HospitalInspections.org

Based on observation and staff interview conducted on 12/9/16, it was determined that the facility failed to conspicuously post signage, specifying the rights of individuals under section 1866 of the Act, with respect to examination and treatment of emergency medical conditions and women in labor.

Findings include:

1. Observation of the Main Hospital Entrance revealed one (1) sign posted next to the gift shop, across from the elevators. The sign was not visible upon entering the facility, when approaching or standing at the main desk, or in the adjacent seating area.

2. The above findings were reviewed with Staff #1.

3. Observation of Emergency Department Pod 3 revealed bays forty six (46), forty seven (47) and fifty (50) with no signage posted or visible.

4. Observation of Emergency Department Pod 4 revealed bay twelve (12) with no signage posted or visible.

5. Observation of Emergency Department Minor Treatment bays six (6) and seven (7) with no signage posted or visible.

6. Observation of Emergency Department Rapid Assessment Room fifteen (15) with no signage posted or visible.

7. Staff #5, Staff #6 and Staff #7 confirmed the above findings.

8. No signage was observed on the Emergency Department Third Floor, thirty (30) bed Observation Unit.

9. Staff #5 and Staff #14 confirmed the above findings.

Based on observation, staff interview, medical record review and facility document review, it was determined that the facility failed to ensure the orthopedic on-call physician respond to an Emergency Department (ED) call.


Findings:
Reference #1: General Rules and Regulations of The Medical Staff of Community Medical Center states, Article III. Admission of Patients ...12. d. ... " On-call physicians must respond to the Emergency Department within twenty (20) minutes. If an on-call specialist does not respond within twenty (20) minutes, cannot come into the hospital within one hour (or such earlier period of time as set forth in the Policies, Procedures, Standards and/or Department/Divisional Rules and Regulations) or refuses to come in to see the patient, the treating physician shall contact the department chair of the specialist or transfer the patient ...".


1.. Review of the on November 2016 Emergency Department Call Schedule revealed on-call orthopedic specialist, Staff #30, was on call on 11/12/16.

2. Review of Medical Record #25 indicated the following:

a. Patient #25, age seven (7) years old presented to the ED, on 11/12/16 at 2118 with a broken right arm.

b. A medical screening exam was initiated (MSE) at 2119.

c. An X-ray of the right forearm that noted a distal radial fracture.

d. The ED Physician, Staff #31 ordered a STAT consult with the on-call orthopedic specialist, Staff #30, at 23:33.

e. The on-call orthopedic specialist, Staff #30, stated to the ED Physician, Staff #31, that he would not come in to see Patient #25, and recommended to the ED Physician, Staff #31, to reduce the arm in the ED.

f. ED Physician, Staff #31, explained to the on-call orthopedic specialist, Staff #30, that he was unable to reduce the arm.

i. The on-call orthopedic specialist, Staff #30, still refused to come in.

g. A second call to Staff #30, Orthopedist, by Staff #31, ED Physician, he reiterated that he was unable to reduce Patients #25's arm.

i. The on-call orthopedic specialist, Staff #30, still refused to come in and recommended that they should transfer Patient #25.

h. Patient #25 was transferred by ambulance on 11/13/16 at 01:17.

3. Patient #25 was in need of assessment and treatment by the on-call orthopedic specialist, Staff #30, and he/she failed to provide either which resulted in the patient having to be transferred to another acute care facility.

4. The above was confirmed with Staff #1.

5. Upon interview, Staff #13 on 12/9/16, stated if an on-call physician does not return a call or refuses to come in, then the ED physician can and does transfer the patients without contacting the department chair.

6. The above was confirmed with Staff # 5, Staff # 6, and Staff #7.