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Based on record review and interview, the hospital failed to ensure compliance with all requirements listed in 489.24. This was evidenced by the hospital's failure to provide stabilizing treatment to a patient (Patient #6) who presented to the hospital's ED (Emergency Department) with an emergent medical condtion which occurred when the On Call Physician (S9) failed to respond and provide ophthalmology services, as requested to do so by the Emergency Department Physician (S8), to Patient #6 after it was determined by the Emergency Department Physician that the patient had an unresolved emergent medical condition and was in need of specialized services for which the On Call Physician (S9) was capable of providing. (Cross reference to findings cited at A2404 and A2407)

Based on record review and interview, the On Call Physician (S9) failed to respond and provide ophthalmology services, as requested to do so by the Emergency Department Physician (S8), to a patient (Patient #6) after it was determined by the Emergency Department Physician that the patient had an unresolved emergent medical condition and was in need of specialized services for which the On Call Physician (S9) was capable of providing. Findings:

The medical record of Patient #6 was reviewed. This review revealed that Patient #6 presented to the ED (Emergency Department) at North Oaks Medical Center on 2/09/10 at 12:00 noon. Review of the "Triage Info" as documented on the "Nursing Chart" revealed that Patient #6 woke up Saturday morning with blurry vision to the left eye and that Patient #6 was blind in the right eye. Review of the "Physician Chart" revealed that S8 was the ED physician who evaluated and provided treatment to Patient #6 while in the ED at North Oaks Medical Center. Documentation on the "Physician Chart" revealed "Patient with progressive left eye pain and blurry vision, foreign body sensation for the last 4 days. Patient states it feels like he got something in his eye" and that Patient #6 was blind in his right eye. Documentation on the "Physician Chart" revealed that S8 conducted an examination of Patient #6 and determined that the patient had "Post-traumatic changes noted on the right. Patient with sclera injection on the left, no subconjunctival hemorrhage, no hyphema. Extraocular muscles intact. Cornea is opacified on the left. Small foreign body noted under left eyelid, removed with Q-tip. No residual foreign material noted." Documentation on the "Physician Chart" revealed that the impression was "Ocular foreign body removed, corneal ulceration. Case discussed with (S9) on call ophthalmology, wish to see the patient in his office now she has tools for evaluation not available in emergency room. Patient informed and understands." Review of the "Disposition Summary" revealed that Patient #6 was discharged from the ED on 2/09/10 at 2:08 p.m. with instructions to go directly to (S9's) office for ophthalmology evaluation. The "Disposition Summary" was signed by Patient #6 and by the ED physician (S8).

Review of the "Nursing Chart" revealed a nursing note dated 2/09/10 at 3:30 p.m. that documented "pt returned to ER stating that (S9's) office would not see him without a $300.00 deposit that he is unable to make at this time. (S8) made aware and has paged Chief of Staff regarding situation ...pt placed in family room, made aware of current situation and asked to wait for further instruction. Social Worker to see patient at patient request regarding obtaining information in financial assistance." Further review of the "Nursing Chart" revealed a nursing note dated 2/09/20 at 4:48 p.m. which documented "(S8) discussing plan of care with family. Family would prefer to go to Baton Rouge for treatment if possible. (S8) calling (Hospital A)". Further review of the "Nursing Chart" revealed a nursing note relating to discharge dated 2/09/20 at 5:20 p.m. which documented "Plan of care discussed with patient. Patient discharged with printed instructions. Pt instructed about transfer to (Hospital A) ER immediately upon d/c to see (name of physician at Hospital A), verbalized understanding and ability to comply. Pain is now 1/10. Patient Discharged by Ambulatory to (Hospital A) per family with direction to (Hospital A)".

Further review of the medical record relating to Patient #6's visit to the ED at North Oaks Medical Center on 2/09/10 revealed an "Addendum" to the medical record that was electronically signed on 2/09/10 by the ED physician (S8) who evaluated and provided treatment to Patient #6 while at North Oaks Medical Center. The "Addendum" documented "patient apparently unable to obtain ophthalmology evaluation with the on-call ophthalmologist (S9). (S9) recontacted, unwilling to evaluate the patient. Patient case then discussed with (name of physician at Hospital A) on-call ophthalmology (Hospital A), patient accepted in transfer for ophthalmology evaluation now".

