HospitalInspections.org

Based on review of medical records, facility's policies and procedures, Medical Staff Bylaws, Medical Staff Rules and Regulations, Administration Physicians' On-Call Monthly schedules for ENT, staff interviews, Transfer Center log, voice recordings, copy of emails, Administrative summary of the event, and credentialing files, it was determined that the facility failed to ensure acceptance of an individual from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who required the such specialized capabilities (Ear Nose and Throat specialist) facilities that were available at the hospital to treat 1 (#2) of 20 sampled patients medical records reviewed.
Findings:

1. Cross refer to A2411 as it relates to failure of the recipient hospital to accept patients when the facility had the capacity and capabilities for patient #2 on 08/02/2016.

Based on review of medical records, facility's policies and procedures, Medical Staff Bylaws, Medical Staff Rules and Regulations, Administration Physicians' On-Call Monthly schedules for ENT, staff interviews, Transfer Center log, voice recordings, copy of emails, Administrative summary of the event, and credentialing files, it was determined that the facility failed to ensure acceptance of an individual from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who required the such specialized capabilities (Ear Nose and Throat specialist) facilities that were available at the hospital to treat 1 (#2) of 20 sampled patients medical records reviewed.


Findings:

Medical Record from transferring Hospital (hospital B) for patient #2

Review of the patient's medical record (#2) from hospital B revealed the triage (assessment by a nurse to determine the priority in which patients will be seen) nurse noted that the patient presented to hospital B on 08/01/16 via ambulance at 9:15 a.m. The triage nurse noted that the patient had fallen and had a laceration above the left eye. The triage nurse noted that the patient was a level four (4) non-urgent priority. The triage nurse and the ED physician (#8) noted that the physician performed the physical examination of the patient at 9:45 p.m. The physician noted that the patient was 87 years old, had a history of advanced dementia (decline in mental ability) and aphasia (total or partial inability to talk). The physician further noted that the patient resided at a local nursing home where the patient had fallen one (1) hour prior to arrival. Further review revealed that patient #2 had fallen "from bed to face first." In addition, the physician noted that the patient had facial bruising, a left periorbital blowout fracture (one [1] or more broken bones in the area surrounding the eye), minimally displaced nasal fracture (a broken nose), and a cut above the left eyelid. The physician's orders included the following: cervical spine x-rays which revealed there were no new injuries to the back, computerized tomography scan (specialized x-ray) of the head and face which revealed the left periorbital blowout fracture, swelling and hematoma (localized collection of clotted blood), and the minimally displaced nasal fracture. Physician orders and nursing documentation revealed Ativan (used to treat anxiety) 2 milligrams was administered intramuscullarly in the patient's left thigh on 08/01/16 at 10:05 p.m. At 10:14 p.m., DTAP (diphtheria, tetanus, and pertussis vaccine) was administered intramuscullarly in the patient's right thigh per physician orders. The nurse noted that a clean dressing was applied to the patient's wound at 10:55 p.m. At 11:25 a.m., the ED physician (#8) wrote orders for the patient to be discharged home with instructions to follow-up with the primary medical doctor in three (3) days. On 08/02/16 at 12:09 a.m., the nurse noted that the ambulance had been contacted to transfer the patient back to the nursing home. At 12:50 p.m., the ED physician (#8) noted that physician (#5) MMC's on-call ENT specialist had sent a message through the ENT's answering service that the physician (#5) would not take the ED physician (#8's) telephone call. On 08/02/16 at 1:05 a.m., the nurse and ED physician (#8) noted that the ED physician (#8) called MMC's AOD (#11). On 08/02/16 at 1:22 a.m., the ED physician (#8) noted that the AOD (#11) called the ED physician back and reported that the ENT/physician (#5) would not take the call. The nurse noted that the patient was transferred back to the nursing home on 08/02/16 at 1:28 a.m. and that the nursing home was provided the physician (#5's) phone number for follow-up treatment.

