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Based on observation and interviews, the facility governing body failed to be responsible for the conduct of the hospital as an institution, as services ceased on 11/19/2010 while patients were receiving services in the hospital.

Findings were:

On 11/19/2010, the Texas Department of State Health Services (DSHS) received word that the hospital had closed, giving patients and staff a short time to vacate the building. Media reports, both television and newspapers, verified this, as did the Bastrop City Police Department. The police had been notified at the time of closure in order to secure the facility.

There was no notification given to CMS or the State of Texas Health Facility Licensing/Compliance Departments at DSHS about the hospital closure. It was reported that there were inpatients and emergency room patients in the facility at the time of closure. The inpatients were discharged and one patient was transferred to another facility via ambulance. It is unknown if the if there was any discharge planning for the patients sent home, or any discharge orders written by a physician. There is nothing known about disposition of facility records, drugs and biologicals, medical devices, or radiation.

Surveyors arrived at the hospital at 8:45 am on 11/22/2010. The TX Department of Transportation signage " H, " the universal sign for " hospital. " was on the highway directing patients to the facility. The " Emergency " and " Entrance " signs located on hospital property were covered by blue electrical tape. One large billboard-like sign welcoming people to Lakeside Hospital was still on the grounds facing the highway.

All external doors to the facility were locked, and a private security team was on-site at the front and the rear of the facility. No one was in the building. Located inside the building (seen through windows) were medical supplies, carts, and other equipment used during normal hospital activity. There were signs on each external door directing people to call a phone number for medical records and a sign directing people to call 911 for emergencies. Two bins used to dispose of personal health information and/or other business documents (locked) were seen on the loading dock. One was empty, but one was full, presumably of documents that needed shredding. The bin could easily be moved from the loading dock.

One former employee on the premises was interviewed at 9 am on 11/22/2010, and reported working at the hospital in the maintenance department since the hospital opened in 2006. The former employee stated that no one had any idea the hospital was closing. The former employee reported that they were called into an office last Friday (11/19/10) and told about the closing, then asked to leave the facility at once.

The surveyors returned to the facility at 10:45 am and found several former employees at the outside entrance. One former employee, the Director of Plan Operations, could no longer get into the building because another company who owns most of the medical equipment came and changed the locks. Another employee, a radiology tech, stated staff members in the radiology department were told on Friday about the closing, but they were able to complete the studies that were in progress on outpatients. The tech also stated that there were possibly 4 inpatients that were discharged from the facility on 11/19/2010 due to the closure.

The Bastrop Police Department was contacted regarding their knowledge of the hospital closure. Contact occurred via telephone on November 19, 2010 immediately following the call to the EMS provider. A police department staff member stated that the Bastrop Police Department was contacted because the facility is within the city limits of Bastrop, and that they were called shortly before the closure " just to make sure that everything went okay, " in case there were any issues from outgoing employees toward management. The staff member was not able to provide the name of the person or people that contacted the police department.

Following notification by Texas Department of State Health Service ' s EMS Compliance Unit, a local EMS company was contacted, as that ambulance service was at the facility at the time the hospital was closed. Contact occurred on 11/19/10 at approximately 3:15 PM via telephone. A staff member reported that the employees were informed, and had five minutes to vacate the facility after they were told by their corporate owners that the facility was closing. This staff member also stated that any patients that remained in the facility were immediately discharged; and that one patient was transported by his ambulance service to another nearby hospital . The staff member stated that there were Deputy Sheriffs present at the time the facility was closed.

Patient #1 was transferred to another acute care hospital on 11/19/2010 due to the closure of Lakeside Hospital. The receiving hospital provided a copy of the medical records that Lakeside Hospital sent with Patient #1 when transferred the afternoon of 11/19/2010. According to the medical records, the patient had been an inpatient at Lakeside since the day before, 11/18/2010, and was being treated for low potassium level and congestive heart failure. There was no documentation provided regarding discharge planning. A physician order, untimed and dated 11/19/2010, stated that the patient should be transferred to another hospital. The order was a verbal order and was not signed by the physician.

Based on observation and interviews, the facility failed to protect and promote each patient's rights, as the hospital closed on 11/22/2010 while providing services to patients. Medical records were unavailable to determine if patient's rights were provided.

Based on observation and interviews, the facility did not ensure that a discharge planning process was in place and for all patients who were receiving services at the time the hospital closed on 11/19/2010. All patients were abruptly discharged and/or transferred to another facility at the time of closure.