Review of North Oaks Medical Center's ED Ophthalmology on call list revealed that (S9) was the Ophthalmologist on call on 2/09/10 which was the date that Patient #6 was in the ED.

S3 (Registered Nurse) was interviewed on 2/18/10 at 1:20 p.m. S3 reported that she was working as the ER charge nurse on 2/09/10 at the time of Patient #6's arrival to the ER. S3 reported that she (S3) was not the nurse who provided care for Patient #6. S3 reported that her role in regards to Patient #6 was contacting Hospital A to arrange for the transfer of Patient #6. S3 reported that she spoke with the nursing supervisor at Hospital A and validated that it was okay to send Patient #6 to Hospital A so that he could be seen for Ophthalmology services.

S4 (Licensed Practical Nurse) was interviewed on 2/18/10 at 1:30 p.m. S4 reported that he worked the 7:00 a.m. through 7:00 p.m. shift on 2/09/10. S4 reviewed the medical record of Patient #6 and reported that did not remember the patient. S4 reported that according to the medical record, his role in relation to providing care for Patient #6 was reviewing the discharge instructions with the patient and informing the patient of the need to go to (S9) for follow up. S4 reported that as far as he was concerned, the patient was discharged from the hospital on 2/09/10 at 2:15 p.m. S4 reported that he had no knowledge of the patient returning to the ER and reporting that he was not seen by S9.

S5 (Registered Nurse) was interviewed on 2/18/10 at 1:40 p.m. S5 reviewed the medical record of Patient #6 and reported that she was the nurse who performed the triage assessment on Patient #6 at the time of Patient #6's presentation to the ER. S5 reported that during the triage assessment, Patient #6 reported that he had woke up in the morning with swelling and blurred vision in his left eye and was blind in his right eye. S5 indicated that she had no knowledge about Patient #6's visit to the ER after the triage assessment.

S6 (Registered Nurse) was interviewed on 2/18/10 at 1:50 p.m. S6 reviewed the medical record of Patient #6 and reported that he did recall the patient. S6 reported that his first interaction with the patient was on 2/09/10 at 5:10 p.m. when the patient and family were in the "family room" waiting for information about being transferred to another hospital. S6 reported that the "family room" is a room located in the ER that provides a quiet and private environment for patients and/or family members. S6 reported that he met with Patient #6 and discussed his transfer to Hospital A. S6 reported that the female who was with Patient #6 reported that she would transport him to Hospital A. S6 reported that he obtained vital signs on Patient #6 prior to his leaving the hospital. S6 reported that Patient #6's vital signs were stable. S6 reported that the patient and female left the hospital and reported that they were going to Hospital A.

S7 (Registered Nurse) was interviewed on 2/18/10 at 2:00 p.m. S7 reviewed the medical record of Patient #6 and reported that she did remember the patient. S7 reported that while she was working in the ER on 2/09/10, someone from "admit" came to her just before 3:30 p.m. and informed her that a patient was in the waiting room reporting that he needed to see S8 (ED physician). S7 reported that she went to the waiting room and met with the patient (Patient #6). S7 reported that Patient #6 informed her that he had been seen in the ED earlier and was told to go to S9's office but was unable to see S9 because of his inability to pay a $300.00 deposit. S7 reported that Patient #6 reported that he was told by the staff at S9's office that he could not be seen by S9 unless he put down a $300.00 deposit. S7 reported that Patient #6 was concerned and wanted to know what he needed to do next because he was worried about his eye. S7 reported that she informed S8 and stated that arrangements were made to transfer Patient #6 to Hospital A.