Midtown Medical Center ENT On-Call schedule and Credentialing File

Review of the Administration Physician's on-call Schedule for August 2016 was reviewed. Review of the on-call schedule confirmed that Physician #5 was an Otolaryngology (ear, nose, and throat [ENT] specialist) physician in the Department of Surgery and was the ENT on-call physician from 08/01/16 at 7:00 a.m. until 08/02/16 at 7:00 a.m. Review of Physician #5 on-call ENT physician's file contained evidence that the physician was privileged to treat facial fractures.

Midtown Medical Center Transfer Log

Review of the Transfer Center's log revealed that on 08/02/16 at 1:20 a.m., the Bed Control Specialist (#7) entered the data regarding a call from physician (#8's) regarding patient (#2). The log noted that physician #8 wanted to talk with physician #5 but that physician #5 refused to "even talk with him, stating he was not on-call for out-side hospitals and he was not on-call for the state of Georgia". The log further noted that the MMC ED physician (#10) did speak with hospital B's ED physician (#5) and that the patient was sent back to the nursing home.
Voice Recordings
Review of the voice recordings from 08/02/16 regarding patient #2 were as follows:
Recording #1 time stamped 08/02/16 at 1:06 a.m.
Physician #8: Emergency Room, physician states his/her name.
Employee #11/AOD: Hey, Dr.
Physician #8: Yes.
Employee #11/AOD: Just so I can have all of my information in front of me in Bed Management ...
Physician #8: Uh-huh, yes.
Employee #11/AOD: What is this patient ' s name?
Physician #8: Gives patient #2's name.
Employee #11/AOD: Huh. Okay. And date of birth?
Physician #8: Ummm.
Employee #11/AOD: How old she is?
Physician #8: 10/26/28, she is 87.
Employee #11/AOD: Umm, okay. And she just had some facial fractures, what, from a fall?
Physician #8: From a fall.
Employee #11/AOD: Okay.
Physician #8: From bed.
Employee #11/AOD: Alright.
Physician #8: Uh-huh.
Employee #11/AOD: But you have already talked to (physician #5) once tonight, is that not correct?
Physician #8: Well, I called, ya know, ENT on-call (physician #5) and then he sent the message to me through the operator that he didn't take calls from outside hospitals. And so I did call her (the operator) back and say that is not how call works.
Employee #11/AOD: That's right.
Physician #8: If you are at a referral center, you take call from whoever calls you.
Employee #11/AOD: Exactly.
Physician #8: And then (the operator) said, "Well, I am going to call him (physician #5) back, but I can tell you he's dug in and he is not going to call you back." I said okay.
Employee #11/AOD: Well, that's kinda crappy.
Physician #8: We'll see how that goes.
Employee #11/AOD: Yeah, we will. Umm, I am going to call him (physician #5) from the office here and I will have him hooked up to you, okay?
Physician #8: Okay, thank you.
Employee #11/AOD: Thanks.
Physician #8: Bye-bye.
Employee #11/AOD: Bye-bye.

