~ Hl.M.lNMD HUMM8EIWICl8/ltlJBfCY DEPMTIENTOFPWLJC HEALlH

STATEMENT Of DEFICEfCIES (X1)~1A

-IWIEOf MCMOER OR....uER

Ga t t uAtAlllD • ...._.Cenlilr

Ql4llO PREFIX

TAG

IUMMARY 8TATEMINT Oii DEflCIEHC8 (EACH DEFICIENCY.._,. IE PMCEEDEO 9V FUU ~T~ OR L9C IDENTIFYING INFOMIATION)

The folcMtng rwlec:ll the lncllngt of tht Oeplrtment of Pubic Hllllh during .. lnlpectior't vilit:

1

Rtpl .. ...., .. DIJ I ••II of Pubic: H9111h: &ne,or ID I 27129, t-ffN

The inlpec;1iof1- llmled to .. epedlc ~ ewnt inYettlglled end does not ,. ... nt the tndlr9 of. ful inlpectiol'I of the fltclllty.

~ Md Slllly Code Sec:lon 1280.1(c): Far . ..,.. of 1111 MClofl -•• imect1111 ~ ...... • ....... In whidl .. llclrw11'• .,.,,..,.110 will one or men requlNmenll of --.. ._ CIUMd. or Is ._ to c:... IMolJS

~or dlllf'I to tht Pllent.

Htelh end 8*y code Section 1279.1(c): "The fldty lhlll lnbm the patient or tht perty reeponlible for ,... pellent of the ecMw'Se event by the time tht repott Is made .•

The CDPH veriled that the f8clity infofmed the patient OI the party ~ for the pant of the .......... by ht time ht rwport w.s mllde.

Hellh aid 8*y Code 1279.1 (b) For .,...... °' Iii aeclon, "81MrM event• ..... 11ff ol,. fall utng: (7)An ..... ever1tor_..ol.,..._..

... .- .. dl9lt1 or ...to&a t11Mtr of • ~

.. ·~·-:: ... · " .... ;.,· >".· .~·". ·: ' ' :··~~· . •",:;<!

A. llUIUllNG

8 . WING

IO PREFIX

TAO

PROWIM'I PLAN Oii CQIUllCTION (EACH Co.ICTM! ACTION IHOUl.O • CROI$. ~TO THI! """'°"""Tl DEl'ICllHCY)

The statements made on the plan of correction are not an admission and do not constitute agreement with the alleged deficiencies herein. This plala of correeti.on i:oastitutes · Community Regl'onat Medic:al Centers written credible allegation of compllance fo the deficiencies noted.

Complaint #: CA00306344 Penalty # 040009720

A. How the correction was accomplished, botn temporarily and permanently for each Individual affected by the deficient practice, Including ony $)1$ttm changes that were made. On 4/2/2012, an Investigation was Immediately authorized by the President of the Medical Staff and the Chair of Surgery. The Chairperson of the Board of Trustees (BOT) was notified by the Chief Quality Officer. On 4/6/2012, the Interim Director of Surgical Services and the Patient safety Officer instructed the cardiovascular surgical nursing staff leadership on the scope of practice for physician assistants and the requirements of a surgeon when a patient Is in the operating room. Education on the scope of practice for physician assistants and the requirements of a surgeon was initiated by the Surgical Services Manager for all nursing surgical and cardiovascular staff. On 4/25/2012, the Interim Director of Surgical Services and the Patient Safety Officer Instructed the nursing surgical staff clinical supervisors on the scope of practice for physician assistants and the requirements of a surgeon when a patient is In the operating room. All surgical and cardiovascular nursing staff were educated on the scope of practice for physician assistance and the requirements of a surlll!On when a patient is In the operating room by Surgical Services Manager with 100% compliance. A !Wl"sjng surgical services staff roster was utilized to ensure all nurslllg surgical staff were educated.

1 4 2013

DEPT OF HEALTH SERVICE~~ , LICENSING & CERTIFICATION-FRE..:i~Q.