The hospital's Medical Staff Bylaws were reviewed. Article 2 addresses information regarding Qualifications, Conditions, and Responsibilities of the medical staff. The "Threshold Eligibility Criteria" documents "To be eligible to apply for initial appointment or reappointment to the Medical Staff, physicians, dentists, oral surgeons, and podiatrists must: (c) be available on a continuous basis, either personally or by arranging appropriate coverage, to respond to the needs of inpatients and Emergency Department patients in a prompt, efficient, and conscientious manner. ("Appropriate coverage" means coverage by a physician, dentist, oral surgeon, or podiatrist who is a member of the Medical Staff with specialty-specific privileges equivalent to the practitioner for whom they are providing coverage.) Compliance with this eligibility requirement means that the practitioner must document his/her ability to: (1) respond immediately, via phone, to STAT pages from the Medical Center and respond, via phone, within 30 minutes for all other pages; and (2) appear in person at the Medical Center to attend to a patient within 30 minutes of being requested to do so;" and "(j) agree to fulfill all responsibilities regarding emergency service call coverage for their specialty;."

The hospital's policy/procedure titled "EMTALA/Emergency Call Schedule" was reviewed. The policy/procedure documents "Members of the active medical staff must participate in the EMTALA/Emergency Call Schedule (within his/her specialty) to provide treatment necessary to stabilize patients with an emergency medical condition. That specialty coverage shall be available at all times. However, the frequency by a specific physician need not exceed one day in three". The policy/procedure documents "When the on-call physician is not available to respond for any reason (called to another hospital, surgery, etc.) that physician must provide the hospital operator with the name of a back-up physician to take his call."

The hospital's policy/procedure titled "Physician Responsibility for Unassigned Patients in the ER as it Relates to Discharging a Patient From a Practice" was reviewed. Under the section of "Physician Responsibility for Unassigned Patients Presenting to the ER", the policy/procedure documents "Regardless to any former relationship that the on-call physician may have had with a patient, the on-call physician must respond to the emergency room and evaluate/treat the patient" OR "The on-call physician may personally contact another medical staff member and request that they accept the patient".

The hospital's Medical Director (S2) was interviewed on 2/18/10 at 1:00 p.m. S2 reviewed the North Oaks Medical Center's ED Ophthalmology on call list and confirmed that (S9) was the Ophthalmologist on call at the time Patient #6 presented to the ED on 2/09/10.

S8 (ED physician) was interviewed on 2/18/10 at 1:10 p.m. S8 reviewed the medical record of Patient #6 and reported that he did remember the patient. S8 reported that his first interaction with Patient #6 was on 2/09/10 at approximately 1:54 p.m. in the ER. S8 reported that Patient #6 presented with left eye pain, blurred vision and poor visual acuity. S8 reported that Patient #6 had a history of blindness in his right eye secondary to a previous injury. S8 indicated that Patient #6's left cornea was cloudy and white with irregularities. S8 reported that Patient #6 had a retained foreign body in the left eye. S8 reported that he removed the foreign body from the patient's left eye while in the ED. S8 reported that he felt that the patient had an infected corneal ulcer which could lead to loss of vision. S8 reported that the patient was already blind in the right eye and he was concerned about him losing sight in the left eye. S8 reported that he contacted the Ophthalmologist on call by phone on 2/09/10 at about 2:10 p.m. S8 reported that S9 was the Ophthalmologist on call. S8 reported that he informed S9 of Patient #6's condition including Patient #6's need for ophthalmology services. S8 reported that S9 told him (S8) that he (S9) was busy in his office and asked if he (S8) could send the patient to his (S9) office. S8 reported that S9 also reported that he had better equipment in his office. S8 reported that he discussed S9's request to have Patient #6 go to his office with Patient #6 and his (Patient #6) family. S8 reported that he felt comfortable with the family transporting Patient #6 to S9's office for evaluation and treatment. S8 reported that Patient #6 was discharged from the ED and told to report directly to S9's office. S8 reported that he was approached sometime around 3:30 p.m. - 4:00 p.m. by S7 (ED RN) and told that Patient #6 had returned to the ER and was not seen by S9. S8 reported that he was concerned because Patient #6's eye injury remained. S8 reported that he called S9's office back and was told by S9's office manager that S9 did not want to see Patient #6 because Patient #6 was rude. S8 reported that he called S9's office again and spoke with S9. S8 reported that S9 told him that he did not have to see the patient. S8 reported that S9 refused to see Patient #6. S8 reported that S9 stated that he (S9) was not going to get paid for his (S9) services anyway and that the patient needed to go to the LSU systems hospital because that is what they are there for. S8 reported that he told S9 that they would have to agree to disagree on this one. S8 reported that he then arranged for Patient #6 to be transferred to Hospital A because Patient #6 needed to be seen for ophthalmology services and the Ophthalmologist on call for North Oaks Medical Center was refusing to see Patient #6.

