HospitalInspections.org

Based on record review and interview, the facility failed to provide adequate physician specialty on-call coverage in the ED per facility policy:

a. several days in March & April, 2021: the same physician was the scheduled ED physician and was also assigned as on-call for general surgery;

b. there was no general surgery coverage in the ED on May 3, 2021.

Findings included:

Record review on 7/14/2021 of facility policy titled" Medical Staff On-Call Roster," showed:

-There will be a defined mechanism for obtaining speciality medical services for patients presenting to the Emergency Department;

-An Emergency Call Schedule will provide for consultation in the identified specialties for the services provided by the Hospital.

a. One physician provided coverage for the Emergency Department and also on-call coverage for general surgery for 7 days:

During an interview on 7/14/2021 at 12:15 PM with Staff B, Facility Trauma Registrar, she stated the facility had only two(2) specialties on-call: family practice and general surgery.

Record review of facility ED Physician schedule and General Surgery On-call Schedules for April- July, 2021 (month-to-date ) showed the following :

- ED schedule schedules dated : March 27, 28, 30, 31 and April 1, 2, 3, 2021
showed the ED physician scheduled was Staff E.

-Surgery On-call schedules dated March 27, 28,30, 31 and April 1, 2, 3, 2021 showed "DR (Staff F ) Out-of Town:-Call Dr (Staff E)."

On 7/15/2021 at 1:05 PM, these findings were discussed with Staff A, CEO. She acknowledged the same physician cannot cover the ED and general surgery.

b. May 3, 2021: no surgeon on-call:

Record review of the medical record (Hospital A) of Patient ID # 1 showed the facility was attempting a transfer to Hospital B (UMMC).

It was documented on 5/3/2021 Hospital A was told there was no surgeon at UMMC Tidwell or UMMC North: "....Both NMMC (sic) Red Oak and Tidwell said they have no surgeon... "

Further review of Hospital A documentation ( by ED physician) dated 5/4/2021 ( 2 AM) showed "attempted to page the surgeon (Staff F) who performed Patient ID # 1's surgeries but no return page ." [Cross refer tag A-2406 for additional information]

Based on interview and record review, the facility failed to maintain an accurate ED Central Log. Patient ID # 1 was transported to the facility via ambulance on 5/3/2021 and was not recorded in the ED Central Log.

Findings included:

TX00387342

Record review of a facility policy titled " Emergency Medical Treatment & Active Labor Act, last review date 04/2019, stated:

Record-keeping:

The hospital must maintain the following....

-a central log on each individual who comes to the emergency department seeking assistance and whether... transferred, admitted, stabilized, discharged, etc...for five(5) years.

During a telephone interview on 7/14/2021 at 8:45 A.M. with Staff J, EMT, he stated: Patient ID # 1 was picked up for transport at Hospital A on 5/3/2021 "....About half-way in route, my partner (paramedic in back with the patient) told me to switch to 'emergency traffic'--light & sirens- because the patient's vital signs were tanking." That is what I did-switched to lights & sirens..."

"A short time later, we pulled up to the ambulance bay at UMMC. A ...male came out waving his arms--he was wearing teal scrubs. He said .... We can't take this patient. We can't accept her here because of her acuity. We can't handle her here. You have to take her somewhere else...."

Record review on 7/15/2021 at 12: 15 PM of the facility ED Central Log for May 3 & 4, 2021 failed to reveal documentation of registration of Patient ID # 1.

At this same time, Staff B, Facility Trauma Registrar, input Patient ID # 1 's name and date of birth into the hospital computer system. She said Patient ID # 1 had never been registered at this facility.

Based on interview and record review, Hospital B failed to provide a medical screening exam (MSE) to a patient transported to the facility from Hospital A by ambulance on 5/3/2021 (Patient ID # 1 ).

Patient ID # 1 was subsequently transported to Hospital C , seen in the ED, and admitted in critical condition to the Intensive Care Unit (ICU).

Findings included:

TX00387342

Hospital A : [originating hospital]

Record review of the medical record (Hospital A) of Patient ID # 1 showed:

-physician order dated 5/3/2021 (1925) : send patient to ER ;

-"Both NMMC (sic) Red Oak and Tidwell said they have no surgeon... [Staff H, house physician) called the patient's surgeon (Staff I ) and he said to send the patient to NMMC (sic) Tidwell..."

-"pt. transfer to E.R. left facility at 22:15: blood pressure is low 71/23 ; map 19 (mean arterial pressure); oxygen saturation 87% (normal is 95-100%); heart rate 113 ;"

-Nursing supervisor (Hospital B) was called. "...explained that our house doctor spoke to patient's surgeon..he said to send the patient to Tidwell. [Tidwell nursing supervisor ] said he would not take the patient and he would send her back to us..."

