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Based on interview and record review, the facility did not ensure there was a written, defined process for physician coverage of Obstetrics and Gynecology patients. This practice increased the risk of a poor health outcome for all Obstetrics and Gynecology patients.

Findings:

During an interview with Medical Doctor 1 (MD 1), on January 21, 2016, at 6:00 PM, he stated there was no Obstetrician (MD who delivers babies) present in the hospital 24 hours a day. He stated the physician on-call (ready and available by phone) group has always provided medical care coverage for the unassigned patients (patients without an MD) and stated that a new agreement has been written so they will also cover the assigned patients (patients with an MD) whose assigned physician is not immediately available. He also stated there was "no policy" regarding the specifics of the Ob/Gyn MD coverage. He stated, "Everyone knows."

During an interview with MD 2, on January 22, 2016, at 10:20 AM, he stated he was the physician on-call for Ob/Gyn. He stated he was responsible for his own group of patients, unassigned pregnant patients, and Ob/Gyn Emergency Department patients. When asked if the on-call group had a contract to provide medical services to facility assigned patients, whose assigned physician is not immediately available, he stated, "It's not official, as a courtesy."

During an interview with Governing Board Member 1 (GB 1), on January 22, 2016, at 2:40 PM, he stated, "I expect appropriately trained professionals at the patient bedside." When asked, what the facility back-up plan was, if the assigned physician was not immediately available, he stated "Not certain."

The contract titled, "Fifth Amendment to Restated Emergency Department Obstetrics/Gynecology Coverage Agreement," dated November 4, 2015, indicated..."2. Coverage Services. Group shall cause one or more Group Physicians in the Specialty to be available on an on-call basis to provide medical care and treatment of Patients, including patients with an assigned physician whose assigned physician is not immediately available (the "Services"), upon the terms and subject to the conditions set forth in this agreement..."


The facility document titled "Community Hospital of San Bernardino Medical Staff OB/GYN Department Rules and Regulations", dated September 21, 2015, indicated "...IV. Conduct...B. The standard of the professional care given to patients shall be in keeping with the highest generally accepted levels of care."


The Medical Staff Bylaws, dated January 28, 2015, indicated "...G. Department Chair Responsibility...5. be a member of the medical executive committee, and give guidance on the overall medical policies of the medical staff and hospital and make specific recommendations and suggestions regarding the department;"