HospitalInspections.org

Based on staff interview, medical record and document reviews, the hospital failed to comply with the Emergency Medical Treatment & Labor Act (EMTALA) 42 CFR 489.24 requirements, as evidenced by:

Hospital 1 failed to provide adequate on call services when:
1. Hospital 1 failed to respond to multiple pages by a transferring physician seeking consultation (refer to A 2404)..
2. The hospital physician on-call list did not have provisions for neurology or gastrointerology physicians (refer to A 2404)..
3. The hospital on-call list had a physician group listed as on-call for orthopedics (refer to A 2404).

These failures put patients at risk for delays to provide medical interventions to minimize serious harm from emergency medical conditions that pose a threat to health and life.

Based on facility document review and staff interviews, Hospital 1 failed to provide adequate on call services when Hospital 1 failed to:
1. Respond to multiple pages by a transferring physician seeking consultation.
2. The hospital physician on-call list did not have provisions for neurology or gastrointerology physicians.
3. The hospital on-call list had a physician group listed as on-call for orthopedics.

Findings:

1. On 8/13/14 the Emergency Department (ED) at Hospital 2 was attempting to arrange a transfer of Patient 1 to Hospital 1 upon the recommendation of a Telemedicine Neurology consult. MD 2, at Hospital 1, consulted with the facility Hospitalist, MD 4, (a physician who takes care of the patients at the hospital in place of individual physicians and remains onsite for a full shift to provide patient care and consultation). The Hospitalist agreed with MD 2, at Hospital 1, that the transfer of Patient 1 was not necessary.

A document titled Transfer Center TeleTracking (which indicated when and for what issue the Hospitalists were paged) showed that on 8/13/14 between 12:37 a.m., and 1:47 a.m., MD 4 was paged 6 times without responding to the Transfer Center or in-house supervisor pages. In an interview, on 8/18/14, with the Director of Emergency Services (DES) indicated that the Transfer Center was a centralized operation that provided information about services available to other hospitals within the system. The Transfer Center could page or call other hospitals and physicians as requested.

On 8/19/14 a document titled Hospitalist Service Agreement was obtained from Hospital 1. Under the Recitals section the agreement, item D (ii) the policy read "ensures that Hospitalist Services are available seven (7) days per week, twenty-four (24) hours per day... Under Exhibit 2.2, Hospitalist Services, it is required that Hospitalists; (a) Provide 24 hour coverage for hospitalized patients and respond to calls within 15 minutes of page.

On 8/18/14, at 3:50 p.m., a phone interview was conducted with MD 2. MD 2 stated that based on the information obtained from MD 1 she did not feel that Patient 1 was in need of transfer. MD 2 stated that she conferred with the facility Hospitalist, MD 4, about the transfer. MD 2 said that MD 4 agreed that Patient 1 did not require transfer.

According to the TeleTracking log on 8/13/14 at 12:19 a.m. MD's 1 & 2 conferred about the transfer. At 12:30 a.m., the log indicated that MD 2 refused the transfer and MD 1 wanted to speak with the Hospitalist (MD 4). At 12:37a.m., MD 4 was paged on the Hospital 1's internal system. At 12:52 a.m., MD 4 was paged again. At 12:56 a.m., MD 1 called back and he was informed that the hospital was still trying to contact MD 4. At 12:59 a.m., a call was placed to the Emergency Department to see if MD 4 was there, but she was not. At 1:13 a.m., the House Nursing Supervisor (HNS) had attempted to page MD 4. At 1:24 a.m., MD 1 again called the HNS and the HNS said she would try to page MD 4 again. At 1:47 a.m., the HNS tried to page MD 4 again with no response. On 8/13/14 at 2:02 a.m. the TeleTracking indicated that Patient 1 had been accepted at another hospital.

On 8/20/14 at 3:30 p.m. MD 4 was interviewed by phone. MD 4 said that she spoke with MD 2 about the transfer and concurred with MD 2's decision. When asked why she did not return the multiple pages MD 4 said that she thought all the calls were regarding the same transfer issue and were not pertinent since there was no transfer. As such, she did not think she needed to respond to the calls. When MD 4 was asked about the Hospitalist Service Agreement indicating that there was a 15 minutes call response time, she did not answer the question. When asked how long she, as the Hospitalist, has to respond to a call or page she said that if she were busy it might be 30 minutes.

2. Review of the hospital's physician on call for the past six months list indicated that there was no physicians on call for neurology services or gastroenteroloy services. Review of the hospital policy titled, "Back-up Panel for the Emergency Department" (revised 2/2012) read under section D that the neurology was not on call, but may still be contaced to see if they are able to provide services:

In an interview on 8/19/14, MD 3 stated that there are no neurologist on call for this hospital. In an interview on 8/21/14, the Vice President for Medical Affairs (VP/MA) also stated that the hospital does not have neurologists on-call.

Review of Hospital 1's Medical Staff Roster indicated that the Internal-Family Medicine Department of the hospital had eight (8) neurology specialty physicians on medical staff at the hospital (3 Active, 2 Associate, 2 Affiliate and 1 Courtesy staff). However, Hospital 1 did not provide for on-call neurology.

3. The hospital provided provided lists for 6 months of specialty on-call providers, February 2014 to August 2014. Each month reviewed showed that an orthopedic physician group was named as on-call vs an individual orthopedic surgeon. The on-call list obtained from the Emergency Department on 8/19/14 also indicated an orthopedic physician group was on-call instead of an individual orthopedic surgeon.