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Hospital B: [turned ambulance away]

Record review of a facility B policy titled "Emergency Medical Treatment & Active Labor Act (EMTALA)", last reviewed 04/19, showed:

-the hospital shall provide a medical screening exam (MSE) by qualified medical personnel for every patient who comes to the emergency department and makes a request for examination or treatment of a medical condition;

-an MSE shall also be conducted when a request is made on behalf of an individual, even if the person requesting the exam is not the individual's legally authorized representative.

~~

Record review on 7/15/2021 at 12: 15 PM of the-ED Central Log ( Hospital B) for May 3 & 4, 2021 failed to reveal documentation of registration of Patient ID # 1. At this same time, Staff B, Facility Trauma Registrar, put Patient ID # 1 's name and date of birth into the hospital computer system. She said Patient ID # 1 had never been registered at this facility.

During interviews on 7/15/2021 between 1:15 and 1:30 PM with two (2) ED Registered Nurses (RN) (ID #C & D ): both stated they would "never turn away an ambulance that arrived with lights & sirens; that would be an EMTALA violation."

During an interview on 7/15/2021 at 1:05 PM with Staff A, CEO , when asked if she had knowledge of any possible EMTALA issues with ED patients in early May 2021, she said:

-In early May, "the CEO of Hospital C called me and asked me to investigate concerns regarding Patient ID # 1, which I did. it was not a 911 call; it was an elective transfer. There was no Memorandum of Transfer and no nurse-to-nurse report. We had no history of an ambulance calling to say we are bringing a patient there. They were probably talking to the wrong hospital. That means there was no EMTALA."

The CEO went on to say the ED would "definitely not" turn away an ambulance that arrived with lights and sirens.
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Hospital C: [ saw patient in ED; admitted to ICU]:

Record review of the ED medical record of Patient ID# (Hospital C)-showed the following:

-MSE dated: 5/3/2021 (22:55) :

-arrival mode: ambulance-critical condition
-patient presents with altered mental status
-Per EMS, pt was sent from "Kindred to UMMC" due to being diagnosed with an acute abdomen and pneumoperitoneum.
-today, pt became somnolent at "Kindred" -so they spoke to the patient's surgeon, who recommended they take her to UMMC ER so he could evaluate her. CT done at "Kindred" done this afternoon showed large pneumoperitoneum, small bowel obstruction, and a large amount of free fluid in her abdomen/pelvis.
-Per EMS, when they arrived in the ambulance bay at "UMMC," they were sent away due to the patient's condition.

Further review of Hospital C physician documentation showed:

-difficulty breathing / placed on BiPAP [Bilevel Positive Airway Pressure];
-a central line was inserted;
-blood cultures drawn;
-"severely hypotensive with systolic in the 50's;" IV Levophed was administered to treat critically low blood pressure;
-IV fluid boluses X 2 were given though pressure bags & IV antibiotics were administered;
-differential diagnoses included: small bowel obstruction; perforated viscus; pleural effusion; respiratory failure, and sepsis.
-Patient # 1 was admitted in critical condition to ICU .

EMS Interviews & record review:

During a telephone interview on 07/13/2021 at 2: 15 PM with Staff I, Operations Manager of "North Cypress EMS," he stated he "received a call on 5/3/2021 at 2041 from EMS crew member stating they were transporting Patient ID# 1 from Kindred Northwest Hospital to United Memorial Medical Center. Upon arrival, my crew was stopped in the Ambulance Bay and UMMC refused to receive care from my crew due to the high level of care the patient needed at 2039 hours. I then told my crew to find and transport the patient to the closest facility..." They transported Patient ID # 1 to Hospital C.

During a telephone interview on 7/14/2021 at 8:45 A.M. with Staff J, EMT, he stated: "....About half-way in route, my partner (paramedic in back with the patient) told me to switch to 'emergency traffic'--light & sirens- because the patient's vital signs were tanking." That is what I did-switched to lights & sirens..."

"A short time later, we pulled up to the ambulance bay at UMMC. A ...male came out waving his arms--he was wearing teal scrubs. He said "Is this the patient from Kindred Northwest? We can't take this patient. We can't accept her here because of her acuity. We can't handle her here. You have to take her somewhere else...."We then transported Patient ID # 1 to Hospital C. EMT verified they arrived at Hospital B with lights & sirens.

Record review of EMS (internal) Incident Report, dated 5/4/2021, completed by Staff J, EMT-- showed documentation of Hospital B's "refusal of care" consistent with what he stated in his interview on 7/14/2021.