Recording #2 time stamped 08/02/16 at 1:15 a.m.
Employee #7/Bed Control Specialist: Cassandra. May I help you, please?
Physician #5: Yes, this is (gives his name).
Employee #11/AOD:: Hey, (physician #5). This is (gives her name).
Physician #5: Yes.
Employee #11/AOD: ...the AOD here (MMC) and I hate to bother you and I know you've already had ...umm ...some conversation with (physician #5 at hospital B).
Physician #5: I have not had any conversation with a doctor at hospital B.
Employee #11/AOD: Okay.
Physician #5: None.
Employee #11/AOD: I understand you already know about this patient (#2) that is ...
Physician #5: I don't know about this patient (#2). I have informed my answering service that I do not accept calls from outside ERs and it is up to them to make hospital to hospital transfers. So, I have not had any conversation with them and I do not know about this patient (#2) and I have not accepted this patient.
Employee #11/AOD: Right. I understand that. (Physician #8) was ...he just wanted to talk to you about some kind of ...it is a facial fracture patient ...an 87-year-old female.
Physician #5: Uh-huh.
Employee #11/AOD: ...and I can always bring the patient (#2) over, well I can, of course with your acceptance , I can always bring the patient over here and have the hospitalist to accept and you to consult.
Physician #5: The point is, is that I am not on-call for every ER around the state and when they call I have informed them ....and I will do this at 2:00 in the afternoon when they call ... they have to make the hospital to hospital transfer for a patient that needs to be admitted. You know ...it is not fair for me to make a relationship with an ER doctor over the phone even for advice because then I have entered into some kind of relationship with a patient that I have never set eyes on.
Employee #11/AOD: Okay ...umm.
Physician #5: So he (physician #8) can't accept ...he can't expect me to take responsibility for that patient. If she needs to be ...for all I know, she ' s got a fracture that's completely inoperable that needs nothing done to it.
Employee #11/AOD: Umm. I agree with you on that and ...
Physician #5: So if that patient (#2) needs to be admitted for treatment then he (physician #8) needs to find the hospital where that patient needs to be admitted and it is not up to me to figure that out for him.
Employee #11/AOD: Alright. We won't call you again, (physician #5).
Physician #5: Thank you.

