HospitalInspections.org

Based on review of Governing Body minutes, review of facility documentation, interview, review of the facility's website, and review of facility accounts payable reports, the Governing Body failed to ensure the facility ensure the financial resources to maintain equipment and contracted services for daily operations of the facility.

The findings included:

Review of Governing Body minutes dated 3/23/18, 4/27/18, and 5/18/18, revealed "...financials reviewed...meeting payroll...funding approved and waiting to be received...concerns about vendors being paid to be able to continue services which has been voiced to [Corporate Owner]..."

Review of facility documentation dated 5/21/18 revealed the facility's Computed Tomography (CT) scanner was out of service and needed repair.

Interview with the Administrator on 6/7/18 at 2:00 PM, in the conference room, revealed "...corporate was emailed on 5/21/18 informing them of the CT scan and the need for the scanner to be fixed...they told us to check the cost...we got the quotes on May 24th and emailed them...we got a quote for a refurbished machine which was a really good price...corporate has the quotes...a call was made today to tell them we need to move on this...the CT being down and not being able to admit the patients impacts our services and scope of service...we have had to transfer patients that could be admitted here or who could have received a CT scan here and not have to be transferred to another facility..."

Review of the facility's website on 6/19/18 revealed radiological services available at the facility included "...CT...Head/Neck/Chest/Thorax/Spine/Extremities..."

Review of facility documentation of e-mail correspondence between the facility and the facility's cardiac monitoring provider dated 5/31/18 at 4:41 PM revealed "...as our letter on May 23, 2018 stated, your cardiac monitoring system will be temporarily shut down Monday, June 4, 2018, at 12:00 PM unless we have received payment in the amount of $18,733.91. Please notify your medical staff so they can arrange alternative care to their patients. As soon as this payment is received in our office, service will be immediately restored. Each month, thereafter, payment is required to be in our office on or before noon on the first day of the month so an interruption of service can be avoided..." Continued review revealed the email was forwarded by the facility to the corporate office on 5/31/18 at 9:03 PM with added documentation of "...This is in reference to our telemetry equipment. The 5/23/18 letter referenced was received and forwarded to you by email Tuesday, May 29, 2018..."

Interview with the Chief Nursing Officer (CNO) on 6/7/18 at 10:30 AM, in the conference room, revealed "...cardiac telemetry was turned off on 6/4/18 related to non-payment to the company who provided the telemetry services...if a patient needs telemetry monitoring we cannot admit them here right now and they would have to be transferred [to another acute care facility]..."

Review of an Accounts Payable (AP) Vendor Aging Report dated 6/11/18 revealed the facility's outstanding accounts payable balance to the cardiac monitoring provider was $9,773.91.

Interview with the Administrator on 6/11/18 at 9:30 AM, in the conference room, confirmed cardiac telemetry monitoring was turned off on 6/4/18 because the contracted provider had not been paid for the service. Further interview revealed "...they sent an email and letter...informing us the services would be discontinued June 4, 2018 if the payment was not made..."

Telephone interview with the Corporate Vice-President of Finance on 6/11/18 at 2:30 PM confirmed "...the facility had a cash flow issue and has lots of contracts that are past due...we are trying to work with the vendors and set up payment plans...hospital cash flow, lack of funds, and decreased collections were part of the issues which have caused the payments to not have been made..." Continued interview revealed "...the charge master [a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider] was not correct which resulted in millions of dollars loss..." Further interview confirmed "...not having [cardiac] telemetry services did impact patient care...they have had to transfer patients from the ED [Emergency Department] who need telemetry monitoring...the CT scan machine went down 5/21/18...we were told initially it would cost $20,000 to be fixed...once they looked at the machine it was found the machine could not be fixed and the parts they had ordered would not fix the problem...have had to transfer all of those patients who had a need for a CT scan..."

Refer to A-083, A-528, and A-529

Based on review of facility scope of services, review of the facility's website, medical record review, and interview, the facility failed to ensure radiological services were available for 5 patients (#1, #2, #3, #6, and #8) of 5 patients reviewed for Computed Tomography (CT) services of 22 patients reviewed for radiological services during the period of 5/21/18 - 6/18/18.

Refer to A-529

Based on review of facility documentation, review of account payable reports, interview, and review of Emergency Department (ED) logs, the facility failed to ensure patient care services were maintained by 2 contracted services (food services and cardiac telemetry services) of 21 contracted services reviewed.

The findings included:

Review of facility documentation of e-mail correspondence from the facility to the food services vendor dated 5/22/18 at 8:40 AM revealed "...our VP [Vice-President] of Finance...set up a payment agreement for $5000.00 per week until the account is paid in full. We mailed the first $5000.00 payment on 5/15/18, but our account is still on hold..."

Review of facility documentation of e-mail correspondence from the food services vendor to the facility dated 5/23/18 at 12:47 PM revealed "...please see payment plan and schedule...review and return with a corporate officer signature by tomorrow...we will keep the account open as long as payments are made as scheduled, the account otherwise remains current with newer invoices..."

