HospitalInspections.org

Based on medical record review, hospital policy review, review of physician on-call schedules, and interview, hospital #2 (named hospital in the complaint) failed to accept a patient in transfer when the hospital had the specialized capabilities not available at the transferring hospital and had the capacity to treat the patient for one (#31) of thirty-one patients reviewed.

The findings included:

Medical record review revealed patient #31 presented to the Emergency Department (ED) of Hospital #1 on April 28, 2011, at 2:30 p.m., with complaints of " ...states sore throat and not feeling well for 3 days. Went to see PA (Physician's Assistant) at Corporate and was sent here for abscess and fever". Continued medical record review revealed the physician's examination demonstrated "...severe edema of left tonsil with whitish exudates and there is slight uvular deviation. Also has a right tonsilar edema". Further medical record review revealed the patient underwent CT (computerized tomography) scan which demonstrated "... marked left greater than right palatine tonsillar enlargement with associated moderate nasal airway narrowing most consistent with tonsillitis without abscess formation". Continued medical record review revealed "... we do not have an ENT (Ear, Nose, Throat) physician on call. We are currently in the process of trying to get this patient transferred". Further medical record review revealed the patient was "Unable to keep in system so transferred to (hospital #3) named hospital (after refusal by hospital #2)".

Medical record review from Hospital #3 revealed the patient was admitted on April 28, 2011, at 7:04 p.m., with a diagnosis of Severe Pharyngitis and given Unasyn (antibiotic) 3 grams intravenously every six hours. Continued medical record review revealed the patient was discharged home on April 29, 2011, with a prescription for Augmentin (antibiotic) 875 mg (milligrams) twice daily for fourteen days.

Review of the physician call schedule for hospital #1 for April 2011, revealed there was no ENT physician on call April 1, 2, 3, 7 - 17, 20, 21, 23 - 30, 2011.

Interview with the Director of Risk Management of hospital #1 on June 16, 2011, at 2:40 p.m., in the Director's office, revealed the hospital had one ENT physician who can take some call but is unable to be on call every night. Continued interview revealed their sister hospital also had no ENT physician on call on the evening of April 28, 2011. Further interview revealed the Transfer Center received a call from the ED regarding the patient and tried to arrange a transfer within the system. Continued interview revealed there was no ENT physician available except at hospital #2 where the on-call ENT physician refused to accept the patient.

Interview with the Medical Director of Emergency Services at hospital #2 on June 17, 2011, at 11:25 a.m., in the administrative conference room, revealed Team Health provides emergency services to the hospital under contract. Continued interview revealed there was annual compliance training for the physicians and this included EMTALA training. Further interview revealed the only persons who can accept or refuse a transfer are the Chief Executive Officer (CEO), his/her designate (Administrator-on-call), or the ED physician. Continued interview revealed the Medical Director "had a meeting with the physicians regarding the expectations of the receiving hospital". Further interview revealed the Medical Director sent a letter to the physician group reminding them "... if the facility has the capacity and capability to take a patient then they will accept the patient". Continued interview revealed "It is unfortunate the ED physicians were not in the loop or they could have prevented the situation". Further interview with the Medical Director of Emergency Services revealed the ENT Physician thought transferring from a higher to a lower level of care was not appropriate.

Review of hospital policy for hospital #2, entitled "EMTALA - Transfer Policy", revealed "The Emergency Physician and the hospital CEO or designee, such as the Access Coordinator, Transfer Center, Or Admitting Nurse, are the ONLY individuals authorized to accept or refuse the transfer of an individual from another facility on behalf of the receiving hospital".

Based on medical record review, review of physician on-call schedules, and interview, hospital #2 (named hospital in the complaint) failed to treat a patient in a timely manner due to the refusal of the on-call physician to accept the patient for one (#31) of thirty-one patients reviewed.