Recording #3 time stamped 08/02/16 at 1:21 a.m.
RECORDING: Thank you for calling (another local acute care hospital) Ear, Nose & Throat. (INAUDIBLE). Physicians and hospitals, please press the zero key now. For quality assurance purposes, this call may be monitored or recorded. Please stay on the line.
Employee #7/Bed Control Specialist: ENT?
Employee #11/AOD: ENT, yeah.
Employee #7/Bed Control Specialist: For facial fracture?
Employee #11/AOD: Well, that's who (physician #8) wants to talk to - just wants to talk to him (physician #5).
Employee #7/Bed Control Specialist: Oh.
SERVICE: Thank you for holding. Gives his/her name. May I help you?
Employee #7/Bed Control Specialist: Hey, (gives her name) from Midtown Medical Center. I am trying to get a hold of (doctor's name) or whoever is on-call for ENT. We have (physician #8) that wants to talk to him (physician #5) about a patient (#2) that he has over there.
Employee #11/AOD: (gives location of hospital B)
Employee #7/Bed Control Specialist: (repeats location of hospital B)
Employee #11/AOD: (physician #8) just wants to talk to him (physician #5).
SERVICE: Uh, yes. (physician #5) said he wasn't going to call (physician #8) because he was, that was an outside ER.
Employee #7/Bed Control Specialist: Well, he (physician #8) said he just wanted to talk to him (physician #5]).
SERVICE: Right, I understand and I've been paging (physician #5) and he said he wasn't going to call (physician #8).
Employee #11/AOD: Okay.
SERVICE: Because this is an outside ER call for him (physician #5).
Employee #7/Bed Control Specialist: Okay.
SERVICE: But are YOU wanting to talk to my doctor that's on-call?
Employee #11/AOD: Who is on-call?
SERVICE: (physician #5) is on-call.
Employee #11/AOD: Well, no, but if (physician #5) is on-call he is supposed to take call from what I understand.
SERVICE: Do YOU want me to take it for YOU? (Physician #5) is already ...he says he is not going to call (physician #8). So my question is, do YOU at Medical Center want to talk to my on-call physician?
Employee #11/AOD: Yeah, I do.
SERVICE: Okay, now ....I'm talking ....I was talking to (Employee #7/Bed Control Specialist), right?
Employee #11/AOD: Yeah, you are.
SERVICE: Okay.
Employee #11/AOD: I am rude and I interrupt.
SERVICE: Oh.
Employee #11/AOD: But, yeah, it's Bed Management.
SERVICE: Okay, hang on one second and let me ....I just ...I know ...I actually just gotten back off the line with (physician #5).
Employee #11/AOD: But what I don't understand is this. If when he (physician #5) is on-call he has to take call ...just say, "I ain't takin it."
SERVICE: I don't ....I honestly ...
Employee #11/AOD: I know, I know it, I know it, I know it. Don't want to put you in that situation.
SERVICE: Yes, ma'am. Hang on one second. And this is on an unassigned patient?
Employee #11/AOD: That's right.
SERVICE: And this is Medical Center Midtown in Columbus, Georgia, correct?
Employee #11/AOD: Right.
SERVICE: And may I have your name, please?
Employee #7/Bed Control Specialist: You can give (gives name). Well, it's ...
SERVICE: repeats the employee's name, okay ...
Employee #7/Bed Control Specialist: Well, it's .....you can use me.
SERVICE: Spells the name.
Employee #7/Bed Control Specialist: Yes ma'am.
SERVICE: Thank you, and you are in Bed Management?
Employee #7/Bed Control Specialist: I am.
SERVICE: It's just I'm just kinda tight on what I can do.
Employee #7/Bed Control Specialist: Well, I understand, I understand. Cool beans.
SERVICE: Let's see ....what's your phone number?
Employee #7/Bed Control Specialist: gives the number and extension.
SERVICE: Repeats the number and extension.
Employee #7/Bed Control Specialist: Yes ma'am.
SERVICE: What's the patient's name (INAUDIBLE)?
Employee #7/Bed Control Specialist: Gives patient (#2's) name and spelling.
SERVICE: Repeats spelling of patient's last name?
Employee #7/Bed Control Specialist: Uh-huh.
SERVICE: Okay. And what's her date of birth?
Employee #7/Bed Control Specialist: 10/26/28.
SERVICE: 10/26/28?
Employee #7/Bed Control Specialist: Uh-huh.
SERVICE: And ...are ya'll thinking about accepting the patient?
Employee #7/Bed Control Specialist: No. No ma'am.
SERVICE: You just need to speak to (physician #5)?
Employee #11/AOD: Yeah, I just need to know something.
SERVICE: Okay, no problem.
Employee #11/AOD: Alright.
SERVICE: Let me go ahead and page (physician #5) and I will have him call you, okay?
Employee #7/Bed Control Specialist: Thank you.
Employee #11/AOD: Okay.
SERVICE: Yes ma'am. Bye-Bye.
Employee #11/AOD: Just tell (physician #5) that (physician #8) just wants to talk to him, ya know? Um, if (physician #8) sends (patient #2) over here all we gotta do is just re-consult and we'll have hospitalist accept the patient and then we'll have (physician #5) as a consult.
Employee #7/Bed Control Specialist: Hopefully (physician #5) will call back in a few minutes.
SERVICE: Okay, (physician #5) has already been paged. He should be calling you shortly, okay?
Employee #7/Bed Control Specialist: Thank you.
SERVICE: You're welcome.
Employee #7/Bed Control Specialist: Bye-bye.
SERVICE: Bye-bye.

Recording #4 time stamped 08/02/16 at 1:23 a.m.
Employee #12/Administrator on-call (AOC) voice recording answers.
Employee #11/AOD: Leaves a message informing the AOC that he/she was trying to get a transfer over to MMC from Hospital B, between (physician #5 and physician #8) for facial fractures. (Physician #5) says he doesn't want to enter into a relationship with any hospital cause it could be anything, and he said he doesn't take call from outside ERs. (Physician #8) is not in the best of moods and says he's going to file an EMTALA violation against us. If you could just call me back and give a little bit of direction, (physician #5) and there's no need to call (physician #5). If you could help me out I sure would appreciate it.

