HospitalInspections.org

Based on review of facility Bylaws, documents, and interview with staff (EMP), it was determined the facility failed to ensure that the Division of Acute and Ambulatory Care (DAAC) was notified in writing at least 60 days prior to the intended commencement of a health care service which had not been previously provided at the facility.

Findings include:

A review of the Medical Staff Bylaws revised September 25, 2017, revealed the addition of practitioners providing Telemedicine Services.
A review of the Agreement the facility entered into on November 13, 2017, with Access Physician, PLLC (Agency) revealed, "Services. Agency shall: (i) provide one (1) Physician to perform the Services seven (7) days a week (including holidays), twelve (12) hours per day between the hours of 7:00 p.m. and 7:00 a.m., local time in the Hospital's time zone; and (ii) ensure that each Physician complies with all terms and conditions... ."
A review of the Access Telemedicine physician's coverage schedules revealed that Telemedicine physicians were scheduled from November 13, 2017, through February 28, 2018, from 7:00 PM to 7:00 AM.
An interview conducted on June 8, 2018, at 2:00 PM with EMP2 confirmed that the facility had failed to notify DAAC prior to the initiation of Telemedicine night time physician coverage on November 13, 2017. Further interview confirmed that the facility had started the new Telemedicine service without DAAC's prior approval.