Findings were:

Patient #1 was transferred to another acute care hospital on 11/19/2010 due to the closure of Lakeside Hospital. The receiving hospital provided a copy of the medical records that Lakeside Hospital sent with Patient #1 when transferred the afternoon of 11/19/2010. According to the medical records, the patient had been an inpatient at Lakeside since the day before, 11/18/2010, and was being treated for low potassium level and congestive heart failure. There was no documentation provided regarding discharge planning. A physician order, untimed and dated 11/19/2010, stated that the patient should be transferred to another hospital. The order was a verbal order and was not signed by the physician.

During a tour of the facility conducted the morning of 11/22/2010, an ex-employee, a radiology technician, stated he was told on Friday about the closing, but was allowed to complete the studies that were in progress on outpatients. He also stated he " thought " there were 4 inpatients that were discharged from the facility on 11/19/2010 due to the closure and was unsure about their status. No medical records were available to determine the status of the 4 inpatients who were discharged.

Based on observation and interviews, the facility failed to meet the emergency needs of patients in accordance with acceptable standards of practice, as the hospital closed abruptly on 11/19/2010 and instructed patients to report to another nearby hospital when they presented for emergency care at the time of closure. Additionally, signage is still in place leading persons with emergency needs toward the closed hospital.

Findings were:

A tour of the hospital was conducted at 8:45 am on 11/22/2010. The TX Department of Transportation signage " H, " the universal sign for " hospital, " was on the highway directing patients to the facility. The " Emergency " and " Entrance " signs located on hospital property were partially covered by blue electrical tape, but one large billboard-like sign facing the highway welcomed people to Lakeside Hospital.

An interview was conducted with the Clinical Manager of a nearby acute care hospital the morning of 11/22/2010. The manager, Staff #2, stated they did not accept any inpatient transfers from Lakeside, but probably received several ED patients. Staff #2 stated that ED staff reported that at 8:30 am, EMS was stating on the scanner that Lakeside was on full diversion. Staff #2 indicated it was rare for a hospital to be on full diversion, but was unaware of the closure at that time. Staff #2 added that the local television news at noon reported the Lakeside closing. Staff #2 recalled that 2 ladies were waiting in the lobby for family members who were being treated in the ED, and the ladies were saying they had first presented to Lakeside ED but were turned away. The Clinical Manager stated that one patient, Patient #2, told their ED staff about being interviewed by an Austin television station about attempting to be seen at the Lakeside ED and subsequently was turned away due to the closure.

Eleven ED records from the nearby hospital were reviewed for the time period of 11/19/2010, 10:27 am - 4:37 pm. None of the records indicated that the patients had been turned away from Lakeside. One of the ED patients was from Austin, 5 were from Smithville, and 5 were from Bastrop near the Lakeside Hospital.

Based on observation, interviews and review of records, the facility failed to ensure that patients had the right to make informed decisions regarding care, as medical records for all patients receiving servies at the time of the hospital closure on 11/19/2010 were not available for review; and all patients were forced to be discharged or transferred immediately due to the closure.

Findings were:

Patient #1 was transferred to another acute care hospital on 11/19/2010 due to the closure of Lakeside Hospital. The receiving hospital provided a copy of the medical records that Lakeside Hospital sent with Patient #1 when transferred the afternoon of 11/19/2010. According to the medical records, the patient had been an inpatient at Lakeside since the day before, 11/18/2010, and was being treated for low potassium level and congestive heart failure. Included in the transfer paperwork was a memorandum of transfer (MOT) filled out, but without a physician signature. The physician signature line included " RBVO " and the physician ' s name (illegible). " RBVO " means " read back verbal order. " The MOT indicated that report was given to the receiving hospital and an accepting physician was named. The reason for transfer was " hospital closing - transferring all patients to appropriate level of care per family request. " A physician order, untimed, and dated 11/19/2010, stated that the patient should be transferred to the other hospital. The order was a verbal order and was not signed by the physician.

During a tour of the closed facility the morning of 11/22/2010, an ex-employee was outside the facility and stated he had worked in the maintenance department since the hospital opened in 2006. He stated that he had no idea the hospital was closing. He said they were called into an office last Friday (11/19/10) and told about the closing and asked to leave the facility. Another employee, a radiology technician, stated he was told on Friday about the closing, but was allowed to complete the studies that were in progress on 2 outpatients. He also stated he " thought " there were 4 inpatients that were discharged from the facility on 11/19/2010 due to the closure and was unsure about their status. No medical records were available to determine the status of the 4 inpatients who were discharged.