Recording #5 time stamped 08/02/16 at 1:35 a.m.
Employee #11/AOD: Hey, (physician #10). Are you still down in the ER? Yeah, you are.
Physician #10: Yeah.
Employee #11/AOD: Hey, look. Are you with a patient?
Physician #10: Go ahead.
Employee #11/AOD: Okay, listen. I got a situation. I called ...umm ... (physician #8) called me to accept a patient, not to accept a patient. He really just wanted to talk to who was on-call for ENT. Well, (physician #5) has done said he's not going to talk to (physician #*8) because he (physician #5) doesn't get into relationships with other ERs (Emergency Rooms) that he doesn't go outside our own ER and accept patients. And I said, but you're (physician #5) on-call. (Physician #5) said well if (physician #5) needs to send a patient over here he needs to get a hospital that will accept one, and I'm thinking, " Well dang, that's why we're calling you (physician #5). " But anyway, (physician #8) is a little bit upset, rightly so, because he (physician #8) cannot get the ENT (physician #5) guy to even talk to him. So I told (physician #8), " Let me see what I can do. " So I called our director on-call (#12) and I haven't ...I did not get an answer. I left a message and have not gotten a response back and then (physician #8) says he is going to put an EMTALA on us and it's going to be, ya know, $17,000 or $20,000 or whatever it is. I always knew em as $50,000, but, anyway, needless to say ...
Physician #10: (LAUGHTER) it's 50.
Employee #11/AOD: Yeah, I thought so too. So, anyway, to avoid that I'm trying to put something together so that (physician #8) calms down and doesn't do that. So have you got any advice for me?
Physician #10: Umm. According to the EMTALA stuff, if (physician #8) is on-call then he should talk to the physician.
Employee #11/AOD:: Well, (physician #5) is the one on-call, but he said he's not going to talk to (physician #8) and, ya know, he was kind of angry and says...ya know...and of course this is on a recorded line, as this is, that he (physician #5) wasn't going to talk to him (physician #8) and wasn't going to call him (physician #8) back.
Physician #10: So if I accept the patient and then call (physician #5) to see the patient that might be an issue as well, huh?
Employee #11/AOD: No, I don't think so. I think ...umm ...but I don't know whether he (physician #5) would get up and come down here and see the patient (#2). But this is my thing. I talked to (physician #8) and I said, " Well, you know a lot of our ENTs don't do facial fractures and I don't have that kind of a physician that is on-call here. "
Physician #10: (INAUDIBLE) facial fracture (INAUDIBLE)
Employee #11/AOD: And then (physician #8) says well I'm thinking about I'm just going to go ahead and send (patient #2) back to the nursing home..ya know ...until you guys can figure out or do whatever. So, all I wanted to do was get back to Bed Management and see if I could put you on the line with (physician #8) to maybe somehow to appease him or to get that patient (#2) down here and then we can consult (physician #5) but I really think (physician #5) should have stepped up to the plate.
Physician #10: Yeah, if he (physician #5) was willing to consult on the patient (#2) if I accept the patient then it would be fine.
Employee #11/AOD: Okay. Well I don't know and now, you see, he (physician #5) has done hung up. Well, he (physician #5) didn't talk to (physician #8). Well, his (physician #5) answering service told (physician #8) that he (physician #5) doesn't take patients from another ERs ...
Physician #10: (INAUDIBLE)
Employee #11/AOD: ... or get in a relationship with anything from another ER.
Physician #10: Yeah, we have no choice as a referral center to take patients, so if (physician #8) reports us for an EMTALA violation he is appropriate. He is correct.
Employee #11/AOD: That's right, I know it, and that's why I ' m ...umm ...standing on edge here.
Physician #10: Yeah.
Employee #11/AOD: But I was wondering if I could connect you to (physician #8).
Physician #10: Yeah, that's fine.