S9 (Ophthalmologist who was on call for the ED at the time Patient #6 presented to the ED) was interviewed on 2/19/10 at 7:05 a.m. S9 reviewed the medical record of Patient #6 and reported that he never saw the patient. S9 reported that the ED physician called him and told him that there was a patient in the ED that needed to come to his office. S9 reported that the ED physician reported that the patient had a corneal abrasion. S9 reported that he told the ED physician to send the patient right away. S9 indicated that he then got a phone call from the ED physician who reported that the patient had returned to the ED and was upset about some papers. S9 reported that in the office, patients are asked to fill out paper work. S9 indicated that the office paperwork includes information about HIPPA and includes a signature about plans for payment. S9 reported that the patient was sent over and the next thing he knew the patient was sent back. S9 went on to talk about his background including his dedication and work in the community. S9 reported that he wanted to know who called the complaint in. S9 was informed that the complaint was from an anonymous source. S9 stated "that's totally unacceptable and we will get into the legalities of that in the future". S9 then made reference to this not being "East Germany" and about being "called down on the carpet" by a government official. When S9 was asked about his conversation with the ED physician in regards to Patient #6, S9 stated "I already told you I walked in my office my phone rang he said he had somebody in the ER that had a corneal abrasion which is not a customary thing to be called on I said no problem send him to my office that was the extent of our conversation". S9 indicated that there was not a specialized lamp in the hospital which he indicated would be needed for examination. S9 indicated that the ED physician did not inform him of the need to come to the hospital to see the patient. When asked if he discussed information relating to Patient #6 presenting to his office with his office staff, S9 replied of course. S9 reported that in the midst of his busy clinic he asked where is the patient from the ER and the staff told him that the patient had left. S9 reported that his office staff told him that the patient was asked to fill out paper work and then a relative that was with the patient got irate about the fact that he had to fill out paperwork at his office and they left and returned to the ER. S9 indicated that this occurred sometime in the afternoon on 2/09/10. S9 reported that he would never say that a patient could not be seen in his office without a $300.00 deposit.

Based on record review and interview, the hospital failed to provide stabilizing treatment to a patient (Patient #6) who presented to the hospital's ED (Emergency Department) with an emergent medical condition. This occurred when the On Call Physician (S9) failed to respond and provide ophthalmology services, as requested to do so by the Emergency Department Physician (S8), to Patient #6 after it was determined by the Emergency Department Physician that Patient #6 had an unresolved emergent medical condition and was in need of specialized services for which the On Call Physician (S9) was capable of providing. Findings:

The medical record of Patient #6 was reviewed. This review revealed that Patient #6 presented to the ED (Emergency Department) at North Oaks Medical Center on 2/09/10 at 12:00 noon. Review of the "Triage Info" as documented on the "Nursing Chart" revealed that Patient #6 woke up Saturday morning with blurry vision to the left eye and that Patient #6 was blind in the right eye. Review of the "Physician Chart" revealed that S8 was the ED physician who evaluated and provided treatment to Patient #6 while in the ED at North Oaks Medical Center. Documentation on the "Physician Chart" revealed "Patient with progressive left eye pain and blurry vision, foreign body sensation for the last 4 days. Patient states it feels like he got something in his eye" and that Patient #6 was blind in his right eye. Documentation on the "Physician Chart" revealed that S8 conducted an examination of Patient #6 and determined that the patient had "Post-traumatic changes noted on the right. Patient with sclera injection on the left, no subconjunctival hemorrhage, no hyphema. Extraocular muscles intact. Cornea is opacified on the left. Small foreign body noted under left eyelid, removed with Q-tip. No residual foreign material noted." Documentation on the "Physician Chart" revealed that the impression was "Ocular foreign body removed, corneal ulceration. Case discussed with (S9) on call ophthalmology, wish to see the patient in his office now she has tools for evaluation not available in emergency room. Patient informed and understands." Review of the "Disposition Summary" revealed that Patient #6 was discharged from the ED on 2/09/10 at 2:08 p.m. with instructions to go directly to (S9's) office for ophthalmology evaluation. The "Disposition Summary" was signed by Patient #6 and by the ED physician (S8).

