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Based on document review and interviews, it was determined that the Hospital failed to ensure anesthesia services, were provided in a well-organized manner, by failing to ensure anesthesia services were available and provided for a patient in need. Therefore, the Condition of Participation 42 CFR 482.52, Anesthesia Services was NOT met, as evidenced by:

Findings include:

1. The Hospital failed to ensure anesthesia services were available to protect the health and safety of the patient. See A-1002

An immediate jeopardy (IJ) investigation was conducted on 7/11/2022 through 7/13/2022 for complaint #IL00148832/221810. The immediate jeopardy began on 7/5/2022, due to the Hospital failed to ensure anesthesia services were available to protect the health and safety of the patient; and was identified on 7/12/2022 at 42 CFR 482.52, Anesthesia Services The IJ was announced on 7/12/2022 at 3:15 PM, during a meeting with Adult Medical Nursing Manager (E #1); Accreditation Manager (E #2); Director of Education/Professional Practice (E #3); CMO -Chief Medical Officer (E # 4 ) and Regulatory Compliance Specialist (E #10), and was not removed by the survey exit date of 7/13/2022.

Based on document review and interview, it was determined for 1 of 1 catheterization lab patient (Pt #1), the Hospital failed to ensure anesthesia services were available to protect the health and safety of the patient. The patient was accepted by the Intensivist (E #6) as a transfer to the Medical ICU after going to the catheterization lab for a thrombectomy. Pt #1 had to be transferred to another facility from the catheterization lab due to lack of anesthesia services. This has the potential to affect all patients that may require anesthesia services.

Findings include:

1. Pt #1's medical record was reviewed throughout the survey (07/11/2021 through 07/12/2021). Pt #1 was transferred on 7/5/2022 by Medical-Flight-Air Evac from alocla hospital to St John's Hospital (SJH) in Springfield with an Acute Left MCA Stroke. An interview was conducted with the Director of Education and Professional Practice (E #3) during the survey. E #3 stated, "This patient was originally transferred to us as a Stat Stroke. (immediate) "

2. The 7/5/2022 "Inpatient Consultation Note" by Vascular/Interventional Neurologist (E #5) stated "Upon admission to St John's Hospital (SJH) (Pt #1) presented with shortness of breath, speech difficulties and right sided weakness. (Pt #1's) CTA (Computed Tomography Angiogram - used to diagnose blockages) head and neck revealed left M2 (middle cerebral artery) occlusion and (Pt #1) was transferred to St John's Hospital for mechanical thrombectomy (removal of a blood clot)." Upon arrival to SJH Cath lab, on 7/5/2022 at 2:28 PM, "(Pt #1) was alert, with right sided weakness and was noted to be in respiratory distress, tachypneic, requiring nonrebreather 15 L (Liters) to maintain 02 (oxygen) saturation and anesthesia was not available to us so she was transferred to (name of another local hospital) for further care." A physician note by E #5 on 7/5/2022 at 6:04 PM stated, "I transferred the patient to (name of another local hospital) as there was immediate availability for anesthesia for thrombectomy (removal of blood clot). The patient's respiratory rate went up to 38-44 with abdominal breathing, on NRB (non-rebreather)15 L, Pt #1 was at risk of respiratory failure if I were to lay patient flat for the procedure. It wasn't safe to proceed without intubation. (Insertion of a breathing tube requiring anesthesia)"

3. On 7/11/2022 at approximately 2:40 PM, a telephone interview was conducted with E #5.
E #5 stated "I made the decision to transfer the patient to (name of another local hospital) . I could not get an Anesthesiologist to intubate an 'urgent' case. The patient was not dying but had an urgent need for intubation. They had several ongoing cases and could only assist if the case was 'emergent.' We needed to get the patient done. I called (name of another local hospital) and they had anesthesia available to do the case. The faster we remove the clot the better. It is important to get the clot removed within 24 hours and we were in 6th hour. If they had more Anesthesiologist, they would have given me the Anesthesiologist. Most generally we do thrombectomy's without anesthesia, this case was different." MD #2 agreed, Pt #1 would not have been transferred if anesthesia personnel would have been available."

4. The Anesthesia Cath Lab schedule was reviewed for 7/5. The schedule included 1 CRNA from 7 AM until 3:30 PM, 1 CRNA 7 AM until 5:30 PM, and 1 MD. Per an interview with MD #2, "The anesthesia personnel were tied up in other cases. There was no anesthesia available, so we needed to transfer the patient."