Was this hospital in operation at any time during the year?
Yes
10.
Operation Open From:
1/1/2010
11.
Operation Open To:
12/31/2010
12.
Name of Parent Corporation:
Southern Mono Healthcare District
13.
Corporate Business Address:
P.O. Box 660
14.
City:
Mammoth Lakes
15.
State:
CA
16.
Zip:
93546 -
17.
Person Completing Report:
Jane Grossblatt
18.
Report Preparer's Phone No.:
760-924-2227
19.
Fax No.:
760-924-4029
20.
E-mail Address:
jane.grossblatt@mammothhospital.com
30.
Submitted by:
jgrossblatt
31.
Submitted Date and Time:
4/29/2011 12:54:39 PM
32.
Corrected by:
denarduy
33.
Corrected Date and Time:
10/13/2011 1:15:34 PM
Section 2 - Hospital Description
LICENSE CATEGORY (TYPE) (Completed by OSHPD.)
Line No.
(1)
1.
License Category:
General Acute Care Hospital
LICENSEE TYPE OF CONTROL
Line No.
(1)
5.
Select the category that best describes the licensee type of control of your hospital (the type of organization that owns the license) from the list below:
District
PRINCIPAL SERVICE TYPE
Line No.
(1)
25.
Select the category that best describes the type of service provided to the majority of your patients. (The type or service is usually consistant with majority of, or mix of reported patient days.)
General Medical / Surgical
Section 3 - Inpatient Services
INPATIENT BED UTILIZATION - DO NOT INCLUDE NORMAL NEWBORNS IN BED UTILIZATION DATA
Line No.
Bed Classification and Bed Designation
(1)
Licensed Beds as of 12/31
(2)
Licensed Bed Days
(3)
Hospital Discharges (including deaths)
(4) Intra-hospital Transfers from Critical Care
(5)
Patient (Census) Days
GAC Bed Designations
1.
Medical / Surgical (include GYN)
13
4,745
504
1,315
2.
Perinatal (exclude Newborn / GYN)
2
730
107
227
3.
Pediatric
0
0
0
0
4.
Intensive Care
2
730
15
25
49
5.
Coronary Care
0
0
0
0
0
6.
Acute Respiratory Care
0
0
0
0
0
7.
Burn
0
0
0
0
0
8.
Intensive Care Newborn Nursery
0
0
0
0
0
9.
Rehabilitation Center
0
0
0
0
15.
Subtotal - GAC
17
6,205
626
1,591
16.
Chemical Dependency Recovery Hospital
0
0
0
0
17.
Acute Psychiatric
0
0
0
0
18.
Skilled Nursing
0
0
0
0
0
19.
Intermediate Care
0
0
0
0
20.
Intermediate Care / Developmentally Disabled
0
0
0
0
25.
Total (Sum of lines 15 thru 20)
17
6,205
626
1,591
Chemical Dependency Recovery Services In Licensed GAC and Acute Psychiatric Beds*
Line No.
Bed Classification
(1)
Licensed Beds
(3)
Hospital Discharges
(5) Patient (Census) Days
30.
GAC - Chemical Dep Recovery Services
0
0
0
31.
Acute Psych - Chemical Dep Recovery Svcs
0
0
0
* The licensed services data for these CDRS are to be included in lines 1 through 25 above.
Newborn Nursery Information
Line No.
(1) Nursery Bassinets
(3) *Nursery Infants
(5) Nursery Days
35.
Newborn Nursery
3
109
241
* Nursery Infants are the "normal" newborn nursery equivalent to discharges from licensed beds.
Skilled Nursing Swing Beds (Completed by OSHPD.)
Line No.
(1)
40.
Number of licensed General Acute Care beds approved for Skilled Nursing Care:
0
Complete lines 43 through 70 only if your hospital has licensed Acute Psychiatric or PHF beds. Include Chemical Dependency Recovery Services provided in licensed Acute Psychiatric beds.
Acute Psychiatric Patients By Unit on December 31
Line No.
(1) Number of Patients
43.
Locked
0
44.
Open
0
45.
Acute Psychiatric Total*
0
Acute Psychiatric Patients By Age Category on December 31
Line No.
(1) Number of Patients
46.
0 - 17 Years
0
47.
18 - 64 Years
0
49.
65 Years and Older
0
50.
Acute Psychiatric Total*
0
Acute Psychiatric Patients By Primary Payer on December 31
Line No.
(1) Number of Patients
51.
