HospitalInspections.org

Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000683), review of twenty closed records and five active records reviewed (R.R), policies/procedures manual, review of medical faculty by laws rules and regulations and documents related to complaint case, it was determined that the hospital failed to provide sufficient oncall specialty services to meet the needs of their community cosistent with the services provided at the hospital.

Based on interview and record review, the hospital failed to provide sufficient oncall specialty services to the meet the needs of their community consistent with the services provided at the hospital.

Findings include:

Review on 03/05/24 at 9:30 AM of the facility's policy title Stabilizing Services in the Emergency Room, Procedure in cases requiring specialized services in the emergency room last update on 07/01/23. Policy stated on the procedures that in cases where a necessary specialized service is unavailable at the specific time, the physician will coordinate a patient transfer to a nearby facility offering said services and certify the necessary risk-benefit analysis has been performed.

1. During interview on 03/06/24 at 10:00 AM it was asked to the facility chief executive officer (employee #1) if facility had on-call physicians who are on the medical staff or who had privileges at the hospital available to provide surgery services and treatment necessary after initial examination to stabilize individuals with emergency medical conditions.

2. Chief executive officer (employee #1) explained in an interview on 03/06/24 at 10:10 AM that the facility did not have surgery on-call services at the emergency room. He stated that the facility had written policies and procedures in place to respond to situations in which a particular specialty is not available. He stated the facility only had 2 surgeons who were on the medical staff that had privileges at the hospital available to surgery services, but those two surgeons did not take turns to perform on call services at the emergency room. He stated that there are not monthly on call roster surgery specialty because the two surgeons who provide services at the facility did not take turns or are assigned to perform on call services at the emergency room since more than a year ago.

3.Chief executive officer (employee #1) stated on interview on 03/06/24 at 10:30 AM that the facility policy in place establish that when a specialty is not available, patients who need treatment of this specialty if received on the emergency room are screened, stabilized, and transferred to other facility who had the specialty.

4. Chief executive officer (employee #1) stated in an interview on 03/06/24 at 10:35 AM that that the hospital does not have a general on call program with surgeons. Our hospital has 2 general surgeons that form part of our medical faculty but none of them perform emergency room general surgeon on call services. Both provide surgery services to admitted patients that comes referral from physicians' offices and to other hospital admitted patients when physicians from other specialties refer patients to them. Those 2 general surgeons provide surgery services to patients consulted from emergency room and in certain circumstances perform surgery procedures to those patients but not on a regular basis. Surgery on call services is not available in the emergency room.

5. The hospital failed to maintain an on-call list of physicians on its medical staff in a manner that best meets the needs of the hospital's patients who are receiving services or are in need of surgery.

6. The following are example of patients who visit facility and based of their chief complaint need further evaluation and treatment that need to be provided by surgery specialty and was not provided due to lack of availability of surgery services on the emergency room:

a. RR #4 is a 62-year-old female, who visited the Emergency Room on 10/02/2023. The patient was diagnosed with appendicitis and requiring a surgical procedure. This case was evaluated and transferred to another facility for surgery on 12/03/2023. Once the case went to the other hospital them refused to allow the patient into the facility and she was sent back. Patient was received at the emergency room and admitted to inpatient services on 12/03/2023. The hospital had the capability to perform the surgery as evidenced by the surgery was performed on 12/04/2023 at 12:50 PM.

b. RR #7 is a 76-year-old female, who visited the Emergency Room on 11/07/2023. The patient was diagnosed with Bleeding Post surgical wound. This patient was evaluated and transferred to another facility for further evaluation and treatment.