HospitalInspections.org

Based on record review and interview for one (Patient #1) of ten patients sampled, the hospital failed, to make immediately available, the full extent of its patient care resources to assess and render care for a patient who required emergency treatment for an active bleed.

Findings include:

The Surveyor interviewed the Medical Director of the Emergency Care Center (E.C.C.) at 8:17 A.M. on 2/27/2018. The Medical Director of the E.C.C. said the incident occurred on 1/8/2018 when Anesthesiologist #1 (the on-call Anesthesiologist) refused to provide anesthesia to Patient #1 who required emergent treatment for an active bleed post tonsillectomy. Patient #1 was transferred to a tertiary hospital for care. The Medical Director of the E.C.C. said he was notified about the incident by the E.C.C. Attending the next morning on 1/9/18. The Medical Director of the E.C.C. said he did not notify any other staff about the incident at this time.

The Surveyor interviewed the E.C.C. Attending by telephone at 11:05 A.M. on 2/27/2018. The E.C.C. Attending said that Patient #1 arrived in the E.C.C. by Emergency Medical Services (E.M.S.) who were concerned for Patient #1's airway, his/her actively bleeding throat and spitting up of large blood clots.

The E.C.C. Attending said she notified Patient #1's Otolaryngology Surgeon of Patient #1's arrival. The E.C.C. Attending said she then notified Anesthesiologist #1 who agreed to provide anesthesia for Patient #1. The E.C.C. Attending said that, after some time, Anesthesiologist #1 called back and said he was not comfortable with providing anesthesia and declined the case. The E.C.C. Attending said she notified the Otolaryngology Surgeon and transferred Patient #1 to a tertiary hospital for emergency treatment. The E.C.C. Attending said, when asked about anesthesia back-up, that if "anesthesia doesn't do it there is no back up".

The Surveyor interviewed E.C.C. Nurse #1 by telephone at 11:35 A.M. on 2/27/2018. E.C.C. Nurse #1 said she cared for Patient #1 in the E.C.C. on 1/8/18. E.C.C. Nurse #1 said that, when Patient #1 presented to the E.C.C., it was reported that Patient #1 started bleeding from the throat earlier in the evening then experienced increased bleeding and was spitting up large clots. E.C.C. Nurse #1 said the E.C.C. Attending called the Surgeon and Anesthesiologist #1 to arrange for an operating room (O.R.) to be prepared. E.C.C. Nurse #1 said Anesthesiologist #1 then called the E.C.C. Attending and declined the case. E.C.C. Nurse #1 said that Patient #1's mother became very upset and was initially refusing to allow Patient #1 to be transferred and police were subsequently notified and a police officer spoke to Patient #1's mother, who then consented for transfer. E.C.C. Nurse #1 said that Patient #1 was actively bleeding upon arrival to the E.C.C. and continued to bleed during his/her stay in the E.C.C. and was still bleeding when transferred to the tertiary hospital. E.C.C. Nurse #1 said that Patient #1 was transferred to the tertiary hospital by an Advanced Life Support (A.L.S.) ambulance because there was a concern for an airway complication and Patient #1 would require immediate airway management if necessary.

The Surveyor interviewed the Vice President of Medical Affairs 7:58 A.M. on 2/28/18. The Vice President of Medical Affairs said that he first heard about the incident on 1/16/18 when reading a letter written on 1/10/18 from the Otolaryngologist who was involved with the incident. The Vice President of Medical Affairs said he forwarded the letter to the Chief of Anesthesia to investigate. The Vice President of Medical Affairs said that a week later he received an email from Anesthesiologist #1 resigning his position as an on-call anesthesiologist for the hospital and that the night in question (1/8/18), Anesthesiologist #1 told the Vice President of Medical Affairs that he was involved in a case with a patient who was in active labor and that he was unaware that the patient was actively bleeding. The Vice President of Medical Affairs said he then interviewed the E.C.C. Attending who confirmed that she had informed Anesthesiologist #1 that Patient #1 was actively bleeding. The Vice President of Medical Affairs said he also interviewed the Labor and Delivery Nurse Manager who stated that no patients were experiencing active labor on 1/8/18 at the time of the incident. The Vice President of Medical Affairs said that the Hospital's expectation of the "on call" Anesthesiologist is to provide service to pediatric and adult patients and the hospital would expect that any anesthesiologist on call would have provided service to Patient #1. The Vice President of Medical Affairs said that there was no excuse for Anesthesiologist #1 to decline Patient #1 treatment. The Vice President of Medical Affairs said that besides interviewing the E.C.C. Attending and Labor and Delivery Nurse Manager there was no further investigation, training, or review of policy and procedures with the medical staff.

The Surveyor interviewed the Chief of Anesthesiology at 10:20 A.M. on 2/28/18. The Chief of Anesthesiology said he found out about the incident from the Vice President of Medical Affairs on 1/16/18. The Chief of Anesthesiology said that both on call and staff Anesthesiologist's are expected to provide service for adult and pediatric patients. The Chief of Anesthesiology said that, after reviewing the incident, he found that Anesthesiologist #1's actions were inexcusable and he should have taken the case. The Chief of Anesthesiology said he did not provide any additional training or a review of the hospitals expectations with medical staff. The Chief of Anesthesiology said he had, previous to this incident, resigned from his position effective 2/28/18, and was leaving this case to be handled by the Vice President of Medical Affairs.

The Surveyor interviewed the Otolaryngology Surgeon by telephone, at 1:10 P.M. on 3/1/18. The Otolaryngology Surgeon said that, on 1/8/18, the family of Patient #1 called him with concerns about a bleeding post-op tonsillectomy patient. The Otolaryngology Surgeon said he encouraged the Patient #1's mother to call 911 and arrange transportation to the hospital as "this was an absolute emergency". The E.M.S. transport brought Patient #1 to the Hospital due to concern for active bleeding. The Otolaryngology Surgeon said he called the Hospital's E.C.C. and spoke with the charge nurse and E.C.C. Attending to arrange an O.R. room to be prepared. The Otolaryngology Surgeon said about 15-20 minutes later he received a call from E.C.C. Attending informing him that Anesthesiologist #1 refused to take the case and that Patient #1 was being transferred to a tertiary care hospital for treatment. The Otolaryngology Surgeon said that he and his colleagues have cared for many pediatric patients at the Hospital for years and in his 29 years of experience as an Otolaryngology Surgeon he has never experienced this kind of treatment for his patient, "they essentially slammed the door in the patient's face".

Refer to tag A 1100