Medicare - Traditional
0
52.
Medicare - Managed Care
0
53.
Medi-Cal - Traditional
0
54.
Medi-Cal - Managed Care
0
55.
County Indigent Programs
0
56.
Other Third Parties - Traditional
0
57.
Other Third Parties - Managed Care
0
58.
Short-Doyle (includes Short-Doyle Medi-Cal)
0
59.
Other Indigent
0
64.
Other Payers
0
65.
Acute Psychiatric Total*
0
* Acute Psychiatric Total on lines 45, 50 and 65 must agree.
Short Doyle Contract Services
Line No.
(1)
70.
During the reporting period, did you provide any acute psychiatric care under a Short-Doyle contract?
No
Inpatient Hospice Program
Line No.
(1)
71.
Did your hospital offer an inpatient hospice program during the report period?
No
If 'yes' on line 71, what type of bed classification is used for this service? (Check all that apply.)
Line No.
Bed Classification
(1)
72.
General Acute Care
No
73.
Skilled Nursing (SN)
No
74.
Intermediate Care (IC)
No
Section 4 - Emergency Department Services (EDS)
EMSA Trauma Center Designation on December 31
(Completed by OSHPD from EMSA data.)
Line No.
(1) Designation
(2) Pediatric
1.
Licensed Emergency Department Level
(Completed by OSHPD from DHS Data.)
Line No.
(1) January 1
(2) December 31
2.
Standby
Standby
Services Available on Premises
(Check all that apply.)
Line No.
Services Available
(1) 24 Hour
(2) On-Call
11.
Anesthesiologist
No
Yes
12.
Laboratory Services
No
Yes
13.
Operating Room
No
Yes
14.
Pharmacist
No
Yes
15.
Physician
No
Yes
16.
Psychiatric ER
No
Yes
17.
Radiology Services
No
Yes
Emergency Department Services
Line No.
EDS Visit Type
CPT Codes
(1)
Visits not Resulting in Admission*
(2) Admitted from ED (Enter Total Only if Details not Available)
(3)
Total ED Traffic (1) + (2)
21.
Minor
99281
1,296
0
22.
Low/Moderate
99282
1,287
0
23.
Moderate
99283
2,708
40
24.
Severe without threat
99284
2,278
242
25.
Severe with threat
99285
677
239
30.
TOTAL
8,246
521
8,767
* DO NOT INCLUDE patients who register but left without being seen, employee physicals and scheduled Clinic-type visits.
Emergency Medical Treatment Stations on December 31
Line No.
(1)
35.
Enter the number of emergency medical treatment stations.
11
Treatment Station - A specific place within the emergency department adequate to treat one patient at a time. Do not count holding or observation beds.
Non-Emergency (Clinic) Visits Seen in Emergency Department
Line No.
(1)
40.
Enter the number of non-emergency (clinic) visits seen in ED.
0
Emergency Registrations, But Patient Leaves Without Being Seen*
Line No.
(1)
45.
Enter the number of EDS registrations that did NOT result in treatment.
20
* Include patients who arrived at ED, but did not register and left without being seen (if available)
Emergency Department Ambulance Diversion Hours
Line No.
(1)
50.
Were there periods when the ED was unable to receive any and all ambulance patients during the year and as a result ambulances were diverted to other hospitals? If 'yes' fill out lines 51 through 62 below. Count only those hours in which the ED was unavailable TO ALL PATIENTS (see instructions).
No
Number of Ambulance Diversion Hours that occurred at Emergency Department
Line No.
Month
(1) Hours
51.
January
0
52.
February
0
53.
March
0
54.
April
0
55.
May
0
56.
June
0
57.
July
0
58.
August
0
59.
September
0
60.
October
0
61.
November
0
62.
December
0
65.
Total Hours
0
Section 5 - Surgery and Related Services
Surgical Services
Line No.
Surgical Services
(1) Surgical Operations
(2) Operating Room Minutes
1.
Inpatient
454
73,665
2.
Outpatient
761
70,560
Operating Rooms On December 31
Line No.
Operating Room Type
(1) Number
7.
Inpatient Only
0
8.
Outpatient Only
0
9.
Inpatient and Outpatient
2
10.
Total Operating Rooms
2
Ambulatory Surgical Program
Line No.
(1)
15.
Did your hospital have an organized ambulatory surgical program?
No
Live Births
Line No.
(1) Number
20.
Total Live Births (Count multiple births separately)*
109
21.
