Ascension St John Nowata

“RESPONSIBILITIES OF MD AND DO CFR(s): The doctor of medicine or osteopathy-- (i) Provides medical direction for the CAH’S health care activities and consultation for, and medical supervision of, the health care staff; This Standard is not met as evidenced by: 41505 Based upon record review and interview, the hospital failed to appoint a Medical Director that provided medical supervision over the Critical Access Hospital’s health care staff. The was evidenced by identifying Hospital I’s Medical Director (Staff J) due to an integrated Governing Body and Medical Staff. Findings: Interview on 05/25/24 at 10:30 a.m. Staff B stated Staff J was Medical Director. Review of Medical Staff Physician list revealed Staff J was not identified. Further interview with Staff B revealed when asked about Staff J, he replied the Governing Body and Medical Staff were integrated with their sister hospital “Hospital I”. Review of the Governing Board and Medical Staff Meeting Minutes from 01/01/23 through 02/01/24 revealed there failed to be documented evidence a Medical Director from the hospital’s medical staff had been appointed for supervision and direction of the health care staff.”

“APPROPRIATE TRANSFER CFR(s): 489.24(e)(1-2) (1) General If an individual at a hospital has an emergency medical condition that has not been stabilized (as defined in paragraph (b) of this section), the hospital may not transfer the individual unless - (i) The transfer is an appropriate transfer (within the meaning of paragraph (e)(2) of this section); and (ii)(A) The individual (or a legally responsible person acting on the individual’s behalf) requests the transfer, after being informed of the hospital’s obligations under this section and of the risk of transfer. The request must be in writing and indicate the reasons for the request as well as indicate that he or she is aware of the risks and benefits of the transfer. (B) A physician (within the meaning of section 1861(r)(1) of the Act) has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labor, to the woman or the unborn child, from being transferred. The certification must contain a summary of the risks and benefits upon which it is based; or (C) If a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bylaws or rules and regulations) has signed a certification described in paragraph (e)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act) in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification. The certification must contain a summary of the risks and benefits upon which it is based. (2) A transfer to another medical facility will be appropriate only in those cases in which - (i) The transferring hospital provides medical treatment within its capacity that minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child; (ii) The receiving facility (A) Has available space and qualified personnel for the treatment of the individual; and (B) Has agreed to accept transfer of the individual and to provide appropriate medical treatment. (iii) The transferring hospital sends to the receiving facility all medical records (or copies thereof) related to the emergency condition which the individual has presented that are available at the time of the transfer, including available history, records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) required under paragraph (e)(1)(ii) of this section, and the name and address of any on-call physician (described in paragraph (g) of this section) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment. Other records (e.g., test results not yet available or historical records not readily available from the hospital’s files) must be sent as soon as practicable after transfer; and (iv) The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. This Standard is not met as evidenced by: 41505 Based upon record review and interview, the hospital failed to implement an appropriate transfer for 1 of 4 patients (#6) who required a higher level of care. This was evidenced by the failure to have a written certification that stated the reason for the transfer, the risks and benefits of the transfer and the patient’s medical condition at the time of transfer. Findings: On 02/02/24 at 10:44 p.m. patient #6, a 12 year old female, presented to the emergency department with the chief complaint of Suicidal Ideation with Intentional Overdose. According to the History of Present Illness, the patient had reportedly taken a combination of over the counter medications with the intent of trying to kill herself. Laboratory tests were obtained, monitoring for medication side effects, and Intravenous medications were administered. Review of the Medical Decision Making revealed “...Patient spoke with counselor on the iPad at (Mental Health Facility K). They are going to try and arrange an inpatient placement. Will continue to monitor the patient this evening.” On 02/03/24 at 8:20 a.m. the Registered Nurse documented “Transport from (K) here to transport patient to (Psychiatric Hospital L) in Oklahoma City. Grandmother (legal guardian) to ride with patient and transport to receiving facility.” Further review of patient #6’s emergency department record revealed there failed to be documented evidence an appropriate transfer certification was implemented. Interview on 03/26/24 at 1:50 p.m. with Staff B revealed facility K was used to conduct the evaluations on their psychiatric patients via iPad and then find placement for inpatient psychiatric care. When asked if the hospital completed any transfer certifications, Staff B replied “no” that everything was set up with Facility K and receiving hospitals.”