The findings included:

Medical record review revealed patient #31 presented to the Emergency Department (ED) of Hospital #1 on April 28, 2011, at 2:30 p.m., with complaints of " ...states sore throat and not feeling well for 3 days. Went to see PA (Physician's Assistant) at Corporate and was sent here for abscess and fever". Continued medical record review revealed the physician's examination demonstrated "...severe edema of left tonsil with whitish exudates and there is slight uvular deviation. Also has a right tonsilar edema". Further medical record review revealed the patient underwent CT (computerized tomography) scan which demonstrated "... marked left greater than right palatine tonsillar enlargement with associated moderate nasal airway narrowing most consistent with tonsillitis without abscess formation". Continued medical record review revealed "... we do not have an ENT (Ear, Nose, Throat) physician on call. We are currently in the process of trying to get this patient transferred". Further medical record review revealed the patient was "Unable to keep in system so transferred to (hospital #3) named hospital (after refusal by hospital #2)".

Medical record review from Hospital #3 revealed the patient was admitted on April 28, 2011, at 7:04 p.m., with a diagnosis of Severe Pharyngitis and given Unasyn (antibiotic) 3 grams intravenously every six hours. Continued medical record review revealed the patient was discharged home on April 29, 2011, with a prescription for Augmentin (antibiotic) 875 mg (milligrams) twice daily for fourteen days.

Review of the physician call schedule for hospital #1 for April 2011, revealed there was no ENT physician on call April 1, 2, 3, 7 - 17, 20, 21, 23 - 30, 2011.

Interview with the Director of Risk Management of hospital #1 on June 16, 2011, at 2:40 p.m., in the Director's office, revealed the hospital had one ENT physician who can take some call but is unable to be on call every night. Continued interview revealed their sister hospital also had no ENT physician on call on the evening of April 28, 2011. Further interview revealed the Transfer Center received a call from the ED regarding the patient and tried to arrange a transfer within the system. Continued interview revealed there was no ENT physician available except at hospital #2 where the on-call ENT physician refused to accept the patient.

Interview with the Medical Director of Emergency Services at hospital #2 on June 17, 2011, at 11:25 a.m., in the administrative conference room, revealed the only persons who can accept or refuse a transfer are the Chief Executive Officer (CEO), his/her designate (Administrator-on-call), or the ED physician. Further interview revealed the Medical Director sent a letter to the physician group reminding them "... if the facility has the capacity and capability to take a patient then they will accept the patient".

Based on medical record review, credentialing file review, review of physician on-call schedules, and interview, hospital #2 (named hospital in the complaint) failed to accept a patient in transfer when it had both the capacity and capability to accept the patient for one (#31) of thirty-one patients reviewed.

The findings included:

Medical record review revealed patient #31 presented to the Emergency Department ( ED) of Hospital #1 on April 28, 2011, at 2:30 p.m., with complaints of " ...states sore throat and not feeling well for 3 days. Went to see PA (Physician's Assistant) at Corporate and was sent here for abscess and fever". Continued medical record review revealed the physician's examination demonstrated "...severe edema of left tonsil with whitish exudates and there is slight uvular deviation. Also has a right tonsilar edema". Further medical record review revealed the patient underwent CT (computerized tomography) scan which demonstrated "... marked left greater than right palatine tonsillar enlargement with associated moderate nasal airway narrowing most consistent with tonsillitis without abscess formation". Continued medical record review revealed "... we do not have an ENT (Ear, Nose, Throat) physician on call. We are currently in the process of trying to get this patient transferred". Further medical record review revealed the patient was "Unable to keep in system so transferred to (hospital #3) named hospital (after refusal by hospital #2)".

Medical record review from Hospital #3 revealed the patient was admitted on April 28, 2011, at 7:04 p.m., with a diagnosis of Severe Pharyngitis and given Unasyn (antibiotic) 3 grams intravenously every six hours. Continued medical record review revealed the patient was discharged home on April 29, 2011, with a prescription for Augmentin (antibiotic) 875 mg (milligrams) twice daily for fourteen days.

