HospitalInspections.org

Based on review of hospital documents and interviews with hospital staff, the hospital failed to enforce policies and procedures to comply with EMTALA requirements.

Findings:

The hospital failed to follow its policies and procedures concerning:

a. availability of on-call physicians for nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) that required the services of an on-call physician. See Tag A-2405 for further details.

b. treatment within its capability for nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) whose medical records were reviewed. See Tag A-2407 for further details.

c. appropriate transfers for two of three (#22, 25) patients who requested to transfer to another hospital. See Tag A-2409 for further details.

d. recipient hospital responsibilities for two of two patients (#26, 27) with a request for transfer from a referring hospital. See Tag A-2411 for further details.

e. the central log. See Tag A-2405 for further details.

Based on review of hospital documents and interviews with hospital staff, the hospital failed to ensure on-call physicians were available to provide patient care. This occurred for nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) that required the services of an on-call physician.

Findings:

Integris Baptist Medical Center (IBMC) is a 629 bed hospital that offers a a wide variety of adult specialty services and limited pediatric services. The hospital also has an off-site inpatient psychiatric facility that is licensed as a part of the hospital.

On-call schedules for IBMC's specialty services were requested and reviewed for the months of November 2014 through May 2015.

The surveyors were not provided the on-call schedule for the hospital's psychiatric specialty.

Patient #20 presented to IBMC with a psychiatric diagnosis. The patient was transferred from IBMC to a State operated inpatient psychiatric facility.

Hospital 6 contacted IBMC requesting to transfer Patient #27 to IBMC. The on-call general surgeon refused to accept the patient. The patient was transferred to Hospital 1.

The neurosurgery (NES) specialty schedule documented a physician on-call everyday. Various days of the monthly NES call schedule documented, " physician name/practice/divert ER [emergency department] except stroke."

In an interview with the medical co-chair of the ER on 05/12/2015 at 12:55 p.m., he was asked to explain the comments documented on the NES call schedule. The co-chair stated that on those days the on-call NES would only take call for patients that presented to IBMC ER with a diagnosis of stroke and patients already established within the NES practice patients. All other patients, who required NES, that presented to IBMC ER that did not fall in either category would be diverted to the on-call Level 2 hospital.

Patients # 1, 5, 10, 12 were diagnosed with neurological disorders that required the services of a NES. The patients were transferred from IBMC to other acute care hospitals.

Integris Baptist Medical Center received a call from the Transfer and Referral Center (TReC) requesting to transfer Patient #26 to IBMC for NES. The patient was not accepted by IBMC. Patient # 26 was transferred to Hospital 3.

Patient # 14 presented to IBMC ED with an open wound. The patient was transferred from IBMC to Hospital 1.

See Tags A-2407 and A-2411 for more details.

Based on review of the hospital documents and interviews with hospital staff, the hospital failed to document the disposition of each individual that presented to the ED. The hospital's ED log for the months of November 2014 through May 2015 were reviewed.

Findings:

On 05/12/2015 at 2:30 p.m., the Administrative Director of the ED was asked who was responsible for maintaining the ED log. The Administrative Director of the ED stated the Clinical Director of the ED was responsible for the ED log.

Later in the afternoon of 05/12/2015, the Clinical Director of the ED was asked who was responsible for the ED log. The Clinical Director of the ED stated the registration clerks were responsible for maintaining the ED log.

The ED log did not contain accurate documentation on the disposition of the individuals that presented to the ED.

The ED log documented a disposition of "routine discharge home" on patients who were either admitted to IBMC or transferred to another acute care hospital. This was confirmed by the Administrative Director of the ED on 05/12/2015.

Policies and procedures regarding the EMTALA requirements for the ED log were not provided to the surveyors.

Based on review of medical records and hospital documents and interviews with hospital staff, the hospital failed to provide treatment within its capability in nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) whose medical records were reviewed.

Findings:

Integris Baptist Medical Center (IBMC) is a 629 bed hospital that offers a a wide variety of adult specialty services and limited pediatric services. The hospital also has an off-site inpatient psychiatric facility that is licensed as a part of the hospital.

Review of the hospital's Medical and Dental Staff Rules and Regulations, documented, ..."The "primary injury" should be the injury most potentially life threatening to the patient and which requires the most immediate attention. The physician with expertise in that specialty shall be notified to take responsibility as the admitting physician..."

Review of the Professional Services Agreement between Integris Baptist Medical Center (IBMC) and the physicians documented, "...Provider shall respond to calls related to Provider's specialty timely and provide inpatient care and consultative services related to Provider's specialty to any patient seen in the INTEGRIS ER while on-call for Provider's specialty..."

The Chief Medical Director was interviewed on 05/12/2015 at 10:35 a.m. He stated patients who were admitted through the IBMC ED with multiple health issues were admitted by the hospitalist. The hospitalist would direct the overall care of the patient, obtaining specialty physicians as needed to care for the patient.

Review of the neurosurgery (NES) on-call schedules from November 2014 to May 2015, documented NES available everyday of the week.

