HospitalInspections.org

Based on review of facility documents and medical records (MR), and staff interviews (EMP), it was determined that the facility failed to ensure that an on-call physician provided further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition for one of one medical records reviewed (MR1).

Findings include:

Review of "Emergency Medical Treatment and Labor Act (EMTALA) Policy ... Revised Dates: ... 7/2010" revealed, "Policy ... The Uniontown Hospital has a documented system for providing On-Call coverage for all services offered by the hospital. ... Definitions: ... 13. On-Call List refers to the list that the Hospital is required to maintain that defines those Physicians who are 'on-call' for duty after the initial Medical Screening Examination to provide further evaluation and/or treatment necessary to Stabilize an individual with an Emergency Medical Condition. The purpose of the On-Call list is to ensure that the Emergency Department is prospectively aware of which Physicians, including specialists and sub-specialists, are available to provide treatment necessary to Stabilize individuals with Emergency Medical Conditions. ... Guidelines ... XI. On-Call Coverage: A. The hospital has a documented system for providing On-Call coverage so that the Emergency Department is prospectively aware of which Physicians, including specialties and sub-specialists, are available to provide Medical Screening Examinations and treatment necessary to Stabilize individuals with Emergency Medical Conditions. ... C. It is the duty and the responsibility of each 'On-Call' Physician to assure to the Hospital the following: 1. Immediate availability, at least by telephone, to the Emergency Department Physician for his/her scheduled 'On-Call' period, or to secure a qualified alternate in the event he/she is temporarily unavailable. 2. Arrival or respond to the Emergency Department within a reasonable time frame as specified in rules and regulations/policies. D. It is the responsibility of On-Call Physicians to respond, examine and treat patients with Emergency Medical Conditions. ... G. The Hospital must document on the Transfer form the name and address of any On-Call Physician who has refused or failed to appear within a reasonable time to provide necessary Stabilizing treatment."

Review of "On Call Coverage ... Revised Dates: ... 7/10" revealed, "Policy: The ED shall utilize the physician on-call schedule prepared by the Medical Staff Office to secure physician coverage as necessary after the initial Medical Screening Examination. The physician on-call schedule will be used to provide further evaluation and/or treatment necessary to stabilize an individual with an Emergency Medical Condition. ... Guidelines: ... VI. The ED Physician must document on the Acute Care Transfer Form the name and address of any on-call physician who has refused or failed to appear within a responsible time to provide necessary stabilizing treatment."

Review of "Physician Physical Response Time to Hospital for Emergent Patients ... Revised Dates: ... 11/10" revealed, "Objective: To set a policy regarding the physician's physical response time to their emergent patients in the hospital. Policy: Unless covered by another physician, members of the Medical Staff of Uniontown Hospital with admitting privileges must respond to emergent patient care matters and be physically present at the hospital within the timeframe specified below upon request by another physician, or appropriate hospital representative."

1) Review of MR1 revealed that the patient presented to the Emergency Department on August 8, 2010, with "significant bleeding" following a tonsillectomy performed four days prior. Further review of MR1 revealed a progress note by EMP17, "I contacted [EMP18} on call for the emergency department. [EMP18] states that because [they were] not the one who did the surgery [they] would not see the patient. I did explain that the patient is in critical condition right now and I am concerned that [they] will not survive the transport due to the significant bleeding. [EMP18] still refused to come in to see the patient in the emergency department even despite my request. ... I did request [EMP18] to evaluate the patient, however, [EMP18] refused." Additional review of MR1 revealed that the patient was transferred by air to another tertiary hospital.

2) Review of MR1 "Authorization And Consent For Acute Care Transfer", completed on August 8, 2010, revealed no documentation of the name and address of the on-call physician who refused and failed to appear within a responsible time to provide necessary stabilizing treatment.

3) Telephone interview with EMP17 on March 18, 2011, at approximately 10:00 AM, confirmed that EMP18 refused to come to the ED when requested and further revealed, "The patient had a Tonsillectomy done four or five days prior to coming into the emergency room. ... I called the on-call specialist, [EMP18], [they] said to get [the patient] to the surgeon that did the surgery. It was not a surgical complication of [EMP18's]."