(X2) liU. TIPl.E CONSTRUCTION

- ...... -OI M1N111R Olt 11.WWR lnlE£T ~ alY, ITATE, Z. COCIE

c ........ 1 ... -....c... _.,_ ......... CA1172t-1aM WCXUITY

Tlle22

IUliliWn' ITATDEHT OI DlflCIUOll (IACN Dll'ICllHCY WUl'f N l'NCllOIO SV NL llfiULATOlrf OR LIC IDINl'lPYINO .. OMIATION)

10443 Cll'dlou11ai• Swgery SeMce Genni

·'11_11,w-(IJ • . ......................... be ....... and ....... ~ .. ,..., fl If a F l"bll b l'9 .... it oor.illlDn wltt alts ...... ~ Pl'Dll••' etllll Ind edmitlillrllon. Palclls lhll be IPPftN9d ~ .. ~ body. Proc:ecU9I lt'9I be IPPf'OV9d by .. ed111111i1118tlon ..s mec1c111 an where such 11 IPPfOf)llMt.

-- Gft *" i••tews, dlnal f9COl'd Ind .. i ........ 4'ocumn .......... hoepbl fllld to .,,.... C.6:tu1u•• Sufll'Y SeMct ,,.... ... ~ Ind medlcll ...,, bijlirwt when ~ Surgeon 1 (CVS 1) ..... Opetllliig Room (OR) Ind 11'9 holplll ptlffllHUI

prior to the douw ot 11'9 ch.c for the oS*1 hemt IUl1Jl'Y on Pliant 1 on 912. CVS 1 dlr'9Clld ~licillt A1.-..nt (PA) 1 to be Ill tn-dw'ge, .,. lnchidual not qulltled to be left ln-ct.ge of the CV eutgety. After CVS 1 left the OR, Ptllient 1 IUtfered m 111 hie blood Iola, Qfdiac aT9lt and Iola of ~ to .. bnlln. The n...ive b6ood lose ...... ~·.- .. dlell Md ....... Ii 111119 of h hemt. Plllient t WM ~ on .. 9'apport der the CV IUl1Jl'Y Sid • of .12 f9ITiained on •IUPPO't·

Findlngl:

Event ID'.WGUB11 112812013

., l'MlflX

TAO

ll'lllOllll)Mt lllLNf °' COMICTION C1ACH COMICTM ACTION IHOW> • CflOll. ~TOM~TI DUICllNCY)

t:ompliance was measured by documentation of ~ducation to 100% of c.Jrdiovascular and surgical nursing ~taff by the Surglcal services Manger and Interim Director. ~of April 30, 2012, compliance with those Instructions was 100% for the nursing surgical staff. Compliance ~I to~ audited by the~ seMces.Mll(lpf ;ind Interim Director 1nd asohhls date remains .t 100% on the staff roster. On 4/12/2012, Medical Executive Committee (MEC) notified the physician by letter to comply with the medical staff bylaws requiring him to remain In the hospital and be available when patients are still In the Operating Room or to arrange for appropriate coverage. The President of the Medical Staff telephoned the physlclan and Informed him of the same expectations and admonished him that failure to adhere to this directive would result in an Immediate summary suspension. The Allied Health Professional (Physiq__iO ASSlbnt) privilege card was modified in accordance wltll T1tte 16 to !state that the personal presence of an approved supervising physician is required when performing surgical procedures under general anesthesia. The privilege card was approved at MEC on 5/10/2012 and Board of Trustees on 7 / 17 /2012. After the event occurred, the Chair of the Department met individually with the practitioner and the Physician Assistant. They were directed that the personal presence of an approved supervising physician is required when performing surgical procedures under general anesthesia at all times. On 4/12/2012 the Medical Executive Committee determined it would be in the best interest of both the physician and the MEC If the case was reviewed by an outside expert. It immediately took steps to send the case in question out for an independent review by an experienced expert c.Jrdiovascular surgeon, even though it was recognited this would cause a t ime delay In resolution of the matter. On 7/ 18/2012 the practitioner and the assl.sting cardiovascular surgeon were directed by the President of the Medical Staff to amend their documentation In the patient record to reflect wh;it accurately happened 0'92. The amended documentation was entered into the record on 7/19/2012.

3:05:55PM

TITl.E ()CB) MTE

Arrt ~ ...,,......,. ..., .,, ....,. n -.-. ~ wf*" .. ...,.,,, NY 11e exc:uMd from COl'l'8dlnO o flet °""' ........ p""4dl lllflc:ilnt pnMclcn to the ....... IEllllllllt fDr nur-. ,__,tie lrdiga 8bo¥8 .. cltc'1: I ~II to m,~tiiflltrii:f.niii.-=--=-=---="I 01 UWlf....,. er not I plln fit«ll'9diorl fl lll'Mdld. F« llftnt i.xn., .. ._ .... Ind.-,. d oon9dlon .. ~Olli ... ..... .._ dlx:umenll ........ _.....to .. ...,. lfcllllkJadll .. d91d, en""""*' plln OI amiclon ......... to CXll'lltttlC•lfal'WI! i*llclllllUd· 1 4 20~3