Employee #11/AOD: Okay, hang on one second.
Employee #7/Bed Control Specialist: I ' m going to put you on hold for a second, okay?
Physician #10: Yeah.
(LONG PAUSE)
Hospital B's ER: ER, this is (gives name). Can I help you?
Employee #7/Bed Control Specialist: Hi. Could I speak with (physician #8), please?
ER: Sure, hold on one second.
Physician #8: Answers.
Employee #7/Bed Control Specialist: Hey, (physician #8). This is (Employee #7/Bed Control Specialist) with Midtown Medical. I have (physician #10) on the line. He's willing to speak to you about (patient #2). Would you like to speak to him (physician #10) about (patient #2)?
Physician #8: (physician #10), from the ER?
Employee #7/Bed Control Specialist: Yes sir.
Physician #8: Okay, I will talk to him (physician #10), but I don't think he can really help me and I went ahead and let the patient go on back to the nursing home.
Employee #11/AOD: I still want you to talk to (physician #10), though, okay?
Physician #8: Okay, okay.
Employee #7/Bed Control Specialist: Hold on, sir. Doctors, I have your lines together.
Physician #10: Yeah, hi ...this is, gives his name. Yes ...uh-huh.
Physician #8: Hey. It's (gives his name). How are you doing?
Physician #10: Yeah, I'm good. What did ya have?
Physician #8: Good. Well, I don't even actually have this patient (#2) anymore. I went ahead and let (the patient) go back to the nursing home. It is a lady who had an orbital blowout fracture and a displaced nasal bone fracture and a large ...like ...periorbital hematoma.
Physician #10: Uh-huh.
Physician #8: She is an 87-year-old lady that fell out of bed. She already has a similar fracture that is old and healed on the other side and she's got very advanced dementia. So, my thought was that she was not really a candidate really for surgical intervention since they obviously didn't do one on the other side when this happened in the past, but I wanted to speak to ENT just to, ya know, get some direction on that because I don't know. I'm just taking my best guess. But I was not able to get anyone from ENT to actually call me back. So, do you have anything to offer in that regard?
Physician #10: Yeah, for just an orbital blunt nasal fracture just needs follow-up with an ENT.
Physician #8: Routinely as an outpatient?
Physician #10: Correct, correct. Uh-huh.
Physician #8: Okay, I think that's probably all that needs to happen as well; unfortunately I just was not able to get that from ENT directly.
Physician #10: Yeah. I am surprised that he (physician #5) didn't want to talk to you but I don't know.
Physician #8: Man, these people. I'm telling you ...their ...I mean really ...their moral compass leaves something to be questioned for sure. So, well, thank you for talking to me.
Physician #10: Okay.
Physician #8: And I'll just pass that along to the nursing home.
Physician #10: Yeah and set up a referral to, again, (physician #5) right?
Physician #8: It was (physician #5), yeah.
Physician #10: It will still be him (physician #5) if you do the referral to whoever is on-call for ENT.
Physician #8: Yeah.
Physician #10: But he is obligated to actually (INAUDIBLE) the patient.
Physician #8: Oh, I know. And, I had very little concern that the patient would be an admission or a transfer or anything like that but I don't know because this is not my area of expertise. So, it just would have been nice to have been able to speak directly to him (physician #5) but.
Physician #10: The CT of the brain was okay, right?
Physician #8: Yeah, everything, I did the head and neck and they were fine.
Physician #10: Yeah, that would be the major concern.
Physician #8: Yeah, I did the C-spine and the head and it was fine.
Physician #10: Okay, cool.
Physician #8: Just facial findings.
Physician #10: Alrighty.
Physician #8: Okay. Thank you so much.
Physician #10: Alright. No problem.
Physician #8: Administrators, thank you, ladies.
Employee #11/AOD: Thank you, (physician #8), and thank you, (physician #10). I appreciate it.
Physician #8: Okay, bye-bye.
Employee #11/AOD: Alright, bye-bye.

