HospitalInspections.org

Based on review of facility policy, review of facility by-laws, review of a Medical Staffing Services Agreement, review of the Daily Log Detail report, review of physician staffing schedules, medical record review, observation, and interview, the facility failed to ensure it provided inpatient services during the period of 11/25/2020 - 1/11/2021 (48 days) for 6 patients (Patient #1, #2, #3, #4, #5, #6) of 6 patients reviewed.

The findings included:

Review of the facility's policy titled Plan for the Provision of Patient Care, dated 6/2018, revealed "...54-bed capacity...patient support is provided by a variety of individuals and departments...inpatient and outpatient departments that provide services and/or patient care...Inpatient Care Units: Intensive Care Unit, Medical/Surgical Unit, OB [Obstetrics] & [and] Nursery, Surgery & Post/Anesthesia Recovery..."

Review of the facility's bylaws titled Advisory Board Charter, dated 3/2019, revealed "...support, manage and furnish facilities, personnel and services, provide diagnostic, medical, surgical and hospital care, outpatient care and other hospital and medically related services..."

Review of a Medical Staffing Services Agreement, dated 4/22/2020, revealed the facility entered into a contract with the staffing organization to provide physicians and nurse practitioners for the facility.

Review of the Daily Log Detail report dated 11/2020 revealed the last inpatient admitted to the facility was on 11/22/2020. The facility's average daily census between 11/25/2020 - 1/11/2021 was zero.

Review of the Multiple Group Schedule (physicians' staffing schedules) dated 11/2020 revealed no hospitalist with admitting privileges was scheduled to work at the facility between 11/25/2020 - 1/11/2021.

Medical record review showed Patient #1 was admitted to the Emergency Department (ED) on 11/25/2020 with diagnoses including Acute Kidney Failure and was transferred to another acute care facility for a higher level of care. Continued review revealed no documentation of the specific higher level of care needed.

Medical record review showed Patient #2 was admitted to the ED on 12/14/2020 with diagnoses including Calculus of Kidney and was transferred to another acute care facility for a higher level of care. Continued review revealed no documentation of the specific higher level of care needed.

Medical record review showed Patient #3 was admitted to the ED on 12/19/2020 with diagnoses including Chronic Obstructive Pulmonary Disease and was transferred to another acute care facility for a higher level of care. Continued review revealed no documentation of the specific higher level of care needed.

Medical record review showed Patient #4 was admitted to the ED on 12/23/2020 with diagnoses including Acute Pancreatitis without Necrosis or Infection and was transferred to another acute care facility for a higher level of care. Continued review revealed no documentation of the specific higher level of care needed.

Medical record review showed Patient #5 was admitted to the ED on 12/25/2020 with diagnoses including Unspecified Intestinal Obstruction of the Small Bowel and was transferred to another acute care facility for a higher level of care. Continued review revealed no documentation of the specific higher level of care needed.

Medical record review showed Patient #6 was admitted to the ED on 12/28/2020 with diagnoses including Pneumonia and Covid-19 and was transferred to another acute care facility for a higher level of care. Continued review revealed no documentation of the specific higher level of care needed.

Observation of the inpatient units on 1/5/2021 at 1:30 PM with the Chief Executive Officer (CEO) showed the facility had no patients in their inpatient units.

During an interview on 1/5/2021 at 1:35 PM, the CEO stated the facility did not provide inpatient services because the facility was unable to "...establish regular [physician] schedules...have to pay some bills to [the physician staffing agency] ...we haven't paid them [staffing agency]..."

During an interview on 1/5/2021 at 2:35 PM, ED Physician #2 confirmed the facility was not admitting inpatients and patients who needed hospitalization were transferred to another acute care facility.

During an interview on 1/5/2021 at 5:30 PM, the CEO confirmed the facility had not provided inpatient services since 11/27/2020.

During an interview on 1/6/2021 at 10:20 AM, the ED Physician #3 confirmed the facility offered no inpatient services and all patients requiring hospitalization were transferred to another acute care facility.

During a telephone interview on 1/6/2021 at 3:22 PM, ED Physician #4 confirmed the facility had no inpatient services.

During a telephone interview on 1/6/2021 at 4:00 PM, ED Physician #5 confirmed the facility did not have inpatient services.

During a telephone interview on 1/6/2021 at 4:30 PM, the Medical Chief of Staff stated "...stuff isn't getting done. A lot of it is financial...they have a [contracting service] to provide nurse practitioners and hospitalists, but they [the facility] aren't paying, so they [providers] aren't going..."

Based on review of a medical staffing provider agreement, review of physician staffing schedules, observation, and interview, the facility failed to ensure a physician was on duty for inpatient admissions from 11/25/2020 to 1/11/2021 (48 days).

Refer to A-0067.

Based on review of facility policy, review of the Employee Staffing Schedules, and interviews, the facility failed to ensure radiology services were available to meet patients' needs 24 hours per day.

