HospitalInspections.org

Based on review of facility documents, medical record (MR), and staff (EMP) interview, it was determined the medical staff failed to provide timely medical care to a patient in respiratory distress (difficulty breathing) in one of ten medical records reviewed (MR10).

Findings include:

Review of the facility's medical staff bylaws "St. Joseph Regional Health Network Medical Staff Bylaws" revealed "Preamble: These Medical Staff Bylaws, which originate with the Medical Staff of St. Joseph Regional Health Network (the System) and to provide framework for self-governance of the Medical Staff in order to permit the Medical Staff to discharge its responsibilities in matters involving the quality of medical care, and to govern the orderly resolution of those purposes .... These Bylaws, as adopted or amended, create a system of mutual rights and responsibilities between Members and the Hospital, and are subject to the corporate authority of the Board in those matters where the Board has ultimate legal responsibility. ... 4. Medical Staff Categories ...4.2 Category Descriptions 4.2.1. Active ... c. Responsibilities. Active Members must: ... iv. Except in circumstances where there is a need for specialty specific services that are not otherwise available, be located within close proximity (no more than thirty (30) minutes travel time) of the Hospital in order to respond to inpatient or emergency care, or be available by phone and have designated another Member with appropriate privileges who is available within such proximity and who has agreed to attend to the Member's patient in an emergency or until the member arrives, in order to assure continuous care to patients. ..."

Review of St. Joseph Medical Center Reading, Pennsylvania Medical Staff Rules and Regulations revealed "I General Rules: The rules and regulations approved by the medical staff and the Board of Trustees are binding on all members of the medical staff. ... All members of the medical staff are obliged to conform to the established ethics of their profession. .... 4. Consult Request Process c) A Stat consult on the floor should be seen within 2 hours. A Stat consult in ICU should be seen within 1 hour. d) Urgent consults and stat consults should be requested by the ordering physician by personally contacting the consulting physician. ..."

Review of MR 10 revealed the patient was admitted on December 30, 2020, with shortness of breath with onset two days ago. Patient tested positive for COVID- 19 on December 27, 2020 and was admitted to the Intensive Care Unit (ICU) on oxygen at 80 L min at 100% on a high flow nasal cannula. Oxygen saturation readings (percentage of oxygen in blood) maintained on this rate varied from 87% - 100% from December 30, 2020, to January 4, 2021. On January 5, 2021, at 0515 the patient had increased shortness of breath. A chest x-ray was completed and showed a left pneumothorax (collapse of the lung). The Virtual ICU Physician was called. Orders were received for intubation and placement of a chest tube. The Cardiothoracic Physician was notified for chest tube placement. Anesthesia was notified for intubation. At 0525, Anesthesia arrived at the bedside, and the patient was intubated. Per facility documentation, the Cardiothoracic Physician arrived at 0645. The patient coded at 0722 when the chest tube was being inserted.

Interview on March 4, 2021, at 12:40 PM confirmed the findings noted above. EMP4 confirmed the Cardiothoracic Physician did not arrive in a timely manner to insert the chest tube. EMP4 noted there was no process in place for staff to work up the chain of command to "escalate the process" when a physician does not report in a timely manner to provide emergent patient care. EMP4 noted their current process needed to be clarified for staff. EMP4 confirmed there was nothing in writing for staff to follow.