HospitalInspections.org

Based on record review and interviews, the hospital failed to follow their policy and did not provide emergency medical care within their capabilities to one patient (patient #1) from hospital A.

Findings include:

- Hays Medical Center's Rural Health Network Agreement with Hospital A reviewed on 8/11/11 revealed Hays Medical Center is responsible for establishing a system for patient transfers from Hospital A.

- Hays Medical Center (HMC) Direct Policy for Emergency Department call system reviewed on 8/10/11 directed the Registered Nurse responsible for answering the phone to follow the hospitals ' patient acceptance policies.

- Review of a HMC " provider interaction documentation form "on 8/10/11, revealed ED Medical Staff B, Physicians Assistant (PA), from Hospital A contacted Hays Medical Center to request a transfer for a 8 year-old patient that required abdominal surgery. Hays Medical Center's Registered Nurse Staff G documented on the form "Physician H, stated I don't feel comfortable with pediatric cases under 13 years of age." Staff G documented they explained physician H's response to, Medical Staff B from Hospital A.

- Hays Medical Center " EMTALA- Emergency Medical Screening. Treatment, Transfers and On-call Roster Policy " addressed the hospital's obligation to accept transfers and directs the staff "If a physician receives a request for transfer and is unwilling or unable to accept the transfer, the physician must refer the request to the Emergency Department physician. The Emergency Department physician shall determine whether to accept the transfer."

Hays Medical Center, Administrative Emergency Department Director E, interviewed on 8/10/11 verified the hospital failed to accept the patient transfer based on physician H ' s reluctance and refusal to perform surgery on a 8 year-old child.

- Review of the Hospital A medical record for patient #1 revealed an eight year old, 90 pound pediatric patient, arrived at Hospital A's emergency department accompanied by the parents from home on 7/30/11 at 5:40pm with abdominal pain and vomiting. Emergency Department staff B, PA (physicians assistant), triaged patient #1 and documented the patient had abdomen pain with vomiting greater than 10 times, HR (heart rate) 111 and a temperature of 100.6 degrees Fahrenheit (normal body temperature is 98.6 degrees). Emergency Department staff B, PA (physicians assistant) ordered a CT scan (computed tomography; noninvasive radiographic procedure with contrast dye to diagnose pathologic conditions) of the abdomen & pelvis, a UA (urine analysis), a CBC (complete blood count), IV therapy and pain medication.

Further review of the medical record revealed the CT scan results dated 7/30/11 at 8:01pm that patient #1 had acute appendicitis and lab results showed an elevated white blood count of 19,000. At 9:15pm patient #1's heart rate was 128 and temperature had elevated to 102.9. Emergency Department PA staff A on 7/30/11 at 9:15pm called Hays Medical Center (their supervising network hospital) to transfer patient #1. Staff B reported Hays Medical Center's Registered Nurse, staff G stated "the on call surgeon does not perform pediatric surgery." Emergency Department PA staff B then contacted Hospital C and was granted a transfer. Patient #1 was transferred to Hospital C by air ambulance.

Review of Hospital C's medical record revealed patient #1 arrived per air ambulance at Hospital C on 7/30/11 at 2:30am. Hospital C, Staff S, Surgeon, examined patient #1 and confirmed the patient had acute appendicitis with possible perforation. On 7/31/11 Hospital C's surgeon performed a laparoscopic appendectomy surgery on patient #1. Patient #1 remained an inpatient at Hospital C until 8/3/11.

Hospital counsel D interviewed on 8/10/11 at 3:45pm verified the hospital staff failed to follow Hays Medical Center's " EMTALA- Emergency Medical Screening. Treatment, Transfers and On-call Roster Policy " for patient #1's transfer

- Hays Medical Center's " EMTALA- Emergency Medical Screening. Treatment, Transfers and On-call Roster Policy " also addressed the hospital's obligation to accept transfers and states "Hays Medical Center (including the Emergency Department physicians and staff physicians) shall not refuse to accept requests for transfers if the patient is in need of the specialized capabilities or facilities available at the hospital."

Review of the Hays Medical Center Emergency Department's privileges for on-call surgeon (Surgeon H) for 7/30/11 has the hospital's core privileges which includes the ability and skill to perform surgical procedure that included . . "the abdomen and its contents. Management of trauma and complete care of critically ill patients with underlying surgical conditions in the emergency department, intensive care unit . . . "

Surgeon H at Hays Medical Center interviewed on 8/10/11 at 3:15pm stated he "does not do surgery on pediatric patients under 13 years of age." This information is not documented on surgeon H's credentialing or privileging file.

Hays Medical Center, Credentialing Manager I and Credentialing Coordinator J interviewed on 8/10/11 at 2:45pm reported the hospital lacked evidence of any age limitations or preferences for Surgeon H.

Quality Assurance Director C on 8/11/11 at 11:00am verified Hays Medical Center performed pediatric surgeries and provided a patient roster that documented the hospital completed 2,134 pediatric surgeries during the last 12 months. Further review of the roster revealed the hospital performed 8 pediatric laparoscopic appendectomy surgeries on patients between 7 years of age to 13 in the last year.

Administrative staff C reported all pediatric surgical cases recover in their 12-bed pediatric unit. Staff C reported the hospital did not have any pediatric patients on 7/30/11 and could accommodate patient #1 that day.

The Hospital Data Base Worksheet completed by Hays Medical Center staff on 8/10/11 revealed the hospital had the capabilities and qualified staff to appropriately care for patient #1.

Hospital counsel D interviewed on 8/10/11 at 3:45pm verified the hospital staff lacked evidence to prove the hospital could not provide an appropriate level of care for patient #1 and could not justify the transfer of patient #1 to another hospital for treatment.

