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. treatment within its capability for one (#4) of twenty patients, whose records were reviewed. See Tag A-2407 for further details.


b. recipient hospital responsibilities for two of nine patients (#17, 18) with a request for transfer from a referring hospital. See Tag A-2411 for further details.

Based on review of medical records and hospital documents, and interviews with hospital staff, the hospital failed to provide treatment within its capability in one (#4) of twenty patients whose records were reviewed.


Findings:


Integris Baptist Medical Center is a 629 bed hospital that offers a a wide variety of adult specialty services and limited pediatric services.


On 08/01/2015, at 10:47 a.m., Patient #4 presented with complaints of left lower leg/extremity (LLE) pain. The emergency department (ED) physician examined the patient and found an "obvious deformity to his LLE." X-rays confirmed the patient had "angulated fractures of the mid left tibia and fibula diaphysis (bone shaft)." No other injuries were confirmed. At 11:32 a.m., the ED physician consulted, by telephone, with the orthopedist on-call, Staff A. According to the ED physician's documentation, Staff A recommended the patient be transferred to another acute care hospital that specialized in pediatric services. The ED physician recorded Staff A stated he did not operate on this age group. The patient was transferred to the other hospital.


According to Staff A's current privilege list, the physician had privileges at the hospital since 09/01/2014, that included, providing services to "patients of all ages"; "adult and pediatric orthopaedic disorders, diagnosis and management of"; "pediatric trauma"; "fixation of traumatic injuries"; "fracture and dislocations of lower extremities..."; and "acute trauma, diagnosis and care - both operative and nonoperative." The credential file and privilege list did not contain evidence any of the above privileges had been amended or deleted. This was confirmed with Staff N on 11/18/2015 at 2:20 p.m.

Based on review of hospital documents and medical records, and interviews with hospital staff, the hospital failed to accept patients from referring hospitals in two (#17 and 18) of nine patients where a request for transfer occurred from a referring hospital.


Findings:


Review of the hospital's policy title, "Patient Transfers - EMTALA", with a revision date of 10/24/2015, documented "...To the extent the Medical Center has the capability and capacity to treat the individual, the Medical Center will accept all appropriate transfers from other facilities..."


1. Patient #17 - According to the documentation on the Integris Baptist Medical Center's (IBMC's) Transfer Center, the Transfer Center received a call on 10/06/2015, at 7:58 p.m. from another acute care hospital's emergency department (ED) with a request for specialty of hand surgery. The Transfer Center Summary (TCS) form documented the patient had a right hand infection with possible sepsis. The TCS form documented conferences between physicians at IBMC and the requesting hospital. The TCS form recorded Staff B, the orthopedist on call for IBMC refused the patient and stated the patient needed to be transfer to (name omitted), another acute care hospital.


On 11/20/2015, and 11/24/2015, IBMC provided data documenting Staff B was in surgery on 10/06/2015 from 7:47 p.m. until 9:35 p.m.


The medical record of Patient #17, from the requesting hospital, was reviewed. According to the medical record, the patient did not sign the consent for transfer until 9:00 p.m.


On 11/24/2015, at 2:00 p.m., a surveyor interviewed Staff S, one of the ED physicians, at the requesting hospital, involved in the care and transfer of Patient #17. Staff S stated Staff B did not mention having any surgeries until his last conversation with Staff B on the night of 10/06/2015. Staff S stated Staff B did not say he was currently in surgery. Staff S stated Patient #17 was not transferred until sometime after 9:00 p.m.


The requesting hospital is approximately 90 miles away from IBMC. At the time the patient was transferred on 10/06/2015, Staff B would have been out of surgery and able to take care of Patient #17.



2. Patient #18 - According to the documentation 10/18/2015, at 0024, the hospital's Transfer Center received a call from another acute care hospital's ED physician with a request for transfer of a patient needing specialty orthopedic services. ~ The Transfer Center Log documented the patient had a pelvic fracture.


~ The ED Transfer Data Form listed the patient's injuries as left superior pubic ramus fracture; right non-displaced pubic ramus fracture with extension into the sacral iliac joint; possible right foot fracture; and laceration on the right chin. IBMC's ED physician took the call; consulted the on-call orthopedist, Staff E; and documented on the form that Staff E did not have the "capability to operate on these types of fractures." The transfer request was denied. The form documented that another orthopedist, Staff F was not on-call. (On the afternoon of 11/18/2015, Surveyors were told Staff F was the only physician who performed the acetabular fractures and complex pelvic fractures.)


~ On 11/18/2015, at 2:00 p.m., Staff E stated he did not perform "complex" pelvic fractures or acetabular fractures. He stated, as far as he knew, Staff F was the only orthopedist at IBMC that performed the surgeries.


~ Review of Staff E's current privilege list, the privileges included: closed (not compound), displaced and nondisplaced pelvic fractures; fixation of traumatic injuries; foot and ankle surgery; fracture and dislocations of lower extremities (including pelvis and hip);, hip and knee conditions, assessment and management of; primary total hip replacement surgery; total joint replacement, hip ,knee, shoulder, primary and revision; trauma, including multisystem trauma; and urgent and emergency orthopaedic problems, treatment evaluation. The was the same information that was listed on Staff F's privileges. This was reviewed and verified with Staff N and Q at the time of review on 11/18/2015.