Review of facility documentation of e-mail correspondence from the food services vendor to the facility dated 6/4/18 at 9:28 AM revealed "...we are again in a position that we show no payment since 5/24/18. You are under a payment plan and we must receive payment by tomorrow in order to keep the account open..." Further review at 9:41 AM revealed "...we will need you to catch up the plan by tomorrow, whether it is payment made online or sent via overnight courier. If we cannot get compliance, the account will be placed on hold by noon tomorrow..."

Review of an Accounts Payable (AP) Aging Report dated 6/11/18 revealed the facility owed the food services vendor $21,795.78.

Interview with the Administrator on 6/11/18 at 9:30 AM, in the conference room, confirmed the facility's food services contract was currently on credit hold related to no payment for services and the vendor required cash payment upon delivery of food.

Review of facility documentation of e-mail correspondence between the facility and the facility's cardiac monitoring provider dated 5/31/18 at 4:41 PM revealed "...as our letter on May 23, 2018 stated, your cardiac monitoring system will be temporarily shut down Monday, June 4, 2018, at 12:00 PM unless we have received payment in the amount of $18,733.91. Please notify your medical staff so they can arrange alternative care to their patients. As soon as this payment is received in our office, service will be immediately restored. Each month, thereafter, payment is required to be in our office on or before noon on the first day of the month so an interruption of service can be avoided..." Continued review revealed the email was forwarded by the facility to the corporate office on 5/31/18 at 9:03 PM with added documentation of "...This is in reference to our telemetry equipment. The 5/23/18 letter referenced was received and forwarded to you by email Tuesday, May 29, 2018..."

Review of facility documentation revealed the telemetry services were turned off on 6/4/18 and the services were turned back on 6/7/18 at 3:30 PM.

Interview with the Chief Nursing Officer (CNO) on 6/7/18 at 10:30 AM, in the conference room, revealed "...cardiac telemetry was turned off on 6/4/18 related to non-payment to the company who provided the telemetry services...if a patient needs telemetry monitoring we cannot admit them here right now and they would have to be transferred [to another acute care facility]..."

Interview with Hospitalist #1 on 6/7/18 at 11:05 AM, in the conference room, revealed "...we do not have telemetry at this point and we cannot admit patients who need telemetry...this would include any patients with electrolyte abnormalities...chest pain patients who come to the ED are evaluated and the decision is made to transfer or admit the patients depending on their diagnosis and diagnostic findings...if they need telemetry we cannot admit them..."

Interview with Physician #2 on 6/7/18 at 1:45 PM, in the ED Nurses station, revealed "...if I have someone who needs to be monitored, then I would call the hospitalist for admission...we cannot admit anyone who might need telemetry right now because we do not have monitoring capability at this point..." Further interview "...I would call...and arrange a transfer for the patient..."

Review of the facility ED logs revealed the facility transferred 4 patients to other hospitals due to symptoms of chest pain between dates of 6/4/18 and 6/7/18.

Review of an Accounts Payable (AP) Vendor Aging Report dated 6/11/18 revealed the facility's outstanding accounts payable balance to the telemetry services vendor was $9,773.91.

Interview with the Administrator on 6/11/18 at 9:30 AM, in the conference room, confirmed cardiac telemetry monitoring was discontinued on 6/4/18 because the contracted company had not been paid for the service. Further interview revealed "...they sent an email on 5/29/18 informing us the services would be discontinued June 4, 2018 if the payment was not made..."

Telephone interview with the Corporate Vice-President of Finance on 6/11/18 at 2:30 PM confirmed "...the facility had a cash flow issue and has lots of contracts that are past due...we are trying to work with the vendors and set up payment plans...the hospital cash flow, lack of funds, and decreased collections were part of the issues which have caused the payments to not have been made..."

Based on review of facility scope of services, review of the facility's website, medical record review, and interview, the facility failed to ensure radiological services were available for 5 patients (#1, #2, #3, #6, and #8) of 5 patients reviewed for Computed Tomography (CT) services of 22 patients reviewed for radiological services during the period of 5/21/18 - 6/18/18.

The findings included:

Review of the facility's Scope of Service (list of offered services) dated 8/8/17 revealed "...basic services provided...inpatient and outpatient services...Computed Tomography [CT]...head/neck/thorax/spine/extremities..."

Review of the facility's website on 6/19/18 revealed radiological services available at the facility included "...CT...Head/Neck/Chest/Thorax/Spine/Extremities..."

Medical record review revealed Patient #1 was admitted to the facility's Emergency Department (ED) on 5/31/18 at 9:00 PM with a diagnosis of a Migraine Headache and was transferred to another acute care hospital on 6/1/18.

Medical record review of an ED Physician's Record dated 5/31/18 at 9:27 PM revealed "...dull aching headache...new onset of headache, vomiting, dizziness...neurological: headache, weakness...otherwise negative..." Further interview revealed "...transfer..."

Medical record review of a Patient Consent/Refusal to Transfer form dated 6/1/18 at 12:50 AM revealed "...diagnosis: headache, HTN [hypertension], r/o [rule out] CVA [Cerebrovascular accident/stroke]...higher level of care not available at this facility...needs CT scan..."

