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Based on interview and record review, the facility failed to provide care within the facility's specialized capabilities to Patient 1 when Physician A, who was on call for gynecological (GYN) care, refused to respond to the emergency room (ER) to evaluate and treat Patient 1's injury. This failure resulted in Patient 1 having to transfer to Hospital B for definitive treatment of her injury.

Findings:

On 4/19/11, the facility and Hospital B both reported a potential violation of the Emergency Medical Treatment and Labor Act (EMTALA), involving Patient 1, to the California Department of Public Health. Patient 1 presented to the facility ER, on 4/17/11, with a labial (groin) hematoma (a collection of blood outside the blood vessel) following a skiing accident. Physician A was on the emergency call list for GYN care. When he was contacted, he declined to to come to the ER to evaluate and treat Patient 1. After numerous attempts to contact other GYN physicians in the local area, the facility transferred Patient 1 to Hospital B for definitive treatment.

On 4/20/11, the facility's call list for GYN care was reviewed. Physician A was listed for GYN call on 4/17/11.

On 4/20/11, Patient 1's record was reviewed. Patient 1's record contained documentation from ER Physician C that Patient 1 had a golf ball sized labial hematoma and was in significant pain with nausea and vomiting. ER Physician C contacted Physician A, who responded that he was no longer taking call because he did not renew his contract (for payment) with the hospital. Physician A agreed with ER Physician C that Patient 1 should be taken to the operating room for an exploration of the hematoma and surrounding area. The document further indicated that Administrative (Admin) Staff D was asked to discuss the situation with Physician A, but Physician A still would not come in to the ER. The ER physician documented she was able to contact a GYN physician at Hospital B who was willing to accept Patient 1 for definitive treatment. Patient 1 was transferred to Hospital B via ambulance after her pain and nausea were stabilized.

On 4/20/11 at 1:30 pm, Admin Staff E stated that he had been made aware of the above ER transfer. Admin Staff E stated the GYN call schedule had been established several months before. Admin Staff E confirmed that the hospital had not come to an agreement with the GYN physicians regarding renewing a contract for reimbursement for call services at the hospital. Admin Staff E stated he had spoken with GYN Physician A and that confusion had occurred because Physician A believed that since he did not have a current contract that he was no longer obliged to be on call for the ER. Admin Staff E provided the Medical Staff policy, titled, "Compliance with EMTALA", dated 8/08, which read, "The On-Call Physician who provides his/her name to the Emergency Room shall be responsible for personally providing coverage during his/her scheduled time or for arranging coverage by another equally qualified Medical Staff member with appropriate clinical privileges."

On 4/21/11 at 4:25 pm, Admin Staff D confirmed she had spoken with Physician A on 4/17/11 after he declined to come to the ER. Admin Staff D confirmed that Physician A believed he was not on call because there was no contract, hence no obligation. Admin Staff D stated she was unable to convince Physician A of his obligation.

On 4/21/11 at 1 pm, Physician A was contacted but declined to speak with the surveyor.

On 6/27 through 6/30/11, an EMTALA survey was conducted, in which 24 ER transfer records were reviewed. No further non-compliance was evident. Admin Staff E shared an ongoing corrective action plan which included the following:
4/26/11 Education provided at the Quarterly Medical Staff meeting
4/29/11 Letter sent to all active Medical Staff members covering their call responsibilities
5/1/11 Medical Staff Newsletter article
5/4/11 Special meeting with the Medical Executive Committee (MEC) with Physician A regarding the bylaws violation.
5/5/11 Letter to Physician A from MEC regarding call obligations.
5/6/11 Letter to all active Medical Staff members regarding call coverage responsibilities and obligations.