Review of the "Nursing Chart" revealed a nursing note dated 2/09/10 at 3:30 p.m. that documented "pt returned to ER stating that (S9's) office would not see him without a $300.00 deposit that he is unable to make at this time. (S8) made aware and has paged Chief of Staff regarding situation ...pt placed in family room, made aware of current situation and asked to wait for further instruction. Social Worker to see patient at patient request regarding obtaining information in financial assistance." Further review of the "Nursing Chart" revealed a nursing note dated 2/09/20 at 4:48 p.m. which documented "(S8) discussing plan of care with family. Family would prefer to go to Baton Rouge for treatment if possible. (S8) calling (Hospital A)". Further review of the "Nursing Chart" revealed a nursing note relating to discharge dated 2/09/20 at 5:20 p.m. which documented "Plan of care discussed with patient. Patient discharged with printed instructions. Pt instructed about transfer to (Hospital A) ER immediately upon d/c to see (name of physician at Hospital A), verbalized understanding and ability to comply. Pain is now 1/10. Patient Discharged by Ambulatory to (Hospital A) per family with direction to (Hospital A)".

Further review of the medical record relating to Patient #6's visit to the ED at North Oaks Medical Center on 2/09/10 revealed an "Addendum" to the medical record that was electronically signed on 2/09/10 by the ED physician (S8) who evaluated and provided treatment to Patient #6 while at North Oaks Medical Center. The "Addendum" documented "patient apparently unable to obtain ophthalmology evaluation with the on-call ophthalmologist (S9). (S9) recontacted, unwilling to evaluate the patient. Patient case then discussed with (name of physician at Hospital A) on-call ophthalmology (Hospital A), patient accepted in transfer for ophthalmology evaluation now".

Review of North Oaks Medical Center's ED Ophthalmology on call list revealed that (S9) was the Ophthalmologist on call on 2/09/10 which was the date that Patient #6 was in the ED.

S3 (Registered Nurse) was interviewed on 2/18/10 at 1:20 p.m. S3 reported that she was working as the ER charge nurse on 2/09/10 at the time of Patient #6's arrival to the ER. S3 reported that she (S3) was not the nurse who provided care for Patient #6. S3 reported that her role in regards to Patient #6 was contacting Hospital A to arrange for the transfer of Patient #6. S3 reported that she spoke with the nursing supervisor at Hospital A and validated that it was okay to send Patient #6 to Hospital A so that he could be seen for Ophthalmology services.

S4 (Licensed Practical Nurse) was interviewed on 2/18/10 at 1:30 p.m. S4 reported that he worked the 7:00 a.m. through 7:00 p.m. shift on 2/09/10. S4 reviewed the medical record of Patient #6 and reported that did not remember the patient. S4 reported that according to the medical record, his role in relation to providing care for Patient #6 was reviewing the discharge instructions with the patient and informing the patient of the need to go to (S9) for follow up. S4 reported that as far as he was concerned, the patient was discharged from the hospital on 2/09/10 at 2:15 p.m. S4 reported that he had no knowledge of the patient returning to the ER and reporting that he was not seen by S9.

S5 (Registered Nurse) was interviewed on 2/18/10 at 1:40 p.m. S5 reviewed the medical record of Patient #6 and reported that she was the nurse who performed the triage assessment on Patient #6 at the time of Patient #6's presentation to the ER. S5 reported that during the triage assessment, Patient #6 reported that he had woke up in the morning with swelling and blurred vision in his left eye and was blind in his right eye. S5 indicated that she had no knowledge about Patient #6's visit to the ER after the triage assessment.