Medical record review revealed Patient #2 was admitted to the facility's ED on 5/31/18 at 10:46 PM with a diagnosis of Hypertension (elevated blood pressure) and was transferred to another acute care hospital on 5/31/18.

Medical record review of an ED Physician's Note dated 5/31/18 at 10:55 PM revealed "...patient reports weeks of left sided weakness...requires CT of his head, but this hospital's scanner remains inoperable today. He will need to be transferred for complete workup and likely admission..."

Medical record review revealed Patient #3 was admitted to the facility on 5/25/18 at 11:00 PM with a diagnosis of Left Flank Pain and was transferred to another acute care hospital on 5/26/18.

Medical record review of an ED Physician's Note dated 5/25/18 at 11:10 PM revealed "...the patient was transferred...with a diagnosis of Possible Renal Blockage..."

Medical record review of an ED Nurse's Note dated 5/25/18 at 11:33 PM revealed "...transfer...for a CT Abdomen and Pelvis as our Scanner is broken..."

Medical record review revealed Patient #6 was admitted to the facility's ED on 6/7/18 at 1:17 AM with diagnosis of Dyspnea, Abdominal Pain, Elevated D-Dimer (blood test for the presence of a Pulmonary Embolus/blood clot) and was transferred to another acute care hospital on 6/7/18.

Medical record review of a Transfer Form dated 6/7/18 at 4:20 AM revealed the patient was transferred via helicopter with diagnoses including Dyspnea, Abdominal Pain, and an Elevated D-Dimer. Further review revealed "...higher level of care not available at this facility...benefits of transfer: obtain level of care/services NA [not available] this facility...service CT..."

Medical record review revealed Patient #8 was admitted to the facility on 6/4/18 at 8:39 PM with diagnosis Chest Pain and Elevated D-Dimer and was transferred to another acute care hospital on 6/4/18.

Medical record review of an ED Physician's Note dated 6/4/18 at 9:00 PM revealed "...patient comes in tonight complaining of chest pain for the past four days...constant pain that improves with nitroglycerin [medication used for chest pain]...took 2 nitroglycerins at home and the pain improved with them. The pain radiated to the left arm...is not associated with shortness of breath, sweating or nausea...report was called to [physician at another acute care hospital] who accepts the patient for transfer to the ED...needs a CT chest to rule out PE [pulmonary embolus]...our CT scanner is down this evening..."

Interview with the Administrator on 6/7/18 at 2:00 PM, in the conference room, revealed the facility's CT scanner had been out of service since 5/21/18. Further interview revealed "...corporate was emailed on 5/21/18 informing them of the CT scan and the need for the scanner to be fixed...they told us to check the cost...we got the quotes on May 24th and emailed them...we got a quote for a refurbished machine which was a really good price...corporate has the quotes...a call was made today to tell them we need to move on this and get the support done...the CT being down and not being able to admit the patients impacts our services and scope of service...we have had to transfer patients that could be admitted here or who could have received a CT scan here and not have to be transferred to another facility..."

Interview with the Radiology Supervisor on 6/7/18 at 3:00 PM, in the Supervisor's office, revealed "...we have not performed CT scans here since May 21, 2018..."

Interview with Hospitalist #1 on 6/8/18 at 11:30 AM, in the conference room, revealed "...we cannot admit patients for a CT scan...resulted in a lot of patients being transferred to another facility..."

Interview with Physician #1 on 6/11/18 at 10:55 AM, in the conference room, revealed "...the medical staff have discussed the CT Scan being down multiple times and other providers have been made aware...normally we would admit patients from the ED or a provider may admit and the hospitalist provide the care while the patients are in the hospital...I have sent multiple e-mails to Corporate and talked with the President of the company several times about the CT scanner...with no CT scan we are not able to admit those patients who would be able to stay here. We have had to send them out to another facility when we could provide the service here...we need the CT scan here to be able to treat our patients and provide the care they need..." Continued interview revealed "...our Emergency Medical Services [EMS] have had a tremendous burden placed on them related to all of the transfers to other facilities...they are making a lot of trips out of the county to transfer these patients...we have transferred a lot of patients by ground or by air due to the CT scanner services not being available..."

Interview with Hospitalist #2 on 6/11/18 at 1:30 PM, in the conference room, revealed "...most of the transfers are initiated in the ED related to no CT scan capability...but if I had a patient on the floor who needed a CT scan we would have to transfer the patient because the service is not available..."

Telephone interview with the Corporate Vice-President of Finance on 6/11/18 at 2:30 PM confirmed "...the facility had a cash flow issue and has lots of contracts that are past due...we are trying to work with the vendors and set up payment plans...hospital cash flow, lack of funds, and decreased collections were part of the issues which have caused the payments to not have been made...the CT scan machine went down 5/21/18...we were told initially it would cost $20,000 to be fixed...once they looked at the machine it was found the machine could not be fixed and the parts they had ordered would not fix the problem...Corporate told them to get 3 quotes for the machine and to send them to us..."

Telephone interview with the Emergency Medical Services Director on 6/11/18 at 3:30 PM revealed "...we have transferred a lot of patients to other hospitals over the past few weeks...it seems to be more since the CT scan has been down..."