HospitalInspections.org

Based on interview and review of records, the facility did not comply with 42 CFR ?489.24, Special responsibilities of Medicare hospitals in emergency cases, in that:
I) the physician did not indicate specific medical benefits and medical risks in transferring 3 of 4 patients (Patient #1, #2, & #3) that were diagnosed to have an "overdose."
II) the facility did not send to the receiving facility at the time of transfer copies of medical records related to the emergency condition of 2 of 4 patients (Patient #1 & #2) that had diagnoses of "overdose."
III) the facility did not provide qualified medical personnel to monitor 1 of 1 patient (Patient #2) who was receiving "Propofol" via IV (intravenous) drip at the time of the transfer.
IV) the facility did not maintain a physicians' on-call list that identified individual physician names and the dates for which they were on-call from 12/01/10 to 03/31/11.
V) the facility did not have a written policy and procedure in place to respond to situations in which a particular specialty is not available or the on-call physician cannot respond because of circumstances beyond the physician's control.

Findings included:

Cross Refer to Tag 2409 for I, II, III

Cross Refer to Tag 2404 for IV, V

Based on interview and record review, the facility:
1) did not maintain a physicians' on-call list that identified individual physician names and the dates for which they were on-call from 12/01/10 to 03/31/11; and
2) did not have a written policy and procedure in place to respond to situations in which a particular specialty was not available or the on-call physician could not respond because of circumstances beyond the physician's control.

Findings included:

On 03/17/11 at 10:06 AM a tour of the Emergency Department (ED) was conducted with the Chief Nursing Officer (CNO) (Personnel #2). He was asked to provide a list of physicians' on-call. The CNO gave the surveyor a 2 page "ED On-Call Roster" which reflected a "Group Roster" with six specialties (general surgery, ophthalmology, retina, orthopedic, orthopedic/hand, and otolaryngology). The roster did not identify individual physician names and specific dates that they were on-call.

In an interview on 03/17/11 at approximately 10:30 AM, the CNO was asked if there was another list of on-call physicians. The CNO replied that there was none. The CNO was asked for policies and procedures for the following: ED list of on-call physicians and how to respond to situations in which a particular specialty was not available or when on-call physicians could not respond because of circumstances beyond the physician's control. The CNO did not provide policies and procedures and stated that the only written document that indicated physicians' on-call was found in the facility's "Bylaws of the Medical Staff" revised on 06/18/2009. He pointed out to the surveyor on page 14 which indicated "4.8.14 Participation in any emergency services "on call" panel or consultation panel as may be required ... "

The "Medical Staff Rules and Regulations" revised 06/18/09 on page 11 required that the facility "will abide by the EMTALA guidelines ..."

Based on interview and record review, the facility did not provide an appropriate medical screening examination to ensure necessary stabilization prior to transferring to another hospital for 1 of 1 patient (Patient #1). Patient #1 presented to the hospital emergency department and within 20 minutes of her arrival she was transported to another hospital.

Findings included:

Patient #1 presented in the ED (emergency department) on 02/26/11 at 2:40 AM. Physician #A4 indicated that the patient had an overdose (Ethanol/ alcohol). Patient #1 was subsequently transferred to Facility B at 3:00 AM on the same day, 20 minutes after she arrived to the ED.

The "Transfer Risks and Benefits and Consent" did not show that Physician #A4 indicated specific medical benefits and medical risks in transferring Patient #1 to Facility B.

In an interview on 03/21/11 at approximately 11:25 AM, the Chief Nursing Officer (CNO/ Personnel #A2) was asked to review the patient's medical record. The surveyor referred the CNO to the document where the physician did not indicate specific medical benefits and medical risks as required. The CNO confirmed the form was not complete.

The "Medical Staff Rules and Regulations" revised 06/18/2009 on page 12 required "If a patient is transferred...the following guidelines must be followed...The individual risks and benefits must be documented..."

