HospitalInspections.org

Based on observation, review of hospital documents and staff interview, the governing body failed to maintain a viable hospital, including hospital admissions; available medical staff credentialed with privileges to admit; and QAPI (quality assurance performance improvement) standards not having been met .

Findings include: The governing body was not effectively responsible for the conduct of the hospital as an institution. The hospital failed to maintain medical staff who were available to admit patients to the facility since June 9, 2009. It was noted on 9/27/10, at 2:00 p.m. that the doors to the main entrance of the hospital were locked and a sign indicated "urgent care closed". After entrance into the building via the attached nursing home, nursing home staff indicated the hospital beds were located at the end of the west wing of the nursing home. During initial interview with the medical records staff on 9/27/10, at 2:30 p.m. it was stated the hospital had not had patients in any of the 10 beds in the past year and stated the "urgent care" had also been closed for approximately 1 year. She further indicated they only provided services which included "same day surgery" and possibly a "swing bed" patient admission.

Upon interview with the administrator/owner on 9/27/10, at 2:40 p.m. it was stated the hospital had been closed for inpatient admissions, including swing bed patients, since June 2009. The administrator/owner further indicated that currently no physicians were available to admit a patient to the hospital. Review of the patient admission/discharge register on 9/27/10, at 3:30 p.m. revealed the date of the most recent hospital admission had been 6/9/09 by physician A. Further review of the admission register revealed that only seventeen(17) admissions had occurred in 2008 and five (5) admissions in 2009. The administrator/owner confirmed that physician A, who had been the previous medical director, had "moved" from the area "a year ago". The administrator/owner stated the current medical director, physician B, had no privileges to admit patients in the facility as he had duties elsewhere as a "locum" around the state of MN. Upon further discussion it was learned the only services provided by the hospital included "same day surgery" 4-5 days per month and outpatient occupational (OT) and physical (PT) therapy. The therapy department was located in the basement of the nursing home and the "same day surgery" was located in the clinic building located on the same grounds as the hospital and accessible via tunnel.

Review of credential files for the only 2 identified active medical staff were as noted: physician B (medical staff director) and the only family nurse practitioner (FNP). Both files lacked a list of requested privileges by each practitioner (physician B and FNP). Review of medical staff meeting minutes for 2009 and 2010 confirmed that no practitioner had requested privileges nor had any practitioner been approved to admit hospital inpatients during the past 15 months. The medical staff meeting minutes dated 7/27/09 stated "current hospital status: [administrator/owner] discussed the temporary status of the hospital. There will be no swing beds or hospital admits for 90 days". The only medical staff meeting minutes since 7/27/09 had been dated 5/24/10 (10 months later) and then again on 7/26/10. These minutes lacked any mention of the current status of the hospital nor any plan related to the recruitment of physician staff. Review of the Board of Directors meeting minutes dated 7/27/09, 5/24/10 and 7/26/10 revealed no discussion related to the current inactivity related to inpatient admissions and/or plan to recruit physician staff with admission privileges.

Interview with the assistant director of nurses (ADON) on 9/27/10, at 3:15 p.m. revealed that she worked from 8:00 a.m. until 4:30 p.m. Monday through Friday or approximately 32 hours/week. It was stated the hospital and nursing home shared 24 hour/day on-call nursing staff coverage during the evenings and week-ends. It was verified the hospital had not routinely staffed the physical presence of an RN (Registered Nurse) 24 hrs/day, 7 days/week. Review of timecards dated 7/1/10 until 9/28/10 confirmed the ADON usually worked 3-4 days/week and averaged 32 hours/week. Review of the on-call coverage timecards from 7/2/10 through 9/28/10 revealed that nursing staff had been paid to be on-call during the week-end coverage and were paid only when called into the facility during the weekday evenings. The facility had not separated the hospital/nursing home on-call staffing schedule, but had a combined schedule.

Interview with the administrator/owner on 9/27/10, at 3:30 p.m. verified the "emergency room" sign had been removed from the community and hospital. Since the urgent care department closed a year ago, policy dated 8/31/09 related to emergency treatment stated "in the event that a person would seek emergency treatment at the Lakeside Medical Center, the Charge Nurse will call 9-1-1." Review of the operating room log confirmed that consulting surgical staff had performed outpatient procedures that included gastroscopies, colonoscopies, laparoscopic cholecystectomy, hernia repair and cataract surgeries. Review of the therapy notebook, listing the tracking log of patients, revealed that monthly outpatient therapies (OT, PT) had been provided routinely.

The hospital had not conducted QAPI activities for contracted services for the past year which included laboratory, nuclear medicine, ambulance, laundry, and tissue donor due to lack of inpatient admissions since 2009. In addition, no direct care services including: medical care, nursing care, pharmacy services or dietary services, had been provided or evaluated for hospital inpatients due to no inpatient admission activity since June 2009.

The administrator/owner reiterated on 9/28/10, at 3:00 p.m. that the last inpatient admission had been June 2009 and confirmed that there were currently no available physicians to admit patients.