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Based on interview and record review, Surgeon A (On Call) failed to respond in person for a surgical consultation for 1 of 1 sampled patient, Patient C. This resulted in the transfer of Patient C to Hospital B in order to have the surgical procedure completed.

Findings:

Per the documentation in the hospital emergency department (ED) report dated11/30/09, Patient C presented to the hospital ' s ED with complaints of abdominal pain at 5:37 P.M. Nursing staff and the ED physician (Physician A) assessed Patient C. Physician A concluded in the report that Patient C had acute appendicitis that required surgical intervention.

The nursing notes in the ED record provided additional information. Staff notified Surgeon A with phone calls/pages on 11/30/09 at 11:19 P.M. Surgeon A returned the calls/page at 11:56 P.M. Additional documentation in the nursing notes provided that there were several phone calls back and forth between ED Physician A and Surgeon A. The review of the hospital's general surgery on call schedule provided that Surgeon A was the on call surgeon for 11/30/09.

Physician A documented in the ED report that Surgeon A was asked twice to come in and provide consultation related to the surgical needs of Patient C, and Surgeon A refused. Documentation provided that Physician A notified the hospital Chief of Staff who called Surgeon A to come to the hospital. Surgeon A again refused.

Surgeon A's refusal to evaluate Patient C resulted in the implementation of hospital policy/procedure titled Emergency Department Backup Panel (#35089.99). Despite implementation of the policy, there was no available surgeon to come in at Hospital A. Consistent with the policy, a surgeon at Hospital B accepted Patient C which resulted in a transfer of Patient C to Hospital B at 4:19 A.M. on 12/1/09.


A corrective plan of action was submitted to the California Department of Public Health in association with consumer complaint #CA00218993. The consumer complaint was initiated prior to the CMS authorized EMTALA inspection.
The corrective plan of action:
1. Chief of Staff, Immediate Past Chief of Staff and Chief of Staff Elect met with the physician regarding regarding back-up panel duties and responsibilities. Responsible: Chief of Staff or designee Completed 12/17/09
2. Chief of Staff composed educational editorial titled "ED Back Up Responsibilities" in which she reviewed the duties and responsibilities of physicians who volunteer for the specialty back up panel. The editorial was sent electronically to medical staff members. The editorial included a link to the hospital policy 35089.99 on Emergency Back Up.
Responsible: Chief of Staff or designee Completed 02/26/10
3. A certified letter outlining ED backup responsibilities was sent to all medical staff members who currently participate in the voluntary back up panel. The hospital policy was included as an attachment to the letter.
Responsible: Chief of Staff and Manager Med Staff Services Completed 02/26/10
4. New medical staff applicants will receive a copy of the hospital policy 35089.99 guiding emergency back up panel duties and responsibilities with their application packet. Responsible: Manager Medical Staff Admin Completed 04/20/10
5. Medical Executive Committee notified of CDPH investigation and details of findings and plan of correction. Responsible: CEO Completed 04/13/10
6. Governing Board notified of CDPH investigation and details of findings and plan of correction. Responsible: CEO Completed 04/13/10

In Compliance, but Previously Out of Compliance . The hospital has had no violations or similar problems for at least the past 6 months;