DEPT OF HEALTH SERVI LICENSING & CERTIFICATION-FRESMO

- A. IUILOINO ··-... °'MOWlDOR~ l1'MlT NJOMtl. crTY. ITAn. 1JI' CODE

Cr • R1J11r ........ Cenelr 11111 ,,._.,"--CA .nt·talil FWMOCOUM'l'V

DWllO l'Mf'IX

TAG

8UMMMV ITATtMl!NT Of' Oll'ICllNCll!I lEACff DEf1CIPCY MUST IE PflECUOEO 8Y Fill AE<MATOR't' OR L8C IDEHTIFY1NO .. OMMllON)

Cotllnuld Ff'Olft ,... 2

·~ mi••• 8llglng the tolowing: • ... (CW t) 111 ....... room while 1he chMt was .. °"" (tor ,... 1) Md ... left 1he holplll ................ -- .. (PA 1) .. tiiit oww .. ...., ... TM Plllltt •1•1d (cMllc ..,... . .. '-t ............ " .. ...,. •• room _, ,. ugeori ... not in .. hoepbl '° llltlnd '° .. plllenL "

The c:lniclll fec:ord for Patient 1 WU rtYiewed on '4117/12. P9liin 1 hed • U'gical repeir d the

Alc:illdft9 Aortic Anlurylm (AM) on -2. ~ ..... Aortic Mlwywn .. • .._.. canclloli .......... ...., ....... "-! lllllOOI• cU llllt ,_, ,._ AM ,.._ open MM ggery n Gl'dlr tD ,..ir.) 8'lllfY ,... ...,.. on •2• .. _.1 ._m. lftd u to caw•"*"°8•. ...,1t11 .. not -..ct unll 9:48 p.m. CVS 1 ne the prtnwy ugeon, - 'Med by PA 1 Md MO 1 (glnel1ll vmc:&lllr U"geOf'i). MO 2 waa the ~· CVS 1 left the OR at 11:-46 a.m. PA 1 and MO 1 IUU'ed the dlell doaed wilh melallic wire llt 11PP10Deil1 IRly 12:00 p.m. and then left the OR.

After PA 1 and MO 1 left the OR, Staff 1 (perfulionilt . a sp«:lalz9d hellh profeMionel .,... to monitor .. heM-Ulg mecNI• CUinO c:.dlovMcullr" open r..t aqery) nalld Patin 1 c::oNlooed to bleed. N. flll time Re~1Ul9d Nuree (RN) 1 (drcaMling "11111.r.t w) Cllled CVS 1 lllbout ... conlnuld tll-4.io. By phone. CV8 1

..... lllDod produdl (b -··· l9d blood • . - ...... to be lldl1• l1l1red to Patin 1; MUllpll ••lllMllklll•dblaod piOduda were

EV911t IO:VtGUB11 1/2&'2013

IO PREFIX

TAG

PRCMDIR'9 fl\M 01 C:C.••CTIOll IEACtf OOMECTlllE ACTION 8HOUlO • °"°8$.

REFERENCED TO ntE N'P~TI ml'lalNCY)

On 7 / 26/2012 the leadership of Surgical services, Chairs of the Facility Executive Advisory Committees and the President of the Medical Staff sent a letter to all members of the medical staff notifying them of the Physician Assistant scope of practice and directing all to adhere to l\he Callfornla Code of Regufatlons Tltfe 16. On 7 /27 /2012 the Medical Directorship for cardlottloracic services was reassigned to another physician. On 8/15/2012, the surgery staff orientation was amended to include the scope of practice for Physician Assistants and surgical practice and expectations of the surgeon when the patient is in the Operating Room. On 8/ 15/2012 a special MEC meeting was held to review the findings of the Investigation. The following actions were taken regarding the physician: A. In regards to the issue of medical record documentation: • A summary of his documentation deflclendes Identified during the external peer review wm be provided to the practitioner to Illustrate the types and severtty of his documentation deficiencies. • tn order to Improve his documentation deficiencies, the physician must successfully complete a University of callfornla San Diego (UCSD) Physician Assessment and Clinical Education (PACE) program in medical record documentation. • The practitioner must abide by all of the hospital policies, medical staff rules and regulations pertaining to medical records documentation. B. In regards to the issue of the chest closure following cardiac surgery, the physician shall remain in the operating room (OR) until the patient's chest is closed. c. Regarding the Issue of leaving the OR and the hospital during the case of. 2012: • There ls evidence that the patient was unstable following the conclusion of surgery. • As a result the patient was not ready to leave the OR. • The responslblllty for the patient's care under these circumstances rests clearly with this physician. • In leaving the OR and the hospltal, he falled to designat another physician qualified to provide the necessary coverage or care. • As a result, there was an untimely response to the patient's deteriorating condition.