Recording #6 time stamped 08/02/16 at 1:50 a.m.
Employee #11/AOD: Gets Employee #9/Director of Women and Children Services on the phone and informs the Director that there was a situation where it's an EMTALA violation. Employee #11 explains that (physician #5) would not speak to (physician #8) at hospital B. Employee #11 states he/she has called and left two (2) messages for the AOC (#12) but that the AOC had not called back as yet. Employee #11 says that he/she wanted to let Employee #9 know what had been done. Employee #11 gives employee #9 (patient #2's) injury details and informs employee #9 that (physician #8) reported that he/she tried to call (physician #5) who refused to speak with (physician #8) and (physician #8) was going to report an EMTALA violation. Employee #11 said that he/she had tried to call (physician #5) and that the physician told him/her that he/she was not going to enter into a relationship with another physician or try to take a patient because he/she did not know anything about that patient. Employee #11 stated, but that's what being on-call is all about. Employee #11 said that he/she tried to explain that to (physician #5). Employee #11 reported that he/she had tried to call the AOC (#12). Employee #11 explained that he/she had spoken with (physician #10) in the ED and that (physician #10) had consulted with (physician #8) and that (physician #8) had already discharged (patient #2) back to the Nursing Home.
Employee #9/Director of Women and Children Services: Are you kidding me?
Employee #11/AOD: No! Well, he couldn't (inaudible).
Employee #9/Director of Women and Children Services: What else could he do?
Employee #11/AOD: I offered to bring the patient (#2) here and then call (physician #5), whether he'd do anything I don't know and it could be a long stay for the patient in the ED and then sent back or he might do something tomorrow. I was getting the Hospitalist in placed then whoever was on-call tomorrow might be more receptive. But, (physician #8) was upset, rightly so, and (physician #8) said he/she was going to file an EMTALA violation.
Employee #9/Director of Women and Children Services: Right
Employee #11/AOD: So, that's where we are.
Employee #9/Director of Women and Children Services: That's what 250,000?
Employee #11/AOD: No, just 50,000. (There is some discussion then about the amount of a fine.)
Employee #9/Director of Women and Children Services: Thanks for calling and letting me know. Don't ever hesitate to call me. I know EMTALA, L&D (labor and delivery) is all about EMTALA and that definitely is a violation, that's why he's (physician #5) is on-call.
Employee #11/AOD: It's on a recorded line, as is this. In the beginning, I was on my walk-around phone but then Bed Management. (Physician #8) tried to call (physician #5) but (physician #5) would not talk with (physician #8) and said that (physician #8) needed to find a hospital that would take that patient. I said that's why we are here. (Physician #10) told (physician #8) he/she was absolutely right. All (physician #5) wanted was to talk with (physician #5)...And, if you're not gonna do the do then don't take call. (Physician #8) said the patient had similar previous fractures and nothing was done, but he/she was upset that (physician #5) was not considerate and would not return (physician #8's) call. I made sure (physician #5) was on-call. The answering service told (physician #5) that (physician #8) was dug in and not going to return his/her call.
Employee #9/Director of Women and Children Services: Thanks for letting me know.

