HospitalInspections.org

Based on record reviews and interviews, the hospital failed to meet the requirement of §489.24 as evidenced by:

1) the hospital failed to provide stabilizing treatment to 1 (#2) of 20 patients transferred who presented to the hospital's Emergency Department with complaints of abdominal pain, an obstructive kidney stone, with a concurrent urinary tract infection when it was within the capability and capacity of the hospital to provide stabilizing treatment for this patient (see findings tag A-2407).

Based on record review and interview, the hospital failed to provide stabilizing treatment to 1 (#2) of 20 patients transferred who presented to the hospital's Emergency Department with complaints of abdominal pain, an obstructive kidney stone, with a concurrent urinary tract infection when it was within the capability and capacity of the hospital to provide stabilizing treatment for this patient.
Findings:

Review of Patient #2's medical record revealed she had arrived at the Emergency Department on 3/14/16 at 6:02 p.m. with the admitting complaint of abdominal pain.

Review of CT results for Patient #2 dated 3/14/16 at 9:40 p.m. revealed in part:
5 mm left distal urethral calculus resulting in moderate left Hydroureternephrosis. Medullary nephrocalcinosis. Multiple bilateral nephrolithiasis. Indeterminate low-density mass measuring 2.8 cm in the medial segment left hepatic lobe. Recommend further evaluation with a liver protocol MRI with and without intravenous gadolinium contrast.

Review of progress notes by S2MD revealed the following:
On 3/14/16 at 11:15 p.m. - I spoke with S5Urologist, he recommends calling patient's urologist S3MD at Hospital "B".

Further review of the medical record for Patient #2 revealed she was transferred to Hospital "B" (42 miles away) in private vehicle on 3/15/16 at 1:57 a.m.

Review of a hospital grievance from Patient #2 dated 3/16/16 revealed the following:
Patient #2 voiced concerns with transfer from Baton Rouge General's ED to Hospital "B". Presented to ED with kidney stones. Due to previous experience, she was aware that she would require inpatient treatment. She states that she made it clear that she did not need to transfer to Hospital "B" for treatment and preferred to stay at Baton Rouge General, even though the last doctor that she saw for kidney stones is in Hammond (location of Hospital "B"). She only saw S3MD once, approximately 6-8 months ago. She reports that the transfer form stated that she requested to be transferred, which she denies. She states that she preferred to stay at Baton Rouge General. Also, her husband stated that the risks of transfer, as listed on the transfer form, were not explained to him (he did not read it initially due to dim lighting). Also, stated that the ED staff did not explain that if she were transferred by ambulance, they would not have had to remove her IV's and re-stick her at Hospital "B".

In a telephone interview on 3/23/16 at 1:34 p.m. with Patient #2, she said she did not agree with the transfer to Hospital "B" on 3/15/16. Patient #2 said she had kidney stones several times in the past and knew if she waited too long to be treated she would have sepsis. Patient #2 said she told the staff several times specifically that she did not want to be transferred. Patient #2 said she had seen a urologist at Hospital "B" once in the past, but she had told the staff she did not need to go back to him. Patient #2 said she had asked the staff several times why they were transferring her and they said it was because of a problem with her insurance not covering everything and they did not have an urologist on hand. Patient #2 said she did sign the consent to transfer, but she was not explained the risk factors on the sheet and it was too dark to read them. Patient #2 reported the hospital made her feel like she did not have a choice but to be transferred because of them not having an urologist and a problem with her insurance. Patient #2 said all she wanted was to be treated before she became septic.

In an interview on 3/24/16 at 9:40 a.m. with S6MD, he said Patient #2 had some obstructive uropathy. S6MD said a urologist had to be consulted because Patient #2 was too sick to go home and she required further treatment because of the urinary tract infection she had with the obstruction. S6MD said S5Urologist was on call for urology and had said S3MD was her urologist that had worked on her prior at Hospital "B". S6MD said he did not remember why Patient #2 was transferred in her own vehicle. S6MD verified Patient #2 could have been treated at Baton Rouge General.

In an interview on 3/24/16 at 3:20 p.m. with S5Urologist, he said he was on call and had received a call on 3/14/16 from the Baton Rouge General ED about Patient #2. S5Urologist said the call was in reference to flank pain and she had been diagnosed with a kidney stone per a CT scan. S5Urologist said they told him she had an urologist in Hammond and had seen that urologist 6 months prior and she had some partial blockage. He said because he felt Patient #2 was stable enough to be seen by her primary urologist at Hospital "B". S5Urologist said he would have admitted her at Baton Rouge General if they could not have gotten in contact with the physician at Hospital "B". S5Urologist said he called back the next morning to the ED to follow up on Patient #2 and she had already been transferred. S5Urologist said he did not speak with or assess Patient #2 on 3/14/16 or 3/15/16. S5Urologist said she was transferred instead of discharged because she needed to have a stent placed for the obstruction.