3:05:55PM

(Xe) DATE

A.rf/~.-..rMnl91dno wlltM .-n.lt (") dlno6lll 8 ~ wtlidlh lnlalllanrnay beac:it..-cl fl'am ~ """"'"';'l~~~~~_J__!~!=_l ----~pOllda----P"*dlafttDlll ...... ~ far~l'oNI. .. ---.-.......... .... ' d ~ ,...._ 0t not• 1*n d OOft9dlan ia pl'Olllded. F0t IU9lg ,..,_., 111.,.. lndlrlVS mnct p1aria d ca'9dlon- dllc**lt*I~ 1118 ... ,_ ~ - madl 8wllatlle" .. ~· If dlldlwidN- Cllld, "'acip'CMd pllll doorredlan ........... b '.'0!3 peiticlpulol1.

S.-2lle7 DEPT OF HEALTH SERVICES 3 d I LICENSING & CERTIFICATION-FRC:SNQ

~HlfM.lM.Ml>tUMH.-vasN1SCV Ol'PMnmlT OF "8.IC HIAllH

- A.M&DING .. ..,

,.

MM 01 MIMlftl ~ """'--R tTRHT ACOAUI. CITY, STA,._ at COOi

c ................. c.... am,__ It,,._, CA unt-1114 l'MINO CCM.rt

Sl.lliliWrl STATEMENT CW DEF1CIENCIU (EACH DEFICEJllCY MUST IE PAECEEDEO 8Y fW. REGULATORY OR LIC IOENT1FVINO N'OAMATION>

N. lflPIC4t:• tll\r 12:46 p.m. the ~ .... fl!Wlllliilt .11» ... " ......... , • ·a·a1ed• .._ Oil1$ 11 .... lie Mmt to ........ -~ ...... ... ,.. dllld. (Codi blue II en tmll'9'fll elt.lllllon whel'e ... heert .. bMling .net ~ lnw11edi1t1 .... lliclfl.) PA 1 rUJIDI~· tD the code blue and rushed back Into the OR and opened .. c:heel (cut .. wire ..... holding the chest '°Ill*) .net lllftld ~ m1111glng .. ..... Pllllnl 1 did not reepond tD .. ...... ....... ~ ....... Pllllnt 1 conlnuld lo ........ •• , .. llfDod IOM. PA 1n MD 2..,._. to ... ...,. (• holoW IJM) lnlD .. '-1 In ,.., ll19Dn to ........ .. t.-t llWPW ........ NI ... ,,_ to piece the CIMUle Wlf9

UfllUCCll ... .

CVS 1 1'9-enWed the OR al 1 :29 p.m. end lldjueted the c.mulla ~. Plllient 1 wa placed on U t...t byp8e8 at ttlis time. CVS 1 attempted to ltlbilize ........ vital elgrla .net llop the blood loa in order to .... from the he.t byput rNIChlne. ~ to take Pllllent 1 off the bypaa INld1lne Mf'9 ~. CVS 1 dedded to pllce Pllent 1 on ECMO (ekh ~ memtn.. oxygecllltiol"I • • mec:hlne detigr'ICI to help oxygenate blood when the heert and lungs Int

teverely demlged) at 3:!53 p.m. Plltilnt 1 OldNlld to tllMd ....., ... ,.... , _

.... on ECMP. N. appmilr .. ,, 7:10 p.m. '119 .. 1..., ....., emdkMlcUlr uoeon (CVS 2) to......._ P111n1 1'1 conlnued bledig. CVS

Ewnt ID:\\GUB11 1/28f2013

IO PllEFIX

TAG

~Pl.NI"' C0"'1K'l10N (EACH COMECl1YE ACTION IH<MO. CROa­~TO THE N'PltOP•TE DIFICllHCY)

• The physician has been directed to either be present or to provide suitable coverage (pre.sence of a privileged cardiothoracic surgeon) following cardiac surgery cases until the patient is stable in the Intensive care Unit {ICU). • Therefore, a fourteen (14) day medleal staff suspension was Imposed.