S6 (Registered Nurse) was interviewed on 2/18/10 at 1:50 p.m. S6 reviewed the medical record of Patient #6 and reported that he did recall the patient. S6 reported that his first interaction with the patient was on 2/09/10 at 5:10 p.m. when the patient and family were in the "family room" waiting for information about being transferred to another hospital. S6 reported that the "family room" is a room located in the ER that provides a quiet and private environment for patients and/or family members. S6 reported that he met with Patient #6 and discussed his transfer to Hospital A. S6 reported that the female who was with Patient #6 reported that she would transport him to Hospital A. S6 reported that he obtained vital signs on Patient #6 prior to his leaving the hospital. S6 reported that Patient #6's vital signs were stable. S6 reported that the patient and female left the hospital and reported that they were going to Hospital A.

S7 (Registered Nurse) was interviewed on 2/18/10 at 2:00 p.m. S7 reviewed the medical record of Patient #6 and reported that she did remember the patient. S7 reported that while she was working in the ER on 2/09/10, someone from "admit" came to her just before 3:30 p.m. and informed her that a patient was in the waiting room reporting that he needed to see S8 (ED physician). S7 reported that she went to the waiting room and met with the patient (Patient #6). S7 reported that Patient #6 informed her that he had been seen in the ED earlier and was told to go to S9's office but was unable to see S9 because of his inability to pay a $300.00 deposit. S7 reported that Patient #6 reported that he was told by the staff at S9's office that he could not be seen by S9 unless he put down a $300.00 deposit. S7 reported that Patient #6 was concerned and wanted to know what he needed to do next because he was worried about his eye. S7 reported that she informed S8 and stated that arrangements were made to transfer Patient #6 to Hospital A.

The hospital's Medical Staff Bylaws were reviewed. Article 2 addresses information regarding Qualifications, Conditions, and Responsibilities of the medical staff. The "Threshold Eligibility Criteria" documents "To be eligible to apply for initial appointment or reappointment to the Medical Staff, physicians, dentists, oral surgeons, and podiatrists must: (c) be available on a continuous basis, either personally or by arranging appropriate coverage, to respond to the needs of inpatients and Emergency Department patients in a prompt, efficient, and conscientious manner. ("Appropriate coverage" means coverage by a physician, dentist, oral surgeon, or podiatrist who is a member of the Medical Staff with specialty-specific privileges equivalent to the practitioner for whom they are providing coverage.) Compliance with this eligibility requirement means that the practitioner must document his/her ability to: (1) respond immediately, via phone, to STAT pages from the Medical Center and respond, via phone, within 30 minutes for all other pages; and (2) appear in person at the Medical Center to attend to a patient within 30 minutes of being requested to do so;" and "(j) agree to fulfill all responsibilities regarding emergency service call coverage for their specialty;."

The hospital's policy/procedure titled "EMTALA/Emergency Call Schedule" was reviewed. The policy/procedure documents "Members of the active medical staff must participate in the EMTALA/Emergency Call Schedule (within his/her specialty) to provide treatment necessary to stabilize patients with an emergency medical condition. That specialty coverage shall be available at all times. However, the frequency by a specific physician need not exceed one day in three". The policy/procedure documents "When the on-call physician is not available to respond for any reason (called to another hospital, surgery, etc.) that physician must provide the hospital operator with the name of a back-up physician to take his call."

The hospital's policy/procedure titled "Physician Responsibility for Unassigned Patients in the ER as it Relates to Discharging a Patient From a Practice" was reviewed. Under the section of "Physician Responsibility for Unassigned Patients Presenting to the ER", the policy/procedure documents "Regardless to any former relationship that the on-call physician may have had with a patient, the on-call physician must respond to the emergency room and evaluate/treat the patient" OR "The on-call physician may personally contact another medical staff member and request that they accept the patient".

The hospital's Medical Director (S2) was interviewed on 2/18/10 at 1:00 p.m. S2 reviewed the North Oaks Medical Center's ED Ophthalmology on call list and confirmed that (S9) was the Ophthalmologist on call at the time Patient #6 presented to the ED on 2/09/10.

