HospitalInspections.org

Based on interview and record review the facility failed to have written policies and procedures in place in the event an on-call physician (physicians who are scheduled to provide treatment and services including consultations to patients when needed) is not available to provide services and consultation to the patients at the Emergency Department (ED).

This failure resulted in an on-call physician to not be available for consult and services at the ED for a particular specialty.

Findings:

On April 27, 2023, at 10:45 a.m., an unannounced visit was conducted at the facility for an EMTALA survey.

On April 27, at 11 a.m., the facilty's "Emergency Room Specialty Call Roster," dated April 2023, was reviewed and indicated Physician 2 was the General Surgery On-Call for April 21 through April 23, 2023.

On April 27, 2023 at 11:15 a.m. an interview with the Emergency Department Secretary (EDS) was conducted. The EDS stated when a doctor puts in a consult, the secretary looks to see who is on-call and notifies the physician. The EDS stated she did not know the process when an on-call physician is unavailable to cover the dates on which he is on-call. The EDS stated there is no back up call list, the patients are transferred out to another hospital.

On April 27, 2023, at 11:25 a.m., an interview with Physician 1 was conducted. Physician 1 stated, on April 21, 2023, he was informed Physician 2, who was on-call for general surgery, was ill and could not take care of patients, so the patients that were in need of general surgery consults were transferred out to other hospitals. Physician 1 stated the other general surgery physician was out of town and could not cover at that time.

On April 27, 2023 at 12:45 p.m., an interview with the Chief Quality Officer (CQO) was conducted. The CQO stated the facility does not have a policy for on-call physician coverage for the ED. The CQO stated, "They are meeting on it tonight, so I will have it for you in the morning."

On April 27, 2023, at 1:20 p.m., Patients 1, 3 and 4's medical records were reviewed with the Quality Analysis Registered Nurse (QARN).

1. Patient 1's face sheet indicated Patient 1 presented to the ED on April 21, 2023, at 7:56 p.m., for nausea, vomiting, and diarrhea.

Patient 1's "ED Physician Note," dated April 21, 2023, at 12:35 a.m., indicated, "...I considered admission for: SBO (Small Bowel Obstruction), given the fact the hospital currently does not have a general surgery as he became acutely ill patient will need to be transferred to a facility that can provide surgical consultation..."

Patient 1's "Interfacility Transfer Form," dated April 22, 2023, indicated, "...Reason for transfer: For equipment or services not available at this facility; gen surg..."

2. Patient 3's face sheet indicated Patient 3 presented to the ED on April 21, 2023 at 6:25 p.m., for abdominal pain.

Patient 3's "ED Physician Note," dated April 21, 2023 indicated, "...Findings consistent with perforated ulcer at the first part of the duodenum...Differential; Small bowel obstruction, Diverticulitis, Appendicitis, Pancreatisis..."

Patient 3's "Interfacility Transfer Form," dated April 21, 2023, indicated, "...Reason for Transfer: For equipment or services not available at this facility; general surgery..."

3. Patient 4's face sheet indicated Patient 4 presented to the ED on April 21, 2023 at 7:12 p.m., with complaints of flu-like symptoms.

Patient 4's "ED Physician Note," dated April 21, 2023, indicated, "...Disposition:...Diagnosis: Acute Appendicitis...Discharge: Transfer..."

Patient 4's "Interfaciltiy Transfer Form," dated April 21, 2023, indicated, "...Reason for Transfer: For equipment or services not available at this facility; General Surgery..."

On April 27, 2023 at 1:30 p.m., an interview with the Corporate Chief Medical Officer (CCMO) was conducted. The CCMO stated the facility does not have a policy for ED on-call physician coverage and they do not have a back up call list. The CCMO stated when he was made aware of Physician 2 being ill and unable to be on-call for general surgery, he called Physician 3 and Physician 4, however, they were both unable to cover at that time.

On April 27, 2023, at 3 p.m., an interview was conducted with the QARN. The QARN stated Patients 1, 3, and 4 were transferred out of the facility to another facility due to no General Surgeon was available for on-call to cover at the ED.

On April 28, 2023 at 11:20 a.m., an interview was conducted with Physician 3. Physician 3 stated he was contacted by Physician 2 on the morning of April 22, 2023, and asked him if he could cover. Physician 3 stated he was out of town and could not cover until 8 p.m. on April 23, 2023.

On April 28, 2023 at 12:15 p.m., an interview was conducted with Physician 4. Physician 4 stated he was contacted by Physician 2 on the morning of April 22, 2023, and asked him to cover and Physician 3 stated he could not cover until 10 p.m. on April 22, 2023.

The facility's policy and procedure titled, "EMTALA," dated February 2023, was reviewed. The policy indicated, "...HGMC and MGMC will maintain a list of physicians on it's medical staff who are on-call for duty after initial examination of the patient to provide further evaluation or stabilizing treatment in accordance with EMTALA regulations and the Hospital's "On-Call" policies and procedures..."

The policy did not include the facility's process in place in the event an on-call is not available to provide services and consultation to the patients at the Emergency Department.