8. The title of position of the person responsible for correction, e.g. Administrator, Director of Nursing or othe• responsible supeNisory personnel. President of Medical Staff and Chief Quality Officer

C. A description of the monitoring process to prevent recurrences of the defidency, the frequency of the monitoring and the individuates) responsible for the monitoring. All cardiovascular surgeries under the care of the physician were monitored concurrently for 2 months by the Patient Safety Department from April 3, 2012 througti June 1, 2012 for compliance with surgeon attendance during surgery as specified by our bylaws. All cases were referred to Peer Review for Medical Staff oversight. All Cardiovascular surgeries under the care of the physician were monitored for compliance with surgeon attendance during surgery as specified by our bylaws retrospectively within 1 week began June 2, 2012 and continued for 6 months until December l, 2012 and referred to Peer Review for Medical Staff oversight.

On 8/15/2012, 10 cases per month were randomly selected for all cardiovascular and Surgical procedures and reviewed by Peer Review for compliance with surgeon attendance during surgery as specified by our bylaws and surgical documentation including surgery times, attendance and the Operating Room report. The review occurred for 3 months with the goal of 100% compliance. Monitoring results was reported to Surgery Advisory, MEC and BOT for 5eptember, October and November 2012.

3:06:56PM

{Xe)DATE

/4trt dlllcilrq ...... lfldlng .. ....... (") ..... dllc:llncr "'*" .. n.IUon mey be llllQlled "'°"' con9Cllng 1~~t~;J~J..._!._!~ thll °""' ..... l"ovtcle ..... pnMc:lon to........ EllCllPl for nurelng hcll!IM. the llndingl --.. 11..-.... 90 di d ~ ........ Ot not. plan d oorl9dlon ii prowlded. For llUl1ling ,_,_., .. -- tlndlngs and plana d COl'l9dlon .. dlacbl!W~ .. -. e.e CIOeUmenll .. .,.,......,.. to .. fllcllly. tr OllkMIClel .. c.o . .,. IPPIOV9d p1an at con9Ctlon it l'lqUilMa to cotl!ltUJM 1 4 2013 ~·· SIMl-2507 DEPT OF HEALTH SERVICliit 8

LICENSING & CERTIFICATION-FRESNO

~HIM.TtlN#DtuWf SSMCESNJff.tCY DIPM1lmff OF P\8.JC+t&M.TH

..... A.BUil.ON)

I .MIO ....... ... Ci NCMlEll Oil IU'Pl.IER

Cima..,_ llllllllllllllMllulC...... ITAeET AOOREll. art. ITATE. 'lJP COOE

llD ....... F--. CA N71MUI l'RDllC)CCUITY

(X4)1D

PAEFOC TAG

8tMWtY STATEMEHT OF OIFICEllCIES (EACH DEl'ICIEHCY MUST IE PRE<:EEDEO BY FULL REGU.ATORY CA LSC IDENTFY1NG INFOAMATION)

Conllnuld From P1119 4

2 fnMIOl9d ~ 1'• aurgicll bleeding and Pllllenl , _ .... d to the ~

....... c.. Uuit. . ~In cdlcll conclllon at . et , .. ·-_..,.... .

On 4'1M2 llt 1:30 p.m., ~ In llltll JllW, ... 1 (plfMlanllt) .... CVS 1 IMt h OR It 1PP1oximllllly 11 :4G e.m., prior to the c::lolure of tt. c:helt. SW 1.-d "(PA 1) and (MD 1) doeed the chest end then left the OR. We were getting l"Mdy to nnlfer (Pltln 1) to the Unil but he ... 111Md1119 problely. (RN 1) celled (CVS 1) end he ....... .... round of blood pnMb:ll ghMr'I to

,... 1. - 2) ... gMlwg the blDod ...... ~ 1 .......... 10 much bit (MD 2) ccMd ,.., .......... ~ .... enough end Plllln 1 CDdld Ill 12:156 p.m.•

SCetf 1 l&et8d, w.t w celled the code ... (PA 1) came IUlhing b8dt in whlle CPR (cerdlopuknonery reeuac:htion) WM in prooeee. (PA 1) decided to open up the chelt wilh c:hMt compNuiO.,. being givel"I. w., lhe opened up the chelt blood W8I

ruehing out. She couldni Nert the c:heet tube and (MO 2) had to glove up and .... inMfting the c:heet tube. (PA 1) end (MO 2) never lnMr19d a d'88t tube. (CVS 1) wun't in and they had to do '°"""*"' (RN 1) got (CVS 1) on ltw phor'9. end got the phorl9 tlO (PA 1'a) _. IO he could bilk to her. He lnlt1ucted (PA 1) how to c:anrUllle (lneert a tube Into the chelt CIVlly) but lhe could not do •. (CVS 1) came in It 1=29 p.m. end ..,... ...

