Although my law office is in Houston, Texas, I handle medical malpractice cases all over Texas, including the Dallas area.
One of the hospitals in the Dallas area is Dallas Medical Center, located at 7 Medical Parkway, Dallas, TX 75234. Located in the Farmers Branch part of the city, the 155-bed hospital offers an emergency room, a complete laboratory, digital x-ray machines, a CT scanner, an MRI machine, ultrasound equipment, a heart catheterization lab, and operating room suites. Its medical services include cardiology, vascular surgery, gastroenterology, colorectal surgery, physical medicine and rehabilitation, primary care, bariatric surgery, and wound care.
The hospital has over 400 physicians on its medical staff, including primary care doctors, cardiologists, gastroenterologist, colorectal surgeons, hepatologists (liver), orthopedic surgeons, spine surgeons, plastic surgeons, urologists, general surgeons, oncologists, and bariatric surgeons (weight loss).
Quality of care concerns
The Centers for Medicare and Medicaid Services regularly send on-site inspectors to conduct surveys of accredited hospitals related to quality care.
As a result of the surveys, Dallas Medical Center received 14 violations since May 23, 2013.
The most recent two violations were on February 13, 2017.
The first violation on this date dealt with blood transfusions and IV medications. The surveyor found that the hospital’s nursing staff did not follow state law and approved hospital policies and procedures by failing to have their blood products checked by two nurses prior to blood administration. These laws, policies, and procedures are, of course, in place for patient safety.
The second violation on this date dealt with grievance review time frames. The Medicare/Medicaid surveyor found that the hospital leadership failed to ensure the provision of a response to multiple patient grievances within a required timeframe. As a former hospital administrator, this type of violation is concerning to me. Patient grievances about quality of care issues provide a unique opportunity for hospital leaders to gain insights about what is really going on in the facility and how to improve patient safety.
The hospital received 12 additional violations on May 23, 2013.
The first violation dealt with infection control responsibilities. The surveyor found that the Dallas Medical Center infection control officer could not even locate the infection control log from 2012. This is, of course, important for infection control purposes, including exposure of patients, hospital staff, healthcare providers, and others to infectious patients.
The second violation concerned deficiencies in the provision of surgical services. The Medicare/Medicaid surveyor found that the hospital failed to ensure that surgical records were completed, as required by the hospital’s own policies and procedures. Of course, surgical records are an important part of the medical records because they help inform and guide additional post-operative care. When they are incomplete or missing, it can create quality of care issues.
The third violation was issued based on the determination by the surveyor that the governing body of Dallas Medical Center failed to act as an effective governing body. One of the major roles of the governing body is to provide oversight on all aspects of the hospital. The surveyor found concerning lapses in the lack of informed consent paperwork, history and physical documentation, and use of patient restraints, as well as violations of patient rights and responsibilities.
The Medicare/Medicaid surveyor found that the hospital violated patient rights, resulting in the fourth violation. This related to the improper use of restraints on a patient. Restraints are highly-regulated based on Texas law and regulations. Experts contend that misuse of restraints can deteriorate a patient’s health care status. This is why it is important for hospitals to have proper policies and procedures, to train its staff to follow them, and for the leadership to provide adequate oversight.
The fifth of violation dealt with the failure of the hospital to respect patient rights by providing care in a safe setting. This violation also stems from the misuse of restraints, because of the lack of proper assessments and physician orders for restraints.
Similarly, the sixth of violation arose from the same misuse of patient restraints, but focused on a violation of patient rights concerning restraint or seclusion. Texas law and regulations, as well as the hospital’s own policies and procedures, require physician orders for restraints that limit the time frame that they may be used. Instead, in this instance, a physician entered an order for restraints on a PRN (as needed) basis, which is not allowed.
The seventh violation also dealt with misuse of restraints or seclusion at the hospital. Once restraints are administered on a patient for behavioral reasons, the nursing staff must perform a face-to-face evaluation of the patient every hour. The hospital failed to do so.
The eighth violation was for the failure to provide registered nursing (RN) supervision of nursing care. Although a variety of nurses, with varying degrees of training, provide skilled care at hospitals, like Dallas Medical Center, the hospital must provide adequate supervision of that nursing care.
The ninth violation on this date dealt with the medical records services. The surveyor found that the hospital failed to ensure that all clinical record entries were legible, completed, dated, timed, and authenticated. It is important to have a complete and accurate medical record for the purpose of future healthcare providers being able to provide continuity of care.
The tenth violation issued by the Medicare/Medicaid surveyor was based on the hospital failing to ensure that a complete history and physical was completed prior to a surgical procedure being performed. A history and physical refers to the process of interviewing the patient about why he or she came to the hospital (the chief complaint), as well as their past medical history and medications, and current illnesses and medications. While this is typically performed by a physician or mid-level provider, like a physician assistant or nurse practitioner, the hospital nursing staff and administration chairs role in ensuring that it is performed before surgery proceeds.
The last violation addressed the failure of the facility to obtain proper informed consents in nine out of 10 clinical records that the surveyor reviewed. Informed consent is ultimately the responsibility of a physician and, under Texas law, cannot be delegated to anyone else. Informed consent refers to the process of a physician counseling with the patient about proposed options for treatment, alternatives, and the risks and benefits of each treatment modality, as well as doing nothing. A surgery should begin only after the nursing staff verifies that this process has been completed and documented.
We are here to help
If you or a loved one has been seriously injured as a result of poor medical or nursing care at Dallas Medical Center, call the experienced medical malpractice and wrongful death attorneys at Painter Law Firm, in Houston, Texas, for a free consultation about your potential case. We handle cases throughout the State of Texas. You may reach us at 281-580-8800.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members and medical malpractice and wrongful death lawsuits against hospitals, doctors, surgeons, anesthesiologists, and other healthcare providers. In 2017, H Texas magazine listed him among Houston’s top lawyers.