an MRI and was transferred to [Name of local hospital] and then returned to the facility. EMP3 confirmed MR5 had no documentation a transfer order was written by the provider or a transfer form was completed.
VIOLATION: INTEGRATION OF EMERGENCY SERVICES Tag No: A1103
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility documents, medical records (MR), and staff interview (EMP) it was determined the facility failed to provide MRI services for six out of six applicable medical records reviewed (MR1, MR2, MR3, MR4, MR5 and MR7).

Findings include:

Review on March 10, 2020, of the facility's "Scranton Hospital Company, LLC Board of Trustees Bylaws," dated July 2012, revealed, "... Article I-General Scope Be it resolved by the Board of Trustees of Regional Hospital of Scranton that the bylaws set out below shall govern the transaction of the business and affairs of the Hospital. 1.1 Purpose The purposes, goals, and objectives of the Board of Trustees of Regional Hospital of Scranton shall be to: ... 1.1 (b) Provide appropriate facilities and services to best serve the needs of patients ..."

Review on March 10, 2020, of the facility "Emergency Department Scope of Services Policy," revised July 18, 2019, revealed "Policy: Emergency Medicine is a dynamic specialty that involves the management of life threatening and non-life-threatening illnesses in patients who present to the Emergency Department for acute care. ... In the event that a patient requires care which is not available at Regional Hospital of Scranton, the patient will be provided a medical screening exam, stabilized and transferred by air or ground to the closest appropriate facility. ..."

Review on March 10, 2020, of the facility MRI staffing schedule from September 29, 2020, to present revealed the facility had two full-time MRI technicians on September 29, 2020. The facility scheduled MRI technician coverage Monday through Friday 7:00 AM to 8:00 PM and on call coverage Monday through Friday 8:00 PM to 7:00 AM. There was 24-hour on call coverage scheduled on Saturday and Sunday.

Continued review of the MRI staffing schedule revealed an MRI technician left employment on October 18, 2019. There was no facility MRI coverage on October 18, 19, 20, 22, and 24, 2019.

Interview on March 10, 2020, with EMP5 at approximately 10:30 AM confirmed the facility had two full-time MRI technicians from September 29, 2020, to October 18, 2020. EMP5 confirmed there was scheduled MRI coverage Monday through Friday 7:00 AM to 8:00 PM. EMP5 confirmed one full-time MRI technician left employment with notice on October 18, 2020. EMP5 confirmed there was no facility MRI coverage on October 18, 19, 20, 22, and 24, 2019.

Continued review of the facility MRI staffing schedule revealed the facility had one MRI technician from October 18, 2019, to January 26, 2020. There was documentation the facility did not have MRI coverage on October 28 and 30, 2019. There was also no MRI coverage November 1, 2, 3, 5, 7, 11, 13, 15, 16, 17, 19, 21, 25, 27, 29, and 30, 2019. There was no MRI coverage December 1, 3, 5, 13 through 19, 24, 25, 2019. There was also no MRI coverage December 27, 2019, through January 7, 2020 and January 11, 12, 18, 19, 25, 26, 2020.

Interview on March 10, 2020, with EMP5, at approximately 11:00 AM confirmed the facility had one MRI technician from October 18, 2019, to January 26, 2020. EMP5 confirmed the facility did not have MRI coverage on October 28 and 30, 2019. EMP5 confirmed there was also no MRI coverage November 1, 2, 3, 5, 7, 11, 13, 15, 16, 17, 19, 21, 25, 27, 29, and 30, 2019. EMP5 confirmed there was also no MRI coverage December 1, 3, 5, 13 through 19, 24, 25, 2019. EMP5 confirmed there was also no MRI coverage December 27, 2019 through January 7, 2020 and January 11, 12, 18, 19, 25, 26, 2020. EMP5 revealed the facility utilizes MRI coverage at another local hospital when they do not have coverage. EMP5 revealed patients are transported to another local hospital for an MRI and returned to the facility. EMP5 revealed the other local hospital is not under the facility's license or provider number.

Review on March 10, 2020, of MR1 revealed MR1 presented to the Emergency Department (ED) on January 25, 2020. MR1 reported falling two days prior from a ladder while hanging curtains on an 85-inch-high window.

Continued review of MR1 revealed an MRI was ordered stat (immediate) on January 25, 2020. Continued review revealed MR1 was transferred to [Name of local hospital] for the MRI. Nursing documentation revealed MR1 eloped from [Name of local hospital] prior to the MRI being completed.