Based on document review and staff interview the hospital failed to accept patient #1, when the hospital had the capabilities and qualified staff to provide the necessary care and treatment for the patient.

Findings include:

- Hays Medical Center's Rural Health Network Agreement with Hospital A reviewed on 8/11/11 revealed Hays Medical Center is responsible for establishing a system for patient transfers from Hospital A.

- Hays Medical Center (HMC) Direct Policy for Emergency Department call system reviewed on 8/10/11 directed the Registered Nurse responsible for answering the phone to follow the hospitals ' patient acceptance policies.

- Review of a HMC "provider interaction documentation form" on 8/10/11, revealed ED Medical Staff B,PA, from Hospital A contacted Hays Medical Center to request a transfer for a 8 year-old patient that required abdominal surgery. Hays Medical Center's Registered Nurse Staff G documented on the form "Physician H, stated I don't feel comfortable with pediatric cases under 13 years of age." Staff G documented they explained physician H's response to, Medical Staff B from Hospital A.

- Hays Medical Center " EMTALA- Emergency Medical Screening. Treatment, Transfers and On-call Roster Policy " addressed the hospital's obligation to accept transfers and directs the staff "If a physician receives a request for transfer and is unwilling or unable to accept the transfer, the physician must refer the request to the Emergency Department physician. The Emergency Department physician shall determine whether to accept the transfer."

Hays Medical Center Administrative Emergency Department Director E interviewed on 8/10/11 verified the hospital failed to accept the patient transfer based on physician H ' s reluctance and refusal to perform surgery on a 8 year-old child.

- Review of Hospital a's medical record for patient #1, an eight year old, 90 pound pediatric patient, revealed the child arrived at Hospital A's emergency department accompanied by their parents from home on 7/30/11 at 5:40pm with abdominal pain and vomiting. Emergency Department staff B, PA (physicians assistant), triaged patient #1 and documented the patient had abdomen pain with vomiting greater than 10 times, HR (heart rate) 111 and a temperature of 100.6 degrees Fahrenheit (normal body temperature is 98.6 degrees). Emergency Department staff B, PA (physicians assistant) ordered a CT scan (computed tomography; noninvasive radiographic procedure with contrast dye to diagnose pathologic conditions) of the abdomen & pelvis, a UA (urine analysis), a CBC (complete blood count), IV therapy and pain medication.

Further the medical record revealed the CT scan results on 7/30/11 at 8:01pm documented patient #1 had acute appendicitis and lab results showed an elevated white blood count of 19,000. At 9:15pm patient #1's heart rate was 128 and temperature had elevated to 102.9. Emergency Department PA, staff A, on 7/30/11 at 9:15pm called Hays Medical Center (their supervising network hospital) to transfer patient #1. Staff B reported Hays Medical Center ' s Registered Nurse, staff G stated "the on call surgeon does not perform pediatric surgery." Emergency Department PA staff B then contacted Hospital C and was granted a transfer. Patient #1 was transferred to Hospital C by air ambulance.

Review of Hospital C's medical record revealed patient #1 arrived per air ambulance at Hospital C on 7/30/11 at 2:30am. Hospital C, Staff S, Surgeon, examined patient #1 and confirmed the patient had acute appendicitis with possible perforation. On 7/31/11 Hospital C's surgeon performed a laparoscopic appendectomy surgery on patient #1. Patient #1 remained an inpatient at Hospital C until 8/3/11.

Hospital counsel D interviewed on 8/10/11 at 3:45pm verified the hospital staff failed to follow Hays Medical Center's " EMTALA- Emergency Medical Screening. Treatment, Transfers and On-call Roster Policy " for patient #1's transfer

- Hays Medical Center's " EMTALA- Emergency Medical Screening. Treatment, Transfers and On-call Roster Policy " also addressed the hospital ' s obligation to accept transfers and states "Hays Medical Center (including the Emergency Department physicians and staff physicians) shall not refuse to accept requests for transfers if the patient is in need of the specialized capabilities or facilities available at the hospital."

Review of Hays Medical Center Emergency Department's privileges revealed on-call surgeon (Surgeon H) for 7/30/11 has the hospital's core privileges which includes the ability and skill to perform surgical procedure that included . . "the abdomen and its contents. Management of trauma and complete care of critically ill patients with underlying surgical conditions in the emergency department, intensive care unit . . . "

Surgeon H at Hays Medical Center interviewed on 8/10/11 at 3:15pm stated he "does not do surgery on pediatric patients under 13 years of age." This information is not documented on surgeon H's credentialing or privileging file.

Credentialing Manager I and Credentialing Coordinator J interviewed on 8/10/11 at 2:45pm reported the hospital lacked evidence of any age limitations or preferences for Surgeon H.

Quality Assurance Director C on 8/11/11 at 11:00am verified Hays Medical Center performed pediatric surgeries and provided a patient roster that documented the hospital completed 2,134 pediatric surgeries during the last 12 months. Further review of the roster revealed the hospital performed 8 pediatric laparoscopic appendectomy surgeries on patients between 7 years of age to 13 in the last year.

Administrative staff C reported all pediatric surgical cases recover in their 12-bed pediatric unit. Staff C reported the hospital did not have any pediatric patients on 7/30/11 and could accommodate patient #1 that day.

The Hospital Data Base Worksheet completed by Hays Medical Center staff on 8/10/11 revealed the hospital had the capabilities and qualified staff to appropriately care for patient #1.

Hospital counsel D interviewed on 8/10/11 at 3:45pm verified the hospital staff lacked evidence to prove the hospital could not provide an appropriate level of care for patient #1 and could not justify the transfer of patient #1 to another hospital for treatment.