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Based on interview and record review the facility failed to ensure there was an on-call medical specialist (physician able to respond to specific patient needs in the emergency department) at all times. Documentation indicated a gastroenterologist (physician specializing in treating patients experiencing intestinal and liver problems) was not available to immediately assess Patient 1 who presented to the hospital with probable hemorrhagic shock (failure of body organs due to bleeding). This deficient practice had the potential to delay treatment and accelerate organ failure.

Findings:

During a review of the "Emergency Trauma Documentation," dated 1/22/2024 at 5:30 A.M., this document indicated Patient 1 was brought into the emergency department from home after a syncopal (fainting) episode. According to this report, Patient 1 stated she started bleeding rectally earlier this morning (1/22/2024). Patient 1 also said she had recent 'abdominal stents' placed at another hospital about 11 days ago. This document also showed the most recent laboratory results for Patient 1 including Hemoglobin (Hgb, compound in red blood cells allowing transport of oxygen to all parts of the body) level of 7.6 (low level). The 'Assessment/Plan' of this document included, not all inclusive: symptomatic anemia (insufficient number of red blood cells), syncope, GI (gastrointestinal) bleed, septic shock (organ damage in response to infection). According to the 'Medical Decision Making' section of this report, Patient 1 had received some of her ordered blood transfusion and had not required medication to raise her blood pressure; the emergency department physician conferred with an on-call intensivist (medical doctor with training and experience in treating critically ill patients), a hospitalist (doctor who provides care for patients at a hospital, similar to a primary care provider), but a GI physician was not available in the hospital at this time. This document noted, due to the lack of sufficient medical staff, the emergency department physician determined it was not appropriate to admit Patient 1 to this hospital; the emergency department physician made a subsequent attempt to transfer Patient 1 to another hospital.

During a review of the "Discharge/Transfer Documentation" dated 1/23/2021, the document indicated Patient 1 came to the hospital with shock likely due to blood loss anemia, possibly from gastric varices (enlarged blood vessels in the gut), sepsis related to a infected necrotic (dying) part of the pancreas. Patient 1's respiratory status continued to worsen and Patient 1's hemoglobin level continued to drop even though Patient 1 was given numerous blood transfusions. Patient 1 was eventually seen by a GI physician but Patient 1 was too ill for an endoscopy (procedure to diagnose and treat problems in the upper GI tract). Patient 1 passed away 1/23/2024 at 4:57 P.M. after she was given comfort measures (treatments used to ease pain and distress when life-prolonging options are not available).

During a review of "Pomona Valley Hospital Medical Center Medical Staff Rules and Regulations", the document indicated the following:
'Those physicians who are on an Emergency On-Call Panel shall be required to provide inpatient consultation when requested on the day consultation is requested. If there is no On-Call Panel for that specialty, resolution of whom to call shall be resolved by the appropriate Department Chair or Vice Chair.'

During a review of the "GI Lab January 2024" (schedule of available on-call GI physicians), this schedule indicated there were no on-call GI physicians on 1/19/2024, 1/20/2024, 1/21/2024, 1/22/2024, 1/23/2024, and 1/26/2024.

During an interview on 5/30/2024 at 9:35 A.M., the Medical Staff VP stated that this hospital has been trying to recruit more GI staff but currently contracted medical staff can terminate their contracts when notice is given by the physician. The Medical Staff VP subsequently verified some GI medical staff terminated their contracts around the time Patient 1 entered the hospital on 1/22/2024.

During an interview on 5/30/2024 at 10:20 A.M., the Medical Chairman stated the hospital is not required to receive an immediate consult from GI (on-call physician). The Medical Chairman recalled that he contacted the Medical Staff VP and the Medical Chairman requested the Medical Staff VP to contact every available GI physician and to contact every hospital able to accept Patient 1's transfer. The Medical Chair then stated the facility was able to find a GI physician who could see Patient 1 the following day, 1/23/2024.