Live Births with Birth Weight Less Than 2500 grams (5 lbs. 8 oz.)
1
22.
Live Births with Birth Weight Less Than 1500 grams (3 lbs. 5 oz)
0
* TOTAL LIVE BIRTHS on line 20 should approximate the number of Perinatal discharges shown in Section 3, line 2, column 3. Include LDR or LDRP births and C-Section deliveries.
Alternate Birthing (Outpatient) Center Information
Line No.
(1)
31.
Did your hospital have an approved alternate birthing (outpatient) program?
Yes
32.
Was your alternate setting was approved as LDR
Yes
33.
Was your alternate setting was approved as LDRP
Yes
Other Live Birth Data
Line No.
(1) Number
36.
How many of the live births reported on line 20 occurred in your alternative (outpatient) setting? Do not include C-Section deliveries.
66
37.
How many of the live births reported on line 20 were C-Section deliveries?
43
Licensed Cardiology and Cardiovascular Surgery Services (Completed by OSHPD.)
Line No.
(1) Licensure
41.
Not Licensed
Note: Complete lines 42 to 85 if licensed for Cardiovascular Surgery Services. Complete lines 55 to 85 if licensed for Cardiac Catheterization only.
Licensed Cardiovascular Operating Rooms
Line No.
(1)
42.
Number of operating rooms licensed to perform cardiovascular surgery on December 31.
0
Cardiovascular Surgical Operations (with and without the HEART/LUNG MACHINE*)
Line No.
(1) Cardio-Pulmonary Bypass USED*
(2) Cardio-Pulmonary Bypass NOT USED
43.
Pediatric
0
0
44.
Adult
0
0
45.
Total Cardiovascular Surgical Operations
0
0
* Also refered to as Extracorporeal Bypass or "on-the-pump" (heart/lung machine).
Coronary Artery Bypass Graft (CABG) Surgeries*
Line No.
(1)
50.
Number of Coronary Artery Bypass Graft (CABG) surgeries performed.
0
* Subset of cardiovascular surgeries reported on line 45 above.
Cardiac Catheterization Lab Rooms
Line No.
(1)
55.
Number of rooms equipped to perform cardiac catheterizations on December 31.
0
Cardiac Catheterization Visits
Line No.
(1) Diagnostic
(2) Therapuetic
56.
Pediatric - Inpatient
0
0
57.
Pediatric - Outpatient
0
0
58.
Adult - Inpatient
0
0
59.
Adult - Outpatient
0
0
60.
Total Cardiac Catheterization Visits
0
0
Distribution of Procedures Performed in Catheterization Laboratory
Complete this table if Cardiac Catheterization Visits are reported in line 60, columns 1 and 2.
Line No.
(1) Procedures
65.
Diagnostic Cardiac Catheterization Procedures (LHC, R & LHC)
0
66.
Myocardial Biopsy
0
71.
Permanent Pacemaker Implantation
0
711.
Other Permanent Pacemaker Procedures (Generator or Lead Replacement)
All other catheterization procedures performed in the lab
0
85.
Total Catheterization Procedures
0
NOTE: Do Not Include Any Of The Following As A Cardiac Catheterization:
Defibrillation
Temporary Pacemaker Insertion
Cardioversion
Pericardiocentesis
Percutaneous Transluminal Balloon Valvuloplasty(PTBV) is very rarely done in these times. Those that are done are generally on pediatric patients.
AICD procedures are frequently done in the cath lab and are very similar to permanent pacemaker implants.
Section 6 - Major Capital Expenditures
Section 127285(3) of the Health and Safety Code requires each hospital to report "acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000)."
Diagnostic and Therapeutic Equipment Acquired During The Report Period
Line No.
(1)
1.
Did your hospital acquire any diagnostic or therapeutic equipment that had a value in excess of $500,000? (If 'Yes', fill out lines 2 through 11, as necessary, below.)
No
Diagnostic and Therapeutic Equipment Detail
Line No.
(1)
Description of Equipment
(2)
Value
(3) Date of Aquisition MM/DD/YYYY
(4)
Means of Acquisition
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Building Projects Commenced During Report Period Costing Over $1,000,000
Section 127285(4) of the Health and Safety Code requires each hospital to report the "commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000)."
Line No.
(1)
25.
Did your hospital commence any building projects during the report period which will require an aggregate capital expenditure exceeding $1,000,000? (If 'Yes', fill out lines 26 through 30, as necessary, below.)