Based on interview and record review:
I) the physician did not indicate specific medical benefits and medical risks in transferring 3 of 4 patients (Patient #1, #2, & #3) that were diagnosed to have an "overdose."
II) the facility did not send to the receiving facility at the time of transfer copies of medical records related to the emergency condition of 2 of 4 patients (Patient #1 & #2) that had diagnoses of "overdose."
III) the facility did not provide qualified medical personnel to monitor 1 of 1 patient (Patient #2) who was receiving "Propofol" via IV (intravenous) drip at the time of the transfer. (Note: Propofol is an anesthetic drug used to produce relaxation and sleep before or during surgery. It is also used in patients on a ventilator, from Bing.com website 03/28/11.)

Findings included:

Patient #1 presented in the ED (emergency department) on 02/26/11 at 2:40 AM. Physician #A4 indicated that the patient had an overdose (Ethanol/ alcohol). Patient #1 was subsequently transferred to Facility B at 3:00 AM on the same day.

Patient #2 presented in the ED on 02/26/11 at 1:45 PM. Physician #A4 indicated that the patient had an overdose (drug). Patient #2 was subsequently transferred to Facility B at 3:05 PM on the same day. At the time of transfer, the patient was receiving "Propofol" via IV drip.

Patient #3 presented in the ED on 10/17/10 at 10:10 PM. Physician #A4 indicated that the patient had an overdose (drug). Patient #3 was subsequently transferred to Facility C at 10:40 PM on the same day.

I) The "Transfer Risks and Benefits and Consent" did not show that Physician #A4 indicated specific medical benefits and medical risks in transferring Patient #1, #2, & #3 to Facility B and C.

In an interview on 03/21/11 at approximately 11:25 AM, the Chief Nursing Officer (CNO/ Personnel #A2) was asked to review the patients' medical records. The surveyor referred to the CNO to the document where the physician did not indicate specific medical benefits and medical risks as required. The CNO confirmed the form was not complete.

The "Medical Staff Rules and Regulations" revised 06/18/2009 on page 12 required "If a patient is transferred...the following guidelines must be followed...The individual risks and benefits must be documented..."

II) The transferring facility did not provide the following medical record copies of Patient #1 & #2 to Facility B at the time of transfer: the patient's history and physical, physician's progress notes, nurse's progress notes, medication record, and/ or laboratory work.

On 03/28/11 at approximately 11:50 AM via phone, the CNO was asked to specify what medical records were sent to Facility B when Patient #1 and #2 were transferred. He replied that their standard procedure was to send the MOT (memorandum of transfer), physician's progress notes, nurse's notes, laboratory and/or diagnostic tests that were performed, medication record, and the patient's H&P (history & physical). The CNO was informed that the medical records he mentioned were not provided to the receiving facility at the time of the transfer. Upon reviewing the patients' medical records, the CNO confirmed the surveyor's assessment.

Policy & Procedure: "Transfer to/ from Another Facility" approved 10/21/08 on page 3 required "Transfer documentation...will provide to the receiving facility a copy of those portions of the patient's medical record that are available and relevant...a. History and Physical b. Patient Home Medication & Allergy Record...e. Laboratory...f. Treatment provided g. MOT."

III) Patient #2 was transferred to Facility B on 03/26/11 at approximately 3:05 PM with "Propofol" via IV (intravenous) drip. The transferring facility did not provide qualified medical personnel to monitor the patient during the transfer.

In an interview on 03/21/11 at approximately 11:15 AM via phone, Personnel #D11 was asked if the paramedics were trained with Propofol medication. Personnel #D11 replied that the paramedics were ACLS certified but were not trained with "Propofol" or the medication pump that went with it. Personnel #D11 explained that he knew about this incident "after the fact" and that this matter "concerned him." He stated that he would have "preferred" if the facility provided a "qualified medical personnel" to monitor the patient during the transfer.

In an interview on 03/24/11 at approximately 11:25 AM via phone, Physician #A4 was asked if he was aware that the paramedics who were involved with the transfer of Patient #2 were not trained with "Propofol" medication and the medication pump. The physician replied that he did not know this. Physician #A4 stated that had he known about this, he would have sent a qualified medical personnel at the time of the transfer.

Policy & Procedure: "Transfer to/ from Another Facility" approved 10/21/08 on page 4 required "Transfer to/ from a Facility...E. the facility discourages the use of the facility staff in accompanying the patient in transport except under extreme circumstances or unusual situations."

"Medical Staff Rules and Regulations" revised 06/18/09 on page 11 required that the facility "will abide by the EMTALA guidelines ..."