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Based on record review and staff interview it was determined the facility failed to comply with 42 CFR 489.24 and 489.20 related to providing on-call specialty services for Ophthalmology for 1 (#1) of 20 sampled patients.

Record review revealed on 1/26/13 a patient presented to the Emergency Department with a chief complaint of a right eye injury following being hit with a piece of metal from welding. The eye exam noted a visual acuity of 0/0 with injury. The ED physician indicated the ophthalmologist on call had been called for approximately an hour with no response. The lack of response from the on call ophthalmologist lead to the patient being transferred to another acute care hospital for eye surgery. Refer to A2404.



The facility has taken corrective actions.

Based on clinical record review, staff interview and policy review it was determined the on-call specialist for ophthalmology did not respond when requested by the emergency department physician for 1 (#1) of 20 sampled patients. This resulted in the unnecessary transfer of the patient and a delay in treatment.

Findings include:

Patient #1 presented to the Emergency Department (ED) on 1/26/13. The patient was triaged at 12:49 a.m. with a chief complaint of a friend welding metal and some went into the right eye. The pain level was listed as 9 out of 10 on the pain scale of 0-10. The vital signs were within normal limits.

A review of the ED nursing notes revealed an eye assessment was completed at 1:06 a.m. with a right eye acuity of 0/0 and left eye 20/20.

A review of the ED physician's documentation revealed the patient was evaluated on 1/26/13 at 1:01 a.m. The chief complaint was an infected eye, decreased vision and pain after the right eye was hit with a metal fragment from grinding. The physical assessment listed the visual acuity of right eye as abnormal, laceration, abnormal cornea, the iris was torn medially, hyphema with possible globe rupture and a complex corneal laceration. Further review of the ED physician's documentation revealed the first call to the ophthalmologist on-call was made at 1:12 a.m. and "multiple attempts" over the next hour. At 2:15 a.m. alternate facilities were contacted. At 3:20 a.m., the ED physician spoke with the receiving facility's physician.
The patient was transferred on 1/26/13 at 5:04 a.m. to another acute care facility for ophthalmology care.

An interview was conducted on 2/13/13 at 2:20 p.m. with the Vice President of the Risk Management. After review of patient #1's clinical record, she confirmed the above findings.

A review of the facility's license revealed that ophthalmology was offered as one of the emergency services. A review of the Hospital Emergency Services, AHCA form 3130-8001 revealed ophthalmology is provided on-site 24 hours per day, 7 days per week.

A review of the Medical staff Rules and Regulations, adopted 1/27/12, page 1, paragraph 1, revealed "if after the initial examination by the Emergency Department physician, the physician determines it is medically necessary that the patient receive the services of a physician listed by the Hospital on its list of on-call physicians for that day, the on-call physician shall be notified and must respond/appear to the Emergency Department within a reasonable period of time for further assessment.... .... In either event, the on-call physician must respond/appear to the ED upon request of the ED physician".

A review of the ED on-call schedule for January 2013 revealed the ophthalmologist in question was on call for 1/26/13.

A review of the facility's policy, EMTALA- Florida Provision of On-Call Coverage, policy # RI 020.780 G, revised 6/12, page 5 of 6, revealed Physician's Responsibility paragraph 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 if appropriate". A review of paragraph 4 revealed, "the on-call physician has a responsibility to provide specialty care services as needed to any individual who comes to the ED either as an initial presentation". A review page 6 of 6, paragraph titled, Physician Appearance Requirements, "if a physician on the on-call list is called by the hospital to provide emergency screening or treatment and either fails or refuses to appear within a defined period of time, the hospital and that physician may be in violation of EMTALA as provided for under section 1867 (d) (1) (C) of the Social Security Act ... ..... If as a result of the on-call physician's failure to respond to an on-call request, the hospital must transfer the individual to another facility for care".

The patient was transferred to another acute care facility due to the ophthalmologist failure to respond to on-call duties.