INTERVIEWS

During an interview (#9) on 08/09/16 at 9:45 a.m. in the Administrative Conference Room, the Director of Mother and Children's Services stated that he/she was the Administrator on-call on 08/02/16 and that he/she had received a call from the AOD (#11) to inform him/her of the situation involving hospital B's ED physician (#8) wanting to consult with the on-call ENT physician (#5). The Director explained that later that morning the situation was addressed in a safety meeting by the Assistant Chief Nursing Officer, the President of the facility (#6), and the Director of Emergency Services (#1).

During an interview (#6) on 08/08/16 at 1:30 p.m. in the Administrative Conference Room, the President of MMC explained that he/she was on-call from the evening of 08/01/16 until the morning of 08/02/16. The President stated he/she had not received a call from the Transfer Center. The President stated that he/she did speak with the physician (#8) and the AOD (#11) that had been involved with the patient (#2's) case. The President said that the AOD (#11) had alerted him/her that a call had come through, that there was a possible situation, but the AOD (#11)

During an interview (#4) on 08/09/16 at 10:20 a.m. in the Administrative Conference Room, the Emergency Room Medical Director stated that there were no problems with on-call acceptance or response to emergencies. He/she explained that the on -call physicians were available for emergency medical conditions and that the on-call physicians typically returned calls within fifteen (15) minutes. The Medical Director stated that as an emergency department physician he/she would call his/her on-call specialist if he/she wanted to consult and if there was not a specialist on-call he/she would transfer the patient to another facility where the patient could be treated by that facility's specialist. The Medical Director stated that he/she had recently handed out EMTALA information within the past six (6) months.

During an interview (#4) on 08/09/16 at 10:20 a.m. in the Administrative Conference Room, the Emergency Room Medical Director stated that there were no problems with on-call acceptance or response to emergencies. He/she explained that the on -call physicians were available for emergency medical conditions and that the on-call physicians typically returned calls within fifteen (15) minutes. The Medical Director stated that as an emergency department physician he/she would call his/her on-call specialist if he/she wanted to consult and if there was not a specialist on-call he/she would transfer the patient to another facility where the patient could be treated by that facility's specialist. The Medical Director stated that he/she had recently handed out EMTALA information within the past six (6) months.

Electronic Mails (E-mails)

The President of MMC (Midtown Medical Center) provided a copy of an email that he/she had received from the physician (#8). Review of the email dated 08/03/16 at 3:44 p.m. revealed the physician (#8) had informed MMC's President and the Senior Vice-President of Operations of the series of events involving patient #2 and that he/she had filed an EMTALA complaint against the ENT physician (#5). Physician #8's email noted that the patient (#2) was almost 90 years old and had advanced dementia. Physician #8 noted that his/her thoughts were that the patient was a candidate for conservative treatment only, and not a surgical candidate. Physician #8 relayed that he/she had called the ENT on-call physician (#5) to discuss the patient (#2) and to determine a care plan for the patient. Physician #8 noted that the on-call ENT physician (#5) relayed a message through the operator that he/she (physician #5) did not take call from outside facilities and that he/she (physician #5) would not get involved with the patient's (#2) case. Physician #8 reported that he/she had called the AOD (#11) who attempted to speak with physician (#5), and that the AOD (#11) had called physician (#8) back and informed him/her that physician (#5) continued to refuse to speak to the outside ED physician (#8).

Incident Report

The President of MMC provided a copy of the Administrative summary of the event. The summary revealed the phone call from the ED physician (#8) was reviewed after receiving physician #8's email. The summary noted that physician #8 never requested a transfer and that the AOD had offered for the patient to be transferred to MMC. In addition, the summary noted that the Emergency Services Director (#1) called hospital B and spoke with the Chief Nursing Officer and was informed by the Chief Nursing Officer that there had not been a request made to transfer the patient and that there were no transfer issues.


Policies and Procedures

EMTALA-ETC, policy number MMC.NUR.ETC.26, effective date 05/22/15, defined accepting transfers as "receipt of an individual in need of specialty services, such as trauma care or NICU (neonatal intensive care unit), will not be refused if the hospital has the capacity to treat the individual. This determination will be based on, but not limited to, availability of qualified staff, beds, and equipment. Lateral transfers from other facilities may not be accepted since it will not enhance the individual's care, unless, there was a mechanical failure of equipment, no intensive care beds available, or other similar situations."
3. Emergent Patient Transfers into Midtown Medical Center (MMC), policy number MMC.NUR.CLO.008, effective date 08/20/14, revealed the purpose of the policy was to facilitate transfer to MMC those emergent patients whose identified care, treatment and service needs cannot be met at the referring facility and can be met by MMC's scope of services and is consistent with the hospi