HospitalInspections.org

Based on review of facility documents and staff interviews (EMP), it was determined that the facility failed to maintain a list of physicians who are on call for duty after the initial examination to provide further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition.


Findings include:

Review of Rules and Regulations of the Medical Staff, revised March 2012 revealed, "... II. Admission ... Section 9 Emergency Care/Unassigned Call (a) Any person presenting at the Emergency Department who has not been referred by or is not the patient of a specific medical staff member, and who does not express a desire for the medical services of an [sic] particular member, shall be assigned to the appropriate physician on call for unassigned patients. ... (d) The Hospital coordinates and maintains a roster of medical staff members on call for primary coverage and specialty consultation. A monthly call schedule shall be available listing medical staff members on call. Physicians are notified by the Hospital of scheduled coverage. The roster is updated on an ongoing basis and made available online to all hospital departments. ..."

Review of Policy HS-LE0007 Emergency Medical Treatment and Active Labor Act (EMTALA), December 30, 2011, revealed, "I. Policy It is the policy of UPMC to comply with all applicable laws and regulations relating to the provision of emergency services, including the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. 1395dd. ... III Scope This policy applies to all domestic UPMC hospitals ... V Procedure 1. ... 11. Each UPMC hospital's Emergency department shall maintain a list of physicians who are on call for duty after the initial examination to provide further evaluation and/or treatment necessary to stabilize an individual with an Emergency Medical Condition. ..."

Review of Policy #ED58 Specialty Physician Coverage, revised December 2001 revealed, "Scope: All emergency department patients. Definition: To provide a list of specialty coverage available for emergency department patients. Policy: ... The following specialty services shall be available for consultation: ...Ophthalmology ... ENT... The specialty physician shall be responsible to seek his/her own replacement in the event he/she is not available. Copy of the call list shall be posted in Emergency Services at all times."

1. Review of the Greenville Campus Emergency Department (ED) on-call schedule for Otolaryngology for December 31, 2011, to June 30, 2012, revealed 30 days of assigned coverage. Unassigned days revealed, "Coverage Unassigned; Call ENT Of Choice." Review of the Ophthalmology on-call schedule for December 31, 2011, to June 30, 2012, revealed 70 days of assigned coverage. Unassigned days revealed, "Calls are being taken by the Answering Service ..."

2. On June 5 2012, at 9:44 AM when asked who is on call for Ophthalmology, EMP6 stated, "The answering service. It is one of the two in the practice." When asked if staff would know who is on call from the on-call list, EMP6 stated, "No. This is it. The answering service would tell you. When asked about Otolaryngology, EMP6 stated, It's the same thing." EMP6 confirmed that no specific names were assigned for the Ophthalmology and Otolaryngology on call schedule.

3. Tour of the ED nursing station at approximately 10:10 AM on June 5, 2012, at the Shenango Valley Campus revealed physician on-call schedules for Ophthalmology and Otolaryngology. The review of the schedules revealed Otolaryngology unassigned days marked, "Coverage Unassigned; Call ENT Of Choice." Review of the Ophthalmology non-covered days were marked, "Calls are being taken by the Answering Service ..."

4. On June 5, 2012, at 10:20 AM, when questioned who was on-call for Ophthalmology, EMP13 stated, "You call the service (answering)." When asked if the on-call physician's name was listed, EMP13 stated, "No it's not listed." When asked about Otolaryngology, EMP13 added, "Same thing (name not listed)."