S8 (ED physician) was interviewed on 2/18/10 at 1:10 p.m. S8 reviewed the medical record of Patient #6 and reported that he did remember the patient. S8 reported that his first interaction with Patient #6 was on 2/09/10 at approximately 1:54 p.m. in the ER. S8 reported that Patient #6 presented with left eye pain, blurred vision and poor visual acuity. S8 reported that Patient #6 had a history of blindness in his right eye secondary to a previous injury. S8 indicated that Patient #6's left cornea was cloudy and white with irregularities. S8 reported that Patient #6 had a retained foreign body in the left eye. S8 reported that he removed the foreign body from the patient's left eye while in the ED. S8 reported that he felt that the patient had an infected corneal ulcer which could lead to loss of vision. S8 reported that the patient was already blind in the right eye and he was concerned about him losing sight in the left eye. S8 reported that he contacted the Ophthalmologist on call by phone on 2/09/10 at about 2:10 p.m. S8 reported that S9 was the Ophthalmologist on call. S8 reported that he informed S9 of Patient #6's condition including Patient #6's need for ophthalmology services. S8 reported that S9 told him (S8) that he (S9) was busy in his office and asked if he (S8) could send the patient to his (S9) office. S8 reported that S9 also reported that he had better equipment in his office. S8 reported that he discussed S9's request to have Patient #6 go to his office with Patient #6 and his (Patient #6) family. S8 reported that he felt comfortable with the family transporting Patient #6 to S9's office for evaluation and treatment. S8 reported that Patient #6 was discharged from the ED and told to report directly to S9's office. S8 reported that he was approached sometime around 3:30 p.m. - 4:00 p.m. by S7 (ED RN) and told that Patient #6 had returned to the ER and was not seen by S9. S8 reported that he was concerned because Patient #6's eye injury remained. S8 reported that he called S9's office back and was told by S9's office manager that S9 did not want to see Patient #6 because Patient #6 was rude. S8 reported that he called S9's office again and spoke with S9. S8 reported that S9 told him that he did not have to see the patient. S8 reported that S9 refused to see Patient #6. S8 reported that S9 stated that he (S9) was not going to get paid for his (S9) services anyway and that the patient needed to go to the LSU systems hospital because that is what they are there for. S8 reported that he told S9 that they would have to agree to disagree on this one. S8 reported that he then arranged for Patient #6 to be transferred to Hospital A because Patient #6 needed to be seen for ophthalmology services and the Ophthalmologist on call for North Oaks Medical Center was refusing to see Patient #6.

S9 (Ophthalmologist who was on call for the ED at the time Patient #6 presented to the ED) was interviewed on 2/19/10 at 7:05 a.m. S9 reviewed the medical record of Patient #6 and reported that he never saw the patient. S9 reported that the ED physician called him and told him that there was a patient in the ED that needed to come to his office. S9 reported that the ED physician reported that the patient had a corneal abrasion. S9 reported that he told the ED physician to send the patient right away. S9 indicated that he then got a phone call from the ED physician who reported that the patient had returned to the ED and was upset about some papers. S9 reported that in the office, patients are asked to fill out paper work. S9 indicated that the office paperwork includes information about HIPPA and includes a signature about plans for payment. S9 reported that the patient was sent over and the next thing he knew the patient was sent back. S9 went on to talk about his background including his dedication and work in the community. S9 reported that he wanted to know who called the complaint in. S9 was informed that the complaint was from an anonymous source. S9 stated "that's totally unacceptable and we will get into the legalities of that in the future". S9 then made reference to this not being "East Germany" and about being "called down on the carpet" by a government official. When S9 was asked about his conversation with the ED physician in regards to Patient #6, S9 stated "I already told you I walked in my office my phone rang he said he had somebody in the ER that had a corneal abrasion which is not a customary thing to be called on I said no problem send him to my office that was the extent of our conversation". S9 indicated that there was not a specialized lamp in the hospital which he indicated would be needed for examination. S9 indicated that the ED physician did not inform him of the need to come to the hospital to see the patient. When asked if he discussed information relating to Patient #6 presenting to his office with his office staff, S9 replied of course. S9 reported that in the midst of his busy clinic he asked where is the patient from the ER and the staff told him that the patient had left. S9 reported that his office staff told him that the patient was asked to fill out paper work and then a relative that was with the patient got irate about the fact that he had to fill out paperwork at his office and they left and returned to the ER. S9 indicated that this occurred sometime in the afternoon on 2/09/10. S9 reported that he would never say that a patient could not be seen in his office without a $300.00 deposit.