Report - Disability Rights Texas

# Provision Assessment of Status Compliance
maintain a medical review system
that consists of non‐Facility
physician case review and
assistance to facilitate the quality of
medical care and performance
improvement.
conducted on 3/31/12. The Monitoring Team requested copies of all internal and
external audit forms, graphs, summaries, action plans, and evidence to support
completion of action plans. In addition, the Facility employs an external physician to
participate at mortality reviews, and to provide feedback on system improvements based
on findings from the mortality review process. The Monitoring Team reviewed the
mortality review summary, administrative reports, hospital records, and the clinical
record of Individual #54.
External Medical Audits
The Monitoring Team noted that only one of the two primary care physicians
participated with the external audit process, and the scores were noted by the
Monitoring Team.
The external audit assessed issues considered essential, and also non‐essential elements.
A current list of each element assessed was not provided to the Monitoring Team for
review. The External audit noted that the physician was 100% compliant with regards to
essential requirements, and no action plans were required to be developed. Two action
plans were developed for Non‐essential elements, and based on evidence provided, both
action plans were not completed at the time of the Monitoring Teams review. The
Monitoring Team was provided with several bar graphs but no summary by the Facility,
so it was not possible to determine the number or percent of cases reviewed, and there
was no information about review of clinical management.
The Monitoring Team noted significant issues with regards to the external medical audit
process. The review process was a specific chart audit process, and because multiple
physicians provided services, such as when cross covering, or on‐call coverage by
alternate physicians, the evaluation process assessed the work of the cross covering
physicians, and not just the physician of record. The process continued to be one that
reviewed mostly administrative process, such as completing assessments, and timely
documentation practices, and did not focus on actual clinical performance. Most
important, although the physician gained 100 percent compliance for essential elements,
the Monitoring Team noted significant areas of deficiency with regards to provision of
medical services, as delineated in Provision L1, of this report.
Mortality Review Process
The Facility had a death since the last compliance visit, which was the first death
reported since the Settlement Agreement was implemented. Individual #54 was a 66
year old female with a history of constipation, bowel obstruction, oral dysphagia, and
was rated at high risk for aspiration. She was admitted to Valley Baptist Hospital due to
fever, vomiting, abdominal distention and absence of bowel movement for two days. She
was diagnosed with bowel obstruction and preparations were being made for an
Rio Grande State Center, November 19, 2012
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