HospitalInspections.org

Based on observations, interviews, open and closed record reviews, and policy and procedure reviews the Governing Body failed to ensure that the facility functioned as a hospital. All patients that presented to the Emergency Department (ED) in need of inpatient care were transferred to other facilities. The only patients admitted to inpatient status were as a result of a scheduled surgery. These failures affected all patients that presented to the ED seeking medical care. The ED averages 45 patients per day/1369 patients per month. The facility census on survey entrance date was one.

Findings included:

1. Record review of the document titled, "Social Security Act," section 1861(e)(1), showed the following definition: (e) The term "hospital means an institution which - (1) Is primarily engaged in providing, by or under the supervision of physicians, to inpatients (A) diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons.

2. Record review of the facility's policy titled, "Scope of Service," reviewed 06/2015, showed the following:
- "This 12 staffed-bed unit operates on a twenty four-hour basis specializing in general medical and surgical care. Patients requiring care range in age from infant to geriatric and include (diagnostics and therapeutic modalities):
- Pneumonia;
- Congestive heart Failure;
- Chest pain;
- Telemetry; and
- Cardiopulmonary.
HOURS OF OPERATION: The Medical Surgical (Med/Surg) unit is staffed 24 hours a day, seven days a week".

3. Observations on 10/27/15 at 1:50 through 10/29/15 at 12:00 PM showed the Med/Surg area with 10 private patient rooms, no infants or Obstetrical services and no medical inpatients.

During an interview on 10/27/15 at 2:45 PM, Staff E, Administrator, stated that the facility only used 10 of the 45 licensed beds and that the other 35 patient rooms were closed. He stated that there were no other inpatient beds in the facility. He stated, "The ambulances don't stop here because we don't have sufficient physician coverage to admit inpatients so EMS (Emergency Medical Services) knows that if they brought patients to our ED that they would have to come back and transfer them to another hospital".

During an interview on 10/28/15 at 8:20 AM, Staff D, Registered Nurse (RN), Director of Nursing, stated that the hospital did not have all of the medical specialty physicians and no Intensive Care Unit (ICU, is a unit in the hospital where seriously ill patients are cared for by specially trained staff) to cover inpatient admissions.

4. Record review of the facility's document submitted to the Department of Health and Senior Services titled, "2015 Projected Core Staffing Plans (Direct Care Givers)," dated CY (calendar year) 2015: January 1 - December 31, showed the following: "Note: As of July 2014 Inpatient admissions were limited to surgical patients only".

5. Record review of the facility's document titled, "Med/Surg Staff Schedule," dated 08/23/15 through 11/14/15 showed that no inpatient nursing staff were scheduled for any Saturday or Sundays.

6. Record review of the facilities surgical records between 05/2015 and present showed that the facility performed 1000 surgeries or an average of 166 a month for six months. The record showed that the number of inpatient admissions was 27 which were all the result of scheduled surgeries and the number of medical inpatient admissions were zero.

During an interview on 10/27/15 at 1:55 PM Staff F, Admission Supervisor, stated that the only inpatients were from after a surgical procedure. Approximately 90% of the patients were outpatients. If there was a patient that was more ill the physician did not have an option to admit the patient to the hospital.

During an interview on 10/27/15 at 2:30 PM, Staff A, Emergency Department (ED) Manager, stated that the facility did not admit patients from the ED to inpatient beds. Staff A stated that if an ED patient needed to be admitted for inpatient care they would be transferred to another area hospital. Staff A stated that the facility did not admit patients directly into the hospital from doctors' offices. Staff A stated that patients were admitted to inpatient status only after a scheduled surgery. Staff A stated that the ED had no "On Call" (physicians available for consultation or to evaluate patients with specific conditions, for example- surgery), specialty or attending physicians to accept patient admissions. Staff A stated that ambulances did not bring very sick patients to this ED because they know that if a patient needed to be admitted they (EMS) would just have return to this hospital and transfer the patient to another hospital.

During an interview on 10/27/15 at 2:50 PM, Staff K, Certified Surgical Technician and Operating Room (OR) Scheduler, stated that all joint replacement and open abdominal surgeries are performed on Mondays or Tuesdays (to allow for inpatient care and to be discharged before the weekend).

During an interview on Tuesday, 10/27/15 at 2:45 PM, Patient #1 stated that he had scheduled hip surgery today. He stated that he would only be there three days and then would be discharged to home on Thursday.

During an interview on 10/27/15 at 2:55 PM, Patient #2 stated that she had a scheduled hysterectomy (removal of the uterus [a hollow, pear-shaped organ that is located in a woman's lower abdomen, between the bladder and the rectum]) yesterday (Monday, 10/26/15). She stated that she would be going home tomorrow (Wednesday 10/28/15).

During an interview on 10/28/15 at 8:37 AM Staff L, Charge Nurse, stated that the Inpatient Services Unit was not open on the weekends. Staff L stated that the nurses work Monday through Friday. She stated that she would be called in if there were any patients admitted on the weekend but she had been working there since January 2015 and no one had ever been called to work on the weekends. Staff L stated that she is scheduled to work on the Med/Surg unit every Thursday and Friday and if there were no patients she would be assigned somewhere else. She stated that the Med/Surg unit usually closes sometime on Thursday after the patients have been discharged.

During an interview on 10/29/15 at 9:25 AM, Staff Y, RN, Med/Surg, stated that she worked in surgery Monday through Wednesday and on the Med/Surg Unit Thursday and Friday. She stated that the Med/Surg Unit usually shuts down on Thursdays and no patients are admitted again until the following Monday. She stated that she had never worked or been called to work on a Saturday or Sunday. Staff Y stated that she had never had a patient on observation status. She stated that all of the patients on the Med/Surg Unit are scheduled surgical inpatients.
During an interview on 10/28/15 at 9:15 AM, Staff C, Chief Experience Officer (CXO-administrative level position charged with oversight of the patient experience, both clinical and patient satisfaction), stated that the facility decided not to admit patients in an attempt to control expenses and satisfy physicians that no longer wanted to care for patients in the hospital. Staff C stated that the hospital focused on areas that produced revenue but did not require a unit to be staffed 24 hours a day, 7 days a week and could allow the physicians to concentrate on their office practices.

During an interview on 10/29/15 at 10:35 AM, Staff GGG, sole Shareholder, Chief Executive Officer (CEO), Chairman of the Board (there were no other Board members) and Compliance Officer (a corporate official in charge of overseeing and managing compliance issues within an organization, ensuring, for example, that a company is complying with regulatory requirements and that the company and its employees are complying with internal policies and procedures), stated that the facility is a safety-net provider for Medicare and Medicaid patients. He stated that the large area hospitals have excluded them from all commercial insurance contracts and he was forced to restructure the facility's patient services and staff. He stated that patients were transferred from the ED because he couldn't run an ICU and that they keep psychiatric patients in observation until they can find a psychiatric bed to transfer them. Staff GGG stated that the facility is always staffed Monday through Wednesday.




29117




29511