HospitalInspections.org

Based on a review of the medical records of 39 patients who presented to the emergency department, review of hospital policies and procedures, review of physician credentials, a review of emergency department central logs, and interviews with administrative staff, it was determined that each facility within the system failed to have a physician on call list that identifies the name of an individual physician to ensure compliance with the requirements of 42 CFR 489.20(r)(2). It was also determined that the system failed to ensure that when an individual comes to the emergency department requesting examination or treatment of a medical condition, an appropriate medical screening is performed to ensure compliance with 42 CFR 489.24(j)(1-2), and the related requirements at 42 CFR 489.20: Responsibilities of Medicare Participating Hospitals in Emergency Cases.

Findings include:

1. The system failed to have a physician on call list that identifies the name of an individual physician. Cross reference 489.20(r)(2)

2. The system failed to provide a medical screening exam to determine whether or not an emergency medical condition existed. Cross reference to regulation 489.24(j)(1-2).

Based on staff interview and review of the Emergency Department (ED) on call lists for Camden, Berlin, Marlton, and Voorhees campuses, within the Virtua System, it was determined that the system failed to ensure that a physician on call list that identifies the name of an individual physician on call for a specialty, is maintained.

Findings include:

1. Review of the on call schedule for Neurosurgery revealed the following:

a. According to Staff #5, on call for Neurosurgery does not change from month to month.

b. Listed under first call was the name of a medical group and not an individual physician.

c. Documented on the on call schedule, "If no response, call" listed a Resident Pager number, but failed to list the name of an individual physician.

d. Upon interview on 12/20/10 at 1:50 PM, Staff #5 stated that a different physician group is now first call for Neurosurgery. The system failed to update the on call list for this specialty.

2. Review of the OB/GYN on call schedule revealed the following:

a. Listed as first on call was the "GYN Resident." The name or telephone/beeper number of that person was not included on the list.

b. The second on call lists the "Center for Women beeper" but does not include the name or telephone/beeper number of that person.

3. Review of the Oral/Maxillofacial Surgery on call schedule for January through December 2010 revealed the following:

a. An individual physician was listed as being on call only one week per month from July through December. The remainder of the on call schedule lists the name of a medical group, not the name of an individual physician.

4. Review of the Hand Surgery on call schedule for July through December 2010 revealed the following:

a. A medical group was listed as on call for 26 out of 31 days for the month of July 2010; an individual physician was listed the remaining 5 days.

b. A medical group was listed as on call for 25 out of 31 days for the month of August 2010; an individual physician was listed the remaining 6 days.

c. A medical group was listed as on call for 23 out of 30 days for the month of September 2010; an individual physician was listed the remaining 7 days.

d. A medical group was listed as on call for 28 out of 31 days for the month of October 2010; an individual physician was listed the remaining 3 days.

e. A medical group was listed as on call for 25 out of 30 days for the month of November 2010; an individual physician was listed the remaining 5 days.

f. A medical group was listed as on call for 24 out of 31 days for the month of December 2010; an individual physician was listed the remaining 7 days.

5. Review of the General Surgery on call schedule for July through December 2010 revealed the following:

a. A medical group was listed as on call for Voorhees, Marlton and Camden for the entire month of July 2010.

i. A medical group was listed as on call for Berlin for 24 out of 31 days in July 2010; an individual physician was listed the remaining 7 days.

b. A medial group was listed as on call for Voorhees and Marlton for the entire months of August, September, October, November, and December 2010.

i. A medical group was listed as on call for Berlin for 24 out of 31 days in August 2010; an individual physician was listed the remaining 7 days.

ii. A medical group was listed as on call for Berlin for 24 out of 30 days in September 2010; an individual physician was listed the remaining 6 days.

iii. A medical group was listed as on call for Berlin for 22 out of 31 days in October 2010; an individual physician was listed the remaining 9 days.

iv. A medical group was listed as on call for Berlin for 24 out of 30 days in November 2010; an individual physician was listed the remaining 6 days.

v. A medical group was listed as on call for Berlin for 27 out of 31 days in December 2010; an individual physician was listed the remaining 4 days.

6. Review of the Cardiology on call schedule for July through December 2010 revealed that a medical group was listed as on call. There was no evidence that an individual physician was identified for each day of the month, for the six month total.

The above on call schedules were reviewed and confirmed with Staff #5.

Based on medical record review, document review and staff interview, it was determined that the facility failed to ensure that when an individual comes to the Emergency Department (ED) requesting examination or treatment of a medical condition, an appropriate medical screening examination is performed by qualified medical personnel.

Findings include:

Patient #1, a 45 year old male with a history of anxiety, panic attacks, bipolar disorder, and schizophrenia presented to the Satellite Emergency Department (SED) on December 2, 2010 with a complaint that he needed money for cigarettes. The patient returned to the SED on December 4, 2010, again with a complaint that he needed money for the bus. The security guard told the patient that he had to leave the premises. At that point, the patient stated that he was going to cut himself if the guard didn't let him in. He was escorted off the property by the security guard.

1. A statement that was taken from the security officer relating to the incident that occurred on December 4, 2010 stated "...During the course of my shift, around 3:45am I (Officers name) went outside to check on the parking lot and saw him (Patient's name) coming up the parking lot towards the ER entrance. I said to him, you can't come in here. You can't come back here. (Patient's name) said why? I'm hearing voices. I (Officer's name) said you are harassing the nurses and doctors that are here. Take a walk with me to the sidewalk. He (Patient's name) said no. I need to see a doctor..."

2. A statement by the security officer indicated that on December 4, 2010, the patient requested a medical exam related to hearing voices.

3. According to complaint specifics on the Department of Health and Senior Services Intake Information form, which was reported by Staff #3, "the patient went across the street and cut himself, 911 was called and the patient was transported to a hospital."

3. The above was verified by Staff #3.