HospitalInspections.org

Based on review of facility documents, staff interview (EMP), and review of medical records (MR), it was determined the facility failed to ensure the physician identified as "on-call" for gynecology was available to provide treatment necessary to stabilize a patient with an Emergency Medical Condition for one of one medical record reviewed (MR1).
Findings include:
Review on March 18, 2024, of the facility policy, "EMTALA" reviewed January 2020, revealed "Purpose: The purpose of this policy is to ensure that the emergency medical treatment and patient transfer policy is based on federal law relating to the emergency medical treatment and medically appropriate transfer of individuals between hospitals. ...Emergency Medical Condition means: 1. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: a. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; b. Serious impairment to bodily functions; or c. Serious dysfunction of any bodily organ or part; or ...On-Call List refers to the list that the Hospital maintains that identifies those physicians who are "on-call" for duty after the initial Medical Screening Examination to provide further evaluation and/or treatment necessary to stabilize an individual with an Emergency Medical Condition. The purpose of the On-Call List is to ensure that the Dedicated Emergency Department is prospectively aware of which physicians, including specialists and sub-specialists, are available to provide treatment necessary to stabilize individuals with Emergency Medical Conditions. ...III. On-Call 1. The Hospital maintains a list of physicians who are on call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition or a woman in labor. 2. The list is available in the Emergency Department. The list is retained for a period of five years. 3. All physicians or specialties are not required to be present on the Hospital's on-call list at all times. 4. On-call physicians, after being contacted by the Emergency Department, must respond within a reasonable timeframe. 5. If the attending Emergency Department physician determines that the patient's medical condition requires the services of a specialist and the on-call specialist is not available or there is no physician on call for the particular specialty, the Emergency Department physician will arrange for appropriate transfer of the patient in accordance with this Policy and the requirements of EMTALA. ..."
Review on March 20, 2024, of the facility, "Wilkes Barre General Hospital Medical Staff Rules And Regulations," dated March 2023, revealed "...6.2 Consultations, Referrals & Emergency Department Call 6.2(a) When the Emergency Department Physician determines that a consultation or specialized treatment beyond the capability of the Emergency Department Physician is needed, the patient shall be permitted to request the services of a specific private physician. This request will be documented in the patient's medical record. The Emergency Department Physician will utilize the rotation call list as set forth in this Section 6.2 if the patient does not have a private Physician who is available and qualified to provide the necessary services. ...6.2(d) The rotation call list, containing the names and phone numbers of the on-call physicians shall be posted in the Emergency Department. In the event the patient does not have a private physician, the private physician refuses the patient's request to come to the Emergency Department, or the physician cannot be contacted within twenty (20) minutes of the initial request, the rotation call list shall be used to select a private physician to provide the necessary consultation or treatment for the patient. A physician who has been called from the rotation list may not refuse to respond. ...Physicians called are required to respond to Emergency Department call by telephone within ten (10) minutes. ..."
Review on March 18, 2024, of MR1, revealed the patient presented to the ED on March 6, 2024, at 18:12 PM, with the complaint of abdominal pain. A CT of the abdomen and pelvis was completed at 19:13 PM which revealed both ovaries were enlarged with a thin-walled cyst anterior to the uterus and ovaries that measured approximately 10.6 x 8.3 centimeters (cm). Magnetic Resonance Imaging (MRI) was recommended. A call was placed to the on-call physician (OTH2) at 23:00 PM with no response. A second call was placed to OTH2 at 00:33 AM. An MRI was completed with physician documentation that revealed a large mass with ovarian etiology. There was a concern about the possibility of an ovarian torsion (when the ovary and sometimes fallopian tube twist on the tissues that support them and can cut off blood supply to the ovary and if not treated promptly can cause tissue in the organ to die). At 04:05 AM a third call was placed to the OTH2 with no response. At 05:22 AM OTH1 discussed the case with a physician at another local hospital and that physician accepted MR1. MR1was transferred to that local hospital at 07:00 AM .

Interview on March 18, 2024, with EMP1 at approximately 10:15 AM, confirmed the above findings. EMP1 confirmed OTH2 did not respond to 3 calls placed by the ED physician and MR1 had to be transferred to another local hospital for gynecological care.

Review on March 18, 2024, of the ED on-call gynecologist schedule dated March 6, 2024, revealed OTH2 was on-call from 07:00 AM on March 6, 2024, to 07:00 AM on March 7, 2024.

Interview on March 18, 2024, with EMP1, at approximately 10:20 AM, confirmed the above findings.

Interview on March 18, 2024, with OTH2 at approximately 1:20 PM, revealed they were aware they were on-call on March 6, 2024. OTH2 revealed the ringer on their phone was turned off so they never heard the phone ring.