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Based on reviews of medical records, policies and procedures, Unassigned Coverage schedules and interview the facility failed to ensure that the on-call Urologist available was utilized to provide treatment necessary after the initial examination to stabilize an individual with an emergency medical condition who was receiving services with resources available at the hospital for one (#3) of twenty-one sampled patients. Refer to findings in Tag A-2404.


Based on medical record reviews, policy and procedure review and staff interview it was determined the facility failed to ensure an individual determined to have an emergency medical condition was provided further medical treatment that was within the facility's capability or transfer the individual to another medical facility for one (#3) of twenty-one patients sampled. Refer to findings in Tag A 2407

Based on reviews of medical records, policies and procedures, Unassigned Coverage schedules and interview the facility failed to ensure that the on-call Urologist available was utilized to provide treatment necessary after the initial examination to stabilize an individual with an emergency medical condition who was receiving services with resources available at the hospital for one (#3) of twenty-one sampled patients.

The findings included:
Review of the facility's Medical Staff Policy/Procedure , Revised 03/09 , " On Call Physicians " revealed in part, " ...2.4.1 Complete the medical screening examination utilizing all services and capabilities of Florida Hospital Heartland which are appropriate to determine if the patient's complaint constitutes an emergency medical condition, and to stabilize and treat ...any emergency medical condition. "


Patient #3 presented to the Emergency Department (ED) on 1/30/2015 at 10:50 a.m. Review of the triage documentation revealed the patient was triaged by an RN (Registered Nurse) at 11:05 a.m. The patient was noted to be a 17 year old male. Review of the RN documentation revealed the patient complained of left testicular (pertaining to the testis) pain for 3 days. The pain was rated as 5 out of 10 on a pain scale of 1-10 with 10 being the worst possible pain.

A MSE (Medical Screening Exam) was performed at 3:44 p.m. by the ED physician. Review of the physician history of the present illness revealed the patient presented with testicular pain and scrotal swelling that started 4 days ago. The pain was noted to be sharp and exacerbated by movement and walking. Review of the physician's physical exam revealed the left scrotum had tenderness, swelling, induration and a mass.

Review of the record revealed an ultrasound (a medical term for a scan that allows Doctors to easily and safely see inside a patient ' s body) of the testes was ordered and completed. Review of the radiologist's ultrasound report revealed normal echo appearance of the right testes. The left testes had an abnormal echo appearance. The radiologist documented the findings were discussed with the physician at 12:58 p.m.

Review of the physician documentation revealed the patient was re-examined at 4:30 p.m. The physician documented he examined and discussed the results with the patient and patient representative. The physician documented the importance of close follow up with Pediatric Urologist (A physician who has specialized knowledge and skills regarding problems of male and female urinary tract and male reproductive organs). Documentation revealed the ultrasound results and list of pediatric urologists was provided to the patient. The physician documented a diagnosis of testicular neoplasm (new and abnormal growth of tissue in some part of the body). The physician wrote discharge orders with education on testicular pain, unclear cause. The physician wrote a prescription for Percocet (for pain) and ibuprofen (for inflammation). Documentation noted the patient was discharged from the ED at 5:17 p.m. There was no evidence the patient was provided pain medication, intervention, or immediate consultation with a urologist to provide relief or eliminate the identified emergency medical condition. Review of the record revealed no evidence the patient's pain was reassessed prior to discharge.

Review of the record from another acute care hospital revealed the 17 year old patient presented for outpatient surgery on 2/4/15 at 3:07 p.m. after being seen by a urologist. Review of the operative report dated 2/4/15 revealed a pre and post-operative diagnosis of left testicular torsion. The procedure was a left orchiectomy and right orchioplexy (surgical freeing of an undescended testicle). The report stated the area was "extremely inflamed" due to the torsion being long standing. Review of the pathology report dated 2/6/15 stated the diagnosis was extensive necrosis (death to most of the cells in an organ or tissue) and hemorrhage (bleeding) consistent with torsion.

An interview was conducted on 7/30/2015 at 5:00 p.m., with the radiologist that performed the ultrasound on Patient #3. The radiologist pulled up the ultrasound and explained his findings to the surveyor. He stated there was no way to confirm the exact diagnosis. He stated it could be a tumor or possibly chronic torsion. He stated he spoke with the ED physician about the findings and pointed this out in his documentation. The radiologist stated the only way to confirm the diagnosis would be to have a urologist surgically explore the scrotum.


The unassigned Coverage-Florida Hospital Heartland Medical Center dated January 2015 was reviewed. Review of the on call log revealed a urologist was on call and available. There was no evidence that the on call urologist was utilized/called to provide treatment necessary after the initial examination to stabilize patient #3's emergency medical condition on January 30, 2015 with resources available to the hospital.

Based on medical record review, policy and procedure review and staff interview it was determined the facility failed to ensure an individual determined to have an emergency medical condition was provided further medical treatment that was within the facility's capability or transfer the individual to another medical facility for one (#3) of twenty-one patients sampled.

Findings include:

The facility's policy titled " Transfers to Another Facility " revised 02/09 was reviewed. The policy revealed in part, " All patients presenting at the hospital requesting care will have all emergency medical conditions stabilized to the extent possible prior to transfer to discharge. "


Review of the record revealed the physician wrote discharge orders with education on testicular pain, unclear cause. The physician wrote a prescription for Percocet (for pain) and ibuprofen (for inflammation). Documentation noted the patient was discharged from the ED at 5:17 p.m. There was no evidence the patient was provided pain medication, intervention, or immediate consultation with a urologist to provide medical examination and treatment as required to stabilize the emergency medical condition for patient #3 on January 30, 2015. Review of the record revealed no evidence the patient's pain was reassessed prior to discharge.

The facility failed to ensure that stabilizing treatment was provided for Patient #3, that was within the capability of staff (Urologist) and facilities (physical space, equipment, specialized services that the hospital provides, (e.g., surgery) that were available on January 30, 2015.

Review of the on call log revealed a urologist was on call to provide treatment on the day patient #3 presented to the ED.

There was no evidence the ED physician consulted the on call urologist to ensure no immediate care and treatment was needed to stabilize the identified emergency medical condition that existed.

Interview with the Director of Risk Management on 7/30/2015 at approximately 6:30 p.m. confirmed the above findings.