Interview on March 10, 2020, with EMP3 confirmed MR1 presented on January 25, 2020, after falling from a ladder while hanging curtains on an 85-inch window. EMP3 confirmed MR1 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI. EMP3 confirmed MR1 eloped from [Name of local hospital] prior to the MRI being completed.

Review on March 10, 2020, of MR2 revealed MR2 presented on January 25, 2020, after MR2 was walking with a walker at home and his legs were not moving well. Documentation revealed MR2 was ordered an MRI stat. Continued review revealed MR2 was transferred to [Name of local hospital] for the MRI and then returned to the facility.

Interview on March 10, 2020, with EMP3 confirmed MR2 presented on January 25, 2020, after MR2 was walking with a walker at home and his legs were not moving well. EMP3 confirmed MR2 was ordered an MRI stat and MR2 was transferred to [Name of local hospital] for the MRI and then returned to the facility.

Review on March 10, 2020, of MR3 revealed MR3 presented on November 3, 2019, complaining of left buttock pain radiating down left leg. Documentation revealed MR3 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI and then returned to the facility.

Interview on March 10, 2020, with EMP3 confirmed MR3 presented on November 3, 2019, complaining of left buttock pain radiating down left leg. EMP3 confirmed MR3 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI and then returned to the facility.

Review on March 10, 2020, of MR4 revealed MR4 presented on January 1, 2020, with a headache and visual changes. MR4 was ordered an MRI stat (immediately) and was transferred to [Name of local hospital] for the MRI and then returned to the facility.

Interview on March 10, 2020, with EMP3 confirmed MR4 presented on January 1, 2020, with a headache and visual changes. EMP3 confirmed MR4 was ordered an MRI stat and was transferred to [Name of local hospital] for the MRI and then returned to the facility.

Review on March 10, 2020, of MR5 revealed MR5 was admitted to the facility on on [DATE], with a cerebrovascular accident (stroke). MR5 was ordered an MRI and was transferred to [Name of local hospital] and then returned to the facility.

Interview on March 10, 2020, with EMP3 confirmed MR5 was admitted to the facility on on [DATE], with a cerebrovascular accident. EMP3 confirmed MR5 was ordered an MRI and was transferred to [Name of local hospital] and then returned to the facility.

Review on March 10, 2020, of MR7 revealed MR7 was brought to the facility Emergency Department (ED) on January 12, 2020, for evaluation of a persistent headache. There was documentation MR7 had lab work and a CT scan of the head. MR7's lab work was within normal limits and CT scan was negative for acute findings. MR7 was diagnosed with dizziness and headache and was discharged home on January 12, 2020, at 22:26. There was no documentation MR7 received an MRI at the facility.

Interview on March 10, 2020, with EMP4, at approximately 2:30 PM confirmed MR7 was brought to the facility ED on January 12, 2020 for evaluation for a persistent headache. EMP4 confirmed MR7's lab work was within normal limits and MR7's CT scan was negative for acute findings. EMP4 confirmed MR7 was discharged home on January 12, 2020, at 22:26 and did not received an MRI at the facility.

Review on March 10, 2020, of the facility's Complaint and Grievance log revealed a grievance was filed with the facility on January 16, 2020, regarding MR7.

Review on March 10, 2020, of the grievance regarding MR7 revealed MR7's mother called the facility on January 16, 2020. MR7's mother was upset and requested her ED co-pay be refunded. MR7's mother stated MR7 should have received an MRI and was discharged with a major headache. MR7's mother stated she was advised by MR7's primary care physician to take the patient to another local hospital to have an MRI completed on January 14, 2020. MR7's mother stated she felt the patient received a lack of care at the facility.

Continued review of the MR7's grievance revealed there was facility documentation the ED co-pay should be written off. There was facility documentation the facility was currently having issues with MRI and full-time technician availability. There was facility documentation MR7 should have been transferred to a local hospital on January 12, 2020, and the patient should not have been discharged .

Interview on March 10, 2020, with EMP4, at approximately, 2:30 PM confirmed the facility Complaint and Grievance log contained a grievance regarding MR7. EMP4 confirmed there was facility documentation the facility was having issues with MRI availability and there was documentation MR7 should not have been discharged . EMP4 confirmed there was documentation the facility did not have MRI coverage on January 12, 2020.