Refer to A-0529.

Based on review of a medical staffing provider agreement, review of physician staffing schedules, observation, and interview, the facility failed to ensure a physician was on duty for inpatient admissions during the period of 11/25/2020 to 1/11/2021 (48 days).

The findings included:

Review of a Medical Staffing Services Agreement dated 4/22/2020 revealed the medical staffing agency would "...exclusively furnish qualified independent contracted Physicians and Allied Professionals...to provide hospital medicine services...Client [facility] agrees to submit payment to [staffing agency] via electronic funds..."

Review of the Physician Staffing Schedule dated 11/2020 revealed the last date the staffing agency provided physician services was 11/24/2020.

Observation on 1/5/2021 at 1:35 PM of the inpatient units with the Chief Executive Officer (CEO) showed the facility had no inpatients.

During an interview on 1/5/2021 at 1:40 PM, the CEO confirmed the facility did not have inpatient patient services because the facility was unable to "...establish regular [physician] schedules...have to pay some bills to [the physician staffing agency] ...we haven't paid them..."

During a telephone interview on 1/6/2021 at 4:30 PM, the Medical Chief of Staff confirmed the facility had not paid the physician staffing agency so the physicians chose not to work at the facility any longer.

Based on review of facility policy, review of the Employee Staffing Schedules, and interviews, the facility failed to ensure radiology services were available 24 hours per day to meet patients' needs.

The findings included:

Review of the facility's policy titled Plan for the Provision of Patient Care dated 6/2018 revealed "...primary purpose of radiology services...provide a study of the anatomical processes of the human body...diagnostic procedures are performed on outpatients and inpatients...provides support to the Emergency Department [ED]..."

Review of the Employee Staffing Schedules dated 11/2020 to 1/5/2021 revealed no radiology staff was scheduled to work the night shift in the radiology department for 23 nights during 11/2020; 27 nights during 12/2020; and no staff was scheduled to work the night shifts from 1/1/2021 through 1/5/2021.

During an interview on 1/5/2021 at 2:00 PM, Radiology Technician #1 stated "...2 or 3 nights a week we don't have [radiology] coverage..."

During an interview on 1/5/2021 at 2:25 PM, ED Physician #2 stated the facility did not provide 24-hour radiology services.

During an interview on 1/5/2021 at 5:30 PM, the Chief Executive Officer (CEO confirmed the facility did not ensure 24-hour radiology services were available.

During an interview on 1/6/2021 at 10:20 AM, ED Physician #3 stated the facility did not provide 24-hour radiology services.

During a telephone interview on 1/6/2021 at 4:00 PM, ED Physician #5 stated "...haven't had 24-hour radiology [services] in 6 months, maybe more..."

During a telephone interview on 1/7/2021 at 10:45 AM, the Human Resources Director confirmed the facility had not provided 24-hour radiology services since 2/2020.

Based on review of facility policy, review of vendor reports, observation, and interview, the facility failed to ensure hot water was available in 1 of 1 Emergency Departments (ED).

The findings included:

Review of the facility's policy titled Water Temperature dated 1/2009 revealed "...the hot water temperature...hand washing terminals shall be maintained at or below 120 degrees Fahrenheit [F]..."

Review of the facility's policy titled Plan for the Provision of Patient Care dated 6/2018 revealed "...Engineering/Maintenance: Responsible for the operations and maintenance requirements...water system..."

Review of a mechanical contractor's vendor report dated 1/31/2020 revealed "...replaced customer [facility] supplied Ignition module on HVAC [Heating, Ventilation, Air Conditioning] unit...Diagnosed Water Heater Issue..."

Observation of the ED on 1/5/2021 at 2:15 PM with the Chief Executive Officer (CEO) revealed no warm or hot water in the sinks in exam room #5 and #7 and in the service sink located behind the nurses' station.

During an interview on 1/5/2021 at 2:20 PM, the ED Nurse Manager stated "...no hot water down here [ED]...don't know how long, maybe 2 or 3 months..."

During an interview on 1/5/2021 at 2:35 PM, ED Physician #2 stated the ED had not had warm or hot water in the exam sinks "...since August [8/2020]..."

During an interview on 1/5/2021 at 3:30 PM, the Maintenance Director confirmed the ED did not have hot water and "...we can't get the water over 91 degrees...they [vendor] recommended a new heater..."

Observation and interview on 1/6/2021 at 10:00 AM with the Maintenance Director and CEO revealed the hot water in ED exam room #2 had a temperature reading of 72 degrees and the temperature reading of the water in ED exam room #5 was 69 degrees. The Maintenance Director confirmed the "...didn't read the temperature of what it needs to be..."

During an interview on 1/6/2021 at 1:00 PM, the CEO confirmed the facility had not repaired or replaced the hot water heater servicing the ED because of lack of monetary funds.