Patient #1 presented to IBMC via private vehicle. The medical record for Patient #1 documented a head injury and cervical fracture as the medical impression. No specialty consults were documented by the ED physician. The patient transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred.

Patient #5 transferred to IBMC from Hospital 4 via emergency vehicle (EV). The medical record for Patient #5 documented acute subarachnoid hemorrhage as the medical impression. At IBMC, the ED physician consulted the on-call NES. The on-call NES recommended to transfer the patient due to no NES coverage at IBMC. Patient #5 was transferred to a third hospital, Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred.

Patient #10 was transported from home to IBMC via EV per family request. The medical record for Patient #10 documented presumed basilar skull fracture and meningitis as the medical impression. The ED physician consulted with the on-call infectious disease specialist who recommended intravenous antibiotics. The patient transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred.

Patient #12 was transported from a nursing home to IBMC via EV per patients "choice". The medical record for Patient #12 documented facial contusion, acute head injury and subdural hematoma as the medical impression. The patient was transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred.

Patient # 14 an inpatient at Hospital 1 left against medical advise (AMA). After having surgery at Hospital 1, the patient presented at IBMC ED via private vehicle. The patient was transferred back to Hospital 1. The transfer form documented, "Alternative to transfer: stay @ IBMC" as the reason the patient was transferred.

Patient #20 was transported from home to IBMC via EV per patients request. While in the IBMC ED the Mobile Assessment Team (MAT) evaluated the patient. The patient was transferred to a State operated mental health facility. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred.

Patient #28 was transported to IBMC from the field after a motor vehicle accident via EV per the patients request. The ED physician consulted with the on-call orthopedist who recommended a "trauma transfer". The on-call orthopedist refused to admit the patient due to "altered sensorium". The patient transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred.

The ED medical co-chair was interviewed on 05/12/2015 at 12:55 p.m. He was asked to review the medical record for Patient #28. After review of the medical record, the co-chair stated the hospital "probably" could have taken care of Patient #28. He told the surveyors that the ED physician that provided the care would have to identify his reason for transferring the patient.

The ED physician that provided care to Patient #28 was interviewed on 05/13/2015 at 8:45 a.m. The ED physician stated at the time of transfer Patient #28 did not have any neurological problems. The ED physician stated he did not consult or contact the on-call hospitalist or any other specialty services.

Based on review of hospital documents and medical records, the hospital failed to ensure individuals request to transfer were in writing. This occurred in two of three patients (#22, 25) medical records reviewed who requested to transfer.

Findings:

A hospital policy titled, "Patient Transfers", documented, "...if the patient or the legally responsible person: (i) makes written request for transfer to another medical facility stating the reasons for the request.....(ii) acknowledges the request and understanding of the risks and benefits of the transfer by signing the Signature Page for patient's Request/Consent to Transfer on the Hospital transfer Form..."

Patient #22 presented to IBMC ED with cardiac issues. The patient and the patient's family requested to be transferred to Hospital 5. The medical record did not contain a request to transfer in writing, from the patient or the legally responsible person acting on the patient's behalf.

Patient #25 presented to IBMC ED with cardiac issues. The patient previously had a procedure at Hospital 5. Patient #25 requested to be transferred to Hospital 5. The medical record for Patient 25 did not contain a request to transfer in writing, from the patient or the legally responsible person acting on the patient's behalf. The transfer form documented, "Lack of facilities, services or staff", as the reason the patient was transferred.

Based on review of hospital documents and medical records and interviews with hospital staff, the hospital failed to accept patients from referring hospitals This occurred in two of two patients (#26, 27) with a request for transfer from a referring hospital.

Findings:

Review of a IBMC policy title, "Patient Transfers", documented, "...The medical center encourages the Emergency Department physician to accept all responsible and medically necessary transfers from other facilities especially rural facilities that have limited resources for preservation of the patients' health and well being..."

The IBMC ED Transfer Process documented, "...The Transfer Center will direct ALL trauma patients(neurosurgery, hand, ortho, etc) to TReC when Baptist is not on Level 2 Trauma Call for the day..."

The Regional Trauma Transfer and Referral Center (TReC) called IBMC and requested to transfer Patient #26 to IBMC per the patients request. The ED physician who received the phone call from TReC was interviewed on 05/13/2015 at 8:45 a.m. He stated that he refused to accept Patient #26 because it was not the hospital's (IBMC) Trauma Level II day and all traumas should go to that hospital. The ED physician also stated the hospital (IBMC) did not have to accept the patient (Patient #26) because of the agreement with the Trauma System.

Hospital 6 called IBMC requesting to transfer Patient #27. The ED physician at Hospital 6 documented, "...I try to transfer the patient to the Baptist facility since we are unable to admit patients under 15 at this facility. The Baptist facility felt that this was a patient we could handle at this facility..." Review of the IBMC ED Transfer Data Form documented, "...Per [name omitted] @ ctr [center]- Dr. [name omitted] stated they can handle in Edmond, transfer not coming..."