Review of the physician call schedule for hospital #1 for April 2011, revealed there was no ENT physician on call April 1, 2, 3, 7 - 17, 20, 21, 23 - 30, 2011.

Interview with the Director of Risk Management of hospital #1 on June 16, 2011, at 2:40 p.m., in the Director's office, revealed the hospital had one ENT physician who can take some call but is unable to be on call every night. Continued interview revealed their sister hospital also had no ENT physician on call on the evening of April 28, 2011. Further interview revealed the Transfer Center received a call from the ED regarding the patient and tried to arrange a transfer within the system. Continued interview revealed there was no ENT physician available except at hospital #2 where the on-call ENT physician refused to accept the patient.

Interview with the Medical Director of Emergency Services at hospital #2 on June 17, 2011, at 11:25 a.m., in the administrative conference room, revealed the only persons who can accept or refuse a transfer are the Chief Executive Officer (CEO), his/her designate (Administrator-on-call), or the ED physician.

Review of the credentialing file of Physician #1 (ENT Physician who refused the transfer) revealed the physician had privileges in Otolaryngology (diseases of the ear, nose, throat) and was Board Certified in Otolaryngology.

Based on medical record review, review of physician on-call schedules, and interview, hospital #2 (named hospital in the complaint) failed to accept a patient who required the specialized services of an Ear-Nose-Throat Physician for one (#31) of thirty-one patients reviewed.

The findings included:

Medical record review revealed patient #31 presented to the Emergency Department (ED) of Hospital #1 on April 28, 2011, at 2:30 p.m., with complaints of " ...states sore throat and not feeling well for 3 days. Went to see PA (Physician's Assistant) at Corporate and was sent here for abscess and fever". Continued medical record review revealed the physician's examination demonstrated "...severe edema of left tonsil with whitish exudates and there is slight uvular deviation. Also has a right tonsilar edema". Further medical record review revealed the patient underwent CT (computerized tomography) scan which demonstrated "... marked left greater than right palatine tonsillar enlargement with associated moderate nasal airway narrowing most consistent with tonsillitis without abscess formation". Continued medical record review revealed "... we do not have an ENT physician on call. We are currently in the process of trying to get this patient transferred". Further medical record review revealed the patient was "Unable to keep in system so transferred to (hospital #3) named hospital (after refusal by hospital #2)".

Medical record review from Hospital #3 revealed the patient was admitted on April 28, 2011, at 7:04 p.m., with a diagnosis of Severe Pharyngitis and given Unasyn (antibiotic) 3 grams intravenously every six hours. Continued medical record review revealed the patient was discharged home on April 29, 2011, with a prescription for Augmentin (antibiotic) 875 mg (milligrams) twice daily for fourteen days.

Review of the physician call schedule for hospital #1 for April 2011, revealed there was no ENT physician on call April 1, 2, 3, 7 - 17, 20, 21, 23 - 30, 2011.

Interview with the Director of Risk Management of hospital #1 on June 16, 2011, at 2:40 p.m., in the Director's office, revealed the hospital had one ENT physician who can take some call but is unable to be on call every night. Continued interview revealed their sister hospital also had no ENT physician on call on the evening of April 28, 2011. Further interview revealed the Transfer Center received a call from the ED regarding the patient and tried to arrange a transfer within the system. Continued interview revealed there was no ENT physician available except at hospital #2 where the on-call ENT physician refused to accept the patient.

Interview with the Medical Director of Emergency Services at hospital #2 on June 17, 2011, at 11:25 a.m., in the administrative conference room, revealed the only persons who can accept or refuse a transfer are the Chief Executive Officer (CEO), his/her designate (Administrator-on-call), or the ED physician. Continued interview revealed the ED physician was not called about the patient but the Transfer Center at hospital #1 called the physician on-call for ENT at hospital #2 to discuss the case with the physician. The ENT physician refused to accept the patient. Continued interview with the Medical Director of Emergency Services revealed the ENT Physician thought transferring from a higher to a lower level of care was not appropriate.