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Based on a review of medical records, policies and procedures, call logs, on-call schedules, and Medical Staff Rules and Regulations and staff interviews, the hospital failed to ensure the on-call physician listed on the on-call list responded when called by the Emergency Department (ED) Physician for 1 (Patient #6) of 20 sampled patients. The hospital was unable to arrange another physician in that specialty to assess/stabilize Patient #6, as a result, he was transferred to another hospital. Refer to findings in Tag A-2404.

Based on a review of medical records, policies and procedures, call logs, on-call schedules, and Medical Staff Rules and Regulations and staff interviews, the hospital failed to ensure the on-call physician listed on the on-call list responded when called by the Emergency Department (ED) Physician for 1 (Patient #6) of 20 sampled patients. The hospital was unable to arrange another physician in that specialty to assess/stabilize Patient #6, as a result, he was transferred to another hospital.

The findings included:

1. Record review revealed Patient #6 presented to the emergency room on 4/21/17 at 9:06 p.m. The nursing note dated 4/21/17, documented the patient arrived ambulatory in the emergency room with complaints of abdominal pain for the past 4 hours which radiated into the right testicle with nausea. The physician note of the 4/21/17 said the patient's symptoms developed 4 hours ago and worsened 2 hours ago. The physical examination showed swelling of the right testicle including into the inguinal area. Blood work, a computerized tomography (CT scan) and an ultrasound of the testicle were ordered and performed. The ultrasound showed the patient had torsion (twisting) of the right testicle with an swollen spermatic cord.

The ED Physician ordered a consult with the urologist on call at 11:11 p.m. The urology physician was called at that time about admitting the patient. At 11:42 p.m., the urology physician on call was called again about admitting the patient. The urology physician was again called at 12:02 a.m. In each instance, there was no response to the telephone calls from the urology physician.

At 12:58 a.m., the ED Physician's note documented "Multiple attempts to call urology. All of the urology physicians they have listed for this service with no return calls." The chief of surgery and on call hospital director were also notified. The nursing supervisor was also notified and was also unable to reach anyone from urology. The hospital called the other 2 other hospitals in the immediate area to determine if the urologist was present at either hospital. They were unsuccessful in finding the on call urologist. This urology physician was on call for the entire county and at all three of the area hospitals.
The the ED Physician documented they attempted to get the police to go to the urology physician's home, but they had no listing of where he lived. At 1:04 a.m., the decision was made to transfer the patient to another hospital to get urology care. The physician at the receiving hospital was contacted and a report was given physician to physician. The patient was transferred at 1:21 a.m., via emergency medical services.

A review of the policy and procedure related to emergency medical on call duty said in the policy that "...each hospital with a dedicated emergency department must maintain a list of physicians on its medical staff who are on call for duty after the initial examination to provide further evaluation and/or treatment necessary to stabilize an individual receiving treatment for an emergency medical condition under EMTALA." Under 6 in the policy it was documented the hospital "must have a written plan for transfer and/or back-up call coverage by a physician of the same speciality or subspecialty. The emergency physician shall determine whether to attempt to contact another such specialist on the medical staff or immediately arrange for a transfer pursuant to this policy.

A review of the on-call list showed the urologist involved averaged 1 week of call per month.

A review of the Medical Staff Rules and Regulations (revised 3/7/16) revealed under "Emergency Roster" (on page 120), ER (emergency room) call responsibilities require physicians to promptly evaluate those patients that "the ER physician feels needs their respective medical speciality, and to help in disposition of those patients from the Emergency Room facility as needed."

2. On 5/1/17, the ER director said the ER staff had attempted to call all of the other urologists in town, but there was no response. He said they have no plan for anyone on secondary call for when the on call doctor was responsible for call at all hospitals in the area.