. ...... He look ov.r from (PA 1) lftd _.. "'.. .. ... bt11dlr1g pona. N. 3:21 p.m.' (Plllleft 1) WM .. 111116118nd (CVS 1) decided to l)lj

Ewnt 10:\WUB11 1/2&'2013

ID PREFIX

TAG

PACMDER'8 PlM OF CO•IECTION (EACH COMECTillE ACTION 8HOUU> • ~ REF&MNCEO TO TI4E APPROPRIATE DEFICIENCY)

On 8/15/2012, 10 cases per month were randomly selected and reviewed by Peer Review for appropriate utilization of Physician Assistants and surgical documentation Including surgery times, attendance and the Operatio.g ROQlll report. The review occ11tred ~or 3 months with 100!£ compliance. Monitoring resu!U were reported to Surgery Advisory, MEC and BOTfor September, October and November 2012. On 8/15/2012, 2 cardiovascular and 2 surgical cases were randomly selected for observation per month by Quality and Patient Safety RN's. The review occurred for 3 months with 100% compliance of adherence to medical staff bylaw expectation of surgeon attendance and Physician Assistant scope of practice. Monitoring results was reported to Surgery Advisory, MEC and BOT for September, October and November 2012 .

o. The dote when the immediate correction of the de/idency was accomplished. Normally this will be no more thon thirty {30} days from the dote of the exit conference. August 15, 2012 08/15/2012

3:05:56PM

LABORATORY DIRECTOR'S OR PROVIDERISUPPlER REJIAESENTATIVE'S SIGNATURE

Arr1dllcilnc¥llllll'nlntn1rVwill1n....,.. M dellCllll a dlllcianey wllldl Ille lnll*lllon mey be em.ad tan~ llat ClllS ......... prowld9 llllllclent pnJl9diol"l ID ........ bclpt fgr ........... lie llndlngl aboV9 .. ~ 90 d uwy wtlllllr or not a plan d Qlll'9dlorl Is ~· Fot,.,,... hOmel. lie ablWI lldngl and plane of COfl'8dlclfl .. clllcbil .. lie-. ll9la dDCumlntl .. made awllllble ID fl8 ~· If d1ldaodaa .. c:llcl, 1n approviad Sllan ol oonw:lon la f'ICIUilie9 ID 4>nllinulid ... ......,. ..

~JM,;TNMDfUIWl .llfMCESltllfW,Y lllPMRBT Cl ·llllliUC HiiM.n,t.

om~ IOENTIFICATION NUMIER: .... A. llUllDING

l . 'MNG

ITMET ADOMll. aTY, ITA,._ 'Ill' COOE MME OI llAO\aR OR IUl'tll.P

Caarun'- ...... ....,C..- ma Fwlf. Fw,CA 11n1-1m wccunv

PRO\llDER'S PlAH OF CORMCTION

.., .•• ~STATEMENT Of DEFICllNCIES

(EACH Ol!l'ICIENCY MU8T IE PRECEElllO BY FU.L R£0lAATORY OR LSC IDENT1FVING INFONMTION)

ID PREFIX

TAG CEACti CORRECTIVE AC1IOH IHOUlO IE CAO$$. REF~ TO THE N'PROPRIATE DEflCIENCY)

Conelnued From pege I

him on ECMO. (CVS 1) Mid, 'At this point thlre ia ......... 1Mt e1n be clone IUrgQlly,' lhlt we ...... ~ (Plln 1) to Cmllc icu.·

On 1/tM2ail tO:lla&. .... en•••• , CVS 1 ............. PA1to ...... clll ..... .

