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Based on record review and interview, the facility failed to maintain compliance with §489.24 to provide medical treatment within its capacity that minimized the risks to the individual's health, in that,

the facility did not admit and utilize it's credentialed/contracted OMFS on-call services to stabilize one of four patients (Patient #3) that was transferred to another facility for OMFS (oral and maxillofacial services).

Cross Reference A-2407

Based on record review and interview, the facility failed to provide stabilizing medical treatment within its capacity that minimized the risks to the individual's health, in that,

The facility did not admit and utilize it's credentialed/contracted OMFS on-call services to stabilize one of four patients (Patient #3) that was transferred to another facility for OMFS (oral and maxillofacial services).


Findings

The OMFS on call physician (Physician #7) was not utilized to benefit the patient condition/outcome for Patient #3.

Patient #3 was transferred to another hospital for OMFS services instead of being admitted to the facility's OMFS Services.

Patient #3 arrived at the Emergency Department (ED) on 9/02/2022, had a complete MSE, and an Emergency Medical Condition (EMC) of Ludwigs Angina and sublingual abscess. The Physician note reflected, "Spoke with ENT (Ear, Nose, Throat) and Plastic surgery who recommended transfer for OMFS coverage...Airway is intact at this time, he is handing secretions and has no difficulty swallowing." Consulted physicians were not named in the record.

The facility's 9/02/2022 Facial Trauma On-call schedule listed Physician #7 on call.

Physician #7 was credentialed for OMFS privileges including treating minor infections, major infections and incision/drainage for ED coverage.

The OMFS physicians were credentialed and contracted for all emergency room call.

Review of the facility's bylaws reflected "Active Staff Members must assume all the responsibilities of the Active Staff, including: (1) providing specialty coverage for the Emergency Department (unless exempted by the MEC and Board) and care for unassigned patients ..."

Review of the physician's contracts reflected "professional medical care to the facility's Emergency Department patients on an on-call basis..."

The facility's 7/20/2020 reviewed "EMTALA - Provision of On-Call Coverage Policy" required, "Physicians on the list must be available after the initial examination to provide treatment necessary to stabilize individuals with EMC's (Emergency Medical Conditions) who are receiving services in accordance with the resources available to the hospital...The on-call schedule may be by specialty or sub-specialty (e.g., general surgery, orthopedic surgery, hand surgery, plastic surgery), as determined by the hospital and implemented by the relevant department chairpersons...Only physicians that are available to physically come to the ER may be included on the on-call list. A physician available via telemedicine does not satisfy the on-call requirements under EMTALA...Physician's Responsibility. The hospital has a process to ensure that when a physician is identified as
being "on-call" to the DED (Dedicated Emergency Department) for a given specialty, it shall be that physician's duty and responsibility to
assure the following:
1. Immediate availability, at least by telephone, to the ED physician for his or her scheduled "on call"
period, or to secure a qualified alternate who has privileges at the hospital if appropriate.
2. If a Transfer Center is being utilized to contact the on-call physician, the on-call physician must
respond to the Transfer Center within a reasonable timeframe (generally, within 30 minutes).
3. Arrival or response to the DED within a reasonable timeframe (generally, response by the
physician is expected within 30 minutes). The ED physician, in consultation with the on-call
physician, shall determine whether the individual's condition requires the on-call physician to
see the individual immediately. The determination of the ED physician or other practitioner who
has personally examined the individual and is currently treating the individual shall be
controlling in this regard.
4. The on-call physician has a responsibility to provide specialty care services as needed to any
individual who comes to the Emergency Department either as an initial presentation or upon
transfer from another facility..."

During an interview on 4/10/23 at 10:12 AM to 12:00 PM, Personnel #4 was asked about OMFS coverage. Personnel #4 stated they were level II trauma hospital and are required to have coverage for trauma patients with facial injuries. However, some cases are too complex for the surgeon or require specialized equipment and have to be transferred. Like a patient with a globe rupture - it is outside of the scope for an ophthalmologist. They would have to transfer it out. Personnel #4 was asked if they have coverage for all days. Personnel #4 stated yes, Coverage all the time unless there is an emergency.

Personnel #4 was asked what required the OMFS coverage. Personnel #4 provided and summarized the 2014 "ACS (American College of Surgeons) Resources for Optimal Care of the Injured Patient" required OMFS for Level I and II. A new version is due to come out. Personnel #4 continued they (Specialists) are privileged for trauma and are on-call for trauma call only. We do not have to have coverage for non-trauma OMFS patient issues.

During a telephone interview on 4/13/2023 ending at 9:13 AM, Personnel #1 and Personnel #4 were asked if the physicians were on call for their specialty or on call for the facial trauma service. Personnel #4 stated the service to cover trauma patients. ASC allows for a multidisciplinary panel to cover for our trauma accreditation. We call it facial trauma. Each of the doctors have different specialties. Personnel #5 and #6 are plastics with different specialties and can do the more complex facial traumas. They specialize in facial. Personnel #6 can do hands. Personnel #7, #8, and #9 are dentist and MD (physicians). Like Personnel #8 can do face trauma call, not plastics. Personnel #7, #8, and #9 have other capabilities outside of dental training and take trauma call. They can do facial fractures, tissue injuries that type of thing. All take call for facial trauma. OMFS is the most difficult - ENT (Ear, Nose, Throat) will see some and OMFS see others depending on the area of the face. Personnel #4 was asked about Patient #3, the Sublingual Abscess. Personnel #4 stated it was not a trauma.