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Based on interview, review of physician's credentialing files, physician's on-call list, and review of the facility's Emergency Medical treatment and Active Labor Act policy, the hospital failed to ensure compliance with requirements under 489.24 in regard to refusal to accept a transfer of a patient requiring specialized care from a referring hospital during the night of 05/16-17/11 and failure to maintain an accurate physician on- call list. This affected Patient 25 and all future patients in need of a transfer to this hospital for specialized care.

Findings Include:

Please refer to A2404 for further details regarding physician on-call list.

Please refer to A2411 for further details regarding refusal to accept transfer.

Based on interview, medical record review, review of the hospital's timeline of phone calls and the hospital's on-call list, the hospital failed to ensure the on-call list accurately reflected that Surgeon 1 was on call the night of 05/16-17/11, delaying the transfer of a patient who needed specialized treatment. This affected Patient 25 and all future patients in need of a transfer to this hospital for specialized care.

Findings:

Review of the medical record for Patient 25, from Hospital B, revealed the hospital received Patient 25 in the hospital's emergency department (ED) on 05/16/11 at 23:15, with a chief complaint of back pain and nausea. A CT scan revealed that patient 25 had a 7.5 cm aneurysm, which appeared to have ruptured. According to documentation in the "emergency room note" another hospital who provided the services Patient 25 needed was contacted to accept the patient for treatment. The hospital that was contacted to accept the transfer of Patient 25 was located approximately 70 miles from Hospital B. Due to the patients emergent condition and weather conditions that prohibited transfer by air, it was recommended that patient 25 be transferred by ambulance to the nearest hospital. St. Elizabeth is located approximately 17 miles from Hospital B and also provided the services that Patient 25 required.

Further review of the emergency room note revealed that when Hospital B attempted to reach the on-call physician for St. Elizabeth, Hospital B was told that Surgeon 2 was on call. Surgeon 2 did not returned Hospital B's call. The emergency room note further documented that Hospital B spoke to the ED physician at St. Elizabeth's who after contacting the vascular surgeon who was on-call, Surgeon 1, informed Hospital B that Surgeon 1 refused the transfer.

Review of a timeline of phone calls processed through Physician Link, a service used by some hospitals to provide contacts for physicians on-call in the ED, was provided by St. Elizabeth Health Center's administrative staff (AR1) on 06/03/11. According to the timeline, Hospital B contacted Physician Link at 0043 on 06/17/11. Physician Link contacted the answering service for Surgeon 2, who was the surgeon identified on St. Elizabeth's call list. After Hospital B was informed Surgeon 2 was not on call, St. Elizabeth's ED and Hospital B's ED were conferenced at 0057 by Physician Link.

A review of St. Elizabeth's Health Center's on-call list for vascular surgery revealed Surgeon 2 was listed as on-call 05/10/11 through 05/17/11, from 12 AM-6:59 AM and 7 AM-11:59 PM; however, review of a fax dated 05/10/11, revealed that Surgeon 2 would be away May 10-16, 2011 and that Surgeon 1 would be on-call.

On exit, at 5:00 P.M., St. Elizabeth Health Center was unable to produce a policy that mapped out how the on-call schedules are created and, as needed, modified.

Based on interview, medical record review, review of physician's credentialing files, and review of the hospital's Emergency Medical Treatment and Active Labor Act policy, St Elizabeth Health Center failed to accept a transfer for a patient that required specialized services during the night of 05/16-17/11. This affected Patient 25 and all future patients in need of a transfer to this hospital for specialized care.

Findings:

Review of the medical record for Patient 25, from Hospital B, revealed the hospital received Patient 25 in the hospital's emergency department (ED) on 05/16/11 at 23:15, with a chief complaint of back pain and nausea. A CT scan revealed that patient 25 had a 7.5 cm aneurysm, which appeared to have ruptured. According to documentation in the "emergency room note" another hospital who provided the services Patient 25 needed was contacted to accept the patient for treatment. The hospital that was contacted to accept the transfer of Patient 25 was located approximately 70 miles from Hospital B. Due to the patients emergent condition and weather conditions that prohibited transfer by air, it was recommended that patient 25 be transferred by ambulance to the nearest hospital. St. Elizabeth is located approximately 17 miles from Hospital B and also provided the services that Patient 25 required. The emergency room note further documented that Hospital B spoke to the ED physician at St. Elizabeth's, who informed Hospital B that Surgeon 1 refused the transfer.

On 06/03/11, a review of the facility's Emergency Medical Treatment and Active Labor Act policy as revised on 08/10 was completed. The policy stated, "The hospital shall accept patients from other facilities if the hospital has specialized capabilities to treat the patient not available at the sending facility ...".

According to Hospital B, Surgeon 1 was on call at St. Elizabeth Health Center and refused to accept the transfer of Patient 25 on the night of 05/17/11. On 06/03/11 at 11:26 A.M., a representative from Hospital B was contacted for interview (Staff C). Staff C stated that the hospital needed to transfer patient 25 to another hospital because they did not have a vascular surgeon. Staff C went on to state that Hospital B was told by the on-call vascular surgeon (Surgeon 1) that he/she would not accept the transfer. Hospital B was not given any reason why the transfer was not accepted, or why it was beyond St. Elizabeth's specialized capability. Staff C stated St. Elizabeth's adminstrative representative (AR1) revealed Surgeon 1 was not employed by the hospital, worked in a community-based practice, and therefore, AR1 could not control the kind of patients Surgeon 1 did or did not accept.


St. Elizabeth Health Center is a level I trauma center and provides services that include, but not limited to, vascular services. In an interview on 06/03/11 at 11:45 A.M. , AR1 and AR2 stated St. Elizabeth Health Center lacked the specialized capability to treat Patient 25. Both stated a leaking aneurysm required a kind of complex surgery the hospital could provide during the day, but not in the middle of night because the surgery would require a vascular surgical team with surgical nurses and scrub technicians experienced in vascular surgery. St. Elizabeth Health Center does have a trauma surgeon and trauma surgical team for the off-hours, but not a vascular surgical team. Both reiterated they did not know why, specifically, the surgeon on-call (Surgeon 1) declined the case. Surgeon 1 was unavailable for interview.

On 06/02/11 at 2:15 P.M. in an interview, AR 1 of St Elizabeth Health Center stated the receiving physician must personally accept a patient for transfer before the patient can be brought to the hospital. AR1 stated that he/she did not know what was said in conversation between Hospital B and Surgeon 1. AR1 stated St. Elizabeth Health Center was not aware, nor did Surgeon 1 say, why the case was declined.

The credentialing file for Surgeon 1 was reviewed on 06/03/11 and revealed that Surgeon 1 had privileges to practice vascular surgery, including core specific surgeries like abdominal aortic aneurysm.