.... .... - to .Plffarm ............ ot .. ugery - doaft of the chelt with ...... CVS 1 llllld he had d**8d ......... and .. -routine. CVS 1 ltllled he allOwed PA 1 to pnlCtice

lbowe her prMlege Clfd • • ... lhe - ~ for '" Advnlld ~ Pr9Clk» Eum Ind for ... ft ftllded IO "*If CIMI ... 0l**'9 R ...... , ............. (IM n.tan of I .... ·tilt Mat .. e holClw ~ Cll'IM) h hlirt .. ;• CVS 1 llld hi _. • ... ~ there ..., ... cld ... \RI .. time.• CV8 1 ..... he left the ""l"Y ... wlfll up to the uni to coql ....

orderl for Plltiel\t 1 at lbout 11 :30 a.m. and then left the holpillll pemi ... llt about 12:<40 p.m.

On 7/16112 at 11 :30 e.m., MO 4 (Chief Olllcer for Qulllty) Ind Admi11iltlllltwt (Admin) 1, boCh ltlifllCI CVS 1 left the OR prior to cloue of the chest bones ba toglllll'. MD 4 Ind Admin S1ldf 1 ltlled that CVS 1 violated the holpiWs Rules and Regulallona under the 8ytliws which do not pennit .. prinwy l&ll9IOft to leeve l'9 OR prior to the pMier1t ~ elltllblilhecf .......

The Rules and R....... and Pol!:::iM of the ...... SlldJ d.eed 2011 ........ , .. 711Vt2 Ind COl1'111111d .. folowtng ~ .....

..-.n· a ·... ea-• Anwlau•~ - Eech a ·•11~11111 pmon11y provide or

Ewnt ID:v.GU811 1f.3ll2013

EC EIV~

:Jt:P I UF HEALTH SERVIC! Lle!NSING & CERTIFICATION-F ESNO

3:05:55PM

TITLE

Any --.cy llillllnlnl erdnQ w1111n....,. (1 0lr1CMI a dlllcllnC:r whiCtl the lnlllMlon llllY bl 4lllOllld tnlln OOl'l'ldlnG PllMdlnD •ii m..nni111d ... Olwr ......-. prV'Me IUlliclll1I ptQlldol'I to"' ........ E>apt rc.w ~ ~ lllftndk9 llbowe _ ...... 90 dll19 fdlcMlr'9"' ... d _.,,,., whllllr or not• '*'1 d COlllldlon ii pnMded. For~ homel. Ill~ lldrlfl and.,._,. cl oon9dlon - dlec:loeatlle 1'4 ~ lolowlng 1111 dlll tw ooaumenta .. lllldl IMilllllll to .. f8cllty. If dlldlllc:lll.,. Clilld. an ~ '*'1 Cl COITIClon la reciue-to~ progr1111

~··

' : · .

eou

... ~ . ,.,

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ITA'llflmff C. OPlCllNCIEI ClCt)~ (X2) MUI. TPl.E COM9TRUCTION ()CJ) 041'! IUINn N10 PlM Of COMecTION IDENTlflCATION IUlaft COWUiTID

A. llUILDING - l . 'MMG ..,,,_ '"' . -"'' .. ·~

WIMl 01MCMJEROR8UPPUER 81MET MlllAUS, CITY, STATE.111' CODE '.~.

c ••• .., ............ c...... i2IU ,___It. ,....._CA ta121·111t FMlllOCCQRY

(X4)IO 8UMMMY IT~T£MENT OF OEFICIENCIU IO PROWlEA'8 PlM OF CONllECT10H (Q)

flMFlX (EACH DEFICIENCY MUST IE PMCISl!O 9Y f'Ull PREFIX (EACH COMEC1M ~ ettOULD IE CA06$- COW\.£n TAG AEOULATO!rf OR LSC llENTIFV1NG INFO......TIOH) TAG REFERENCa> TO THE ~TE DEFICIENCY)

Conllnued Ft'Olft pep I

~ ..... b ~ c:are Md c::oMflG8 blllCllof•ww ......... F .... to .... .......... ........ ... ... .... b c:otrwc:lve ......... -~ .... , ..... w ,,, .• ...................... 1., ..... .., ....... c.9 for .. "' .. .......... .... .. ..., , •. .... ~Gib ... ... ..... ...... tr~~. The CCW9ftng

~ mull ... ••11111Ue Ind qtJlllll&I to ..eume ,..,. tllbllly for the petielD cMtng the enlirely of the allftCllig phyliclln'• llbNnce •.. lt " ecpedld M 1 ~ on Cll wll rMpond to ..... " ............. llltllllnl ... ....., . f1t) ....... al ..... Qllled Ind ........... In

................ - (30) ...... of My Cll to

..... NCll IJft/ ...... "'*'8lion trMmenl end 11111••• ........ In Clfllln ~11•11 men ....... ···- mey be requRd. Under Artlde VI Correclve Aclof'I Md Mdlol'I 6.1.1 the ralowlng docurnenCllllon -noted: W"'1 a member mey h9ve ~ conduct likely to be (1) detl lmentill to .,.uertt llfllly or to the delNely of quality plllent <*'Cl wtlhin the hoepit,11; . .. ( •> below app4icab'9 profeMionlll mndlrdl ... mey be lnitllted by the Pretident of the Commlltee ... •

CVS 1 left the open heart swgery on Ptltient 1 prior

~ E c E I v E

to cloeir1g of .. chlel Ind prior to lllbllzllion In vio111ion of hoepbl medlcll .... byllws. CVS 1 left ~ ., indMdull not qudfi•d to bt left in FEB 14 r(\ '•}

ctwoe (PA 1). PlllAlnt 1.-.. m1111¥1 ~ Lv :J ... ... CVS fllt· ,_OR Ind . •*HllMil ... ...... c:.dl9c ..... Bica• d .. m1111u1 DEPT OF HEALTH SERVICES

-- 111111 .. loll d mtygllt to the lnln. PJlllnt LICENSING & CERTIFICATION-FAE 1 - ..., on 111 IUPPOl'I- P.aent 1 rtmlllned on

Ewnt D:MU811 112812013 3:05:5SPM

Ar'lj ~......,.ending wlll M .... (")-.-1 Cllftdency wtlid't fie lnMMiOrl me, lle-.ICI tan COIT9Clng PfvWllng l II CllelliiilllCI

hi°"" ...... prO'lldl lllillcllent "'**" '° ........ &clpt for nur""8 tiorw. ........ lbo'4 ... +ctoeeb'e '°·.,. .......... d uwy """'-or not 1 plln d con9dioll It ~· For nur""8 tiorw. fie.,... ftndll9 Ind pllr1I d correc:tlon.,. ~ 14 _. tollowlnQ Ill ci.e .... documenll R mlCll ..... to the flctltY. If dllle:llllCM M Cllld, M ~ p!ln rA corl'9Cllon la requillet to COf'OIUed prccJlm

~ ..

DATE

.,

r--r-

µ '-'

NO

(X9)°"TE

~lHNetUWt •t.'ICE8/llllMCt ...... ffOIWHIAl.nt

CJ(t)~ IDENTIFICATION NUlaR: .....

> i /'

A. llUllDIHG .. .,.., -Of""°"'°"' OR~ S1'AEET MIORUS, CITY, STATE. 'lJIP CCOE

C•• a ... Rlllulll..._.c.lllr -.U F...-St. "--CA N721-1U. FRElllO COUNTV

Ot'llD PMFOC

TAG

8'MMRY $TAT£MEHT Of~ (EACH DmCIENCY MU8T If PAECUDEO IY Ali REGUlATORY OR l8C IDEHTIFYINO INFONMT10N)

Continued From Piii' 7

llfewpport•-2.

This ~ fllild. to ~ ....... ,y(ill) • • , . ·• ·1'ilfi. ~ ' .................. a.. ...... - -·";)),..,.,_ ........ ~·,~ . "'"""""'·- -· .................. ~----­...................... ..... "' ...., - 8*y COdl 8eclcl'I 1do.1(c).

l'ftCMDElt'S P\M 0. COllMCTION (UCHCCRRECTM! ACTION~IE ~ RIFEMNCED TO 'llC .W9'CWNATe llEf1CIEHCV)

DEPT OF HEALTH SERVICES LICENSING & CERTIACATION-FRE 00

Ewnt ID:WQU811 1/2&'2013 3:05:56PM

TITLE

Mt~ ~Wdl'O wlfl Ill ... ri dlllClllll I dellcllllC.y wtlidl .. NllMlcln-....... rr.ini correclno ~ ... dlelmlNd

............ p'CMll UlldintprollCllOl'ltDlll ..... E>aptfQrllll'lilg ......... ,__..lbcM .. ~'°--~--­" wwr """*or not 1 ~ ol ~ II~. For nur""8 holll9e. "'.ei-11nc1n11 encl ..,_of conldfon - dledoeltll914 _. flllllowlr'jg .. - .... documenla- mede lwllltlle to ... fldlty. If Clllci9iildll 119 cllld. 111 IPP'IMCI ~of corrdon .. ~to conllnuld ~ ~.

(XCI) lll'TE

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