HospitalInspections.org

Based on reviews of medical records, policies and procedures, on-call schedules, medical staff roster, facility license, physician privileges, and interviews, the facility failed to ensure that their Physician on call policy and procedure was followed as evidenced by failing to ensure that the on-call physicians who are on the hospital ' s medical staff are available to provide treatment necessary after the initial examination to stabilize individuals with an emergency medical condition for 1 of (SP#1) of twenty three (23) sampled patients. Refer to findings in Tag 2404.

Based on interviews and reviews, of medical records, policies and procedures, Medical Staff Roster, facility license, Physician on call schedules and MD privileges, the facility failed to provide medical treatment for Endocrinology Services that was within its capacity, which resulted in an inappropriate transfer for one (SP# 1) of twenty three sampled patients. Refer to finding in Tag 2409.

Based on reviews of medical records, policies and procedures, on-call schedules, medical staff roster, facility license, physician privileges, and interviews, the facility failed to ensure that their Physician on call policy and procedure was followed as evidenced by failing to ensure that the on-call physicians who are on the hospital's medical staff are available to provide treatment necessary after the initial examination to stabilize individuals with an emergency medical condition who for 1 (SP#1) of twenty three (23) sampled patients.

The findings are:

The hospital's policy entitled, " Emergency Medical Treatment and Active Labor Act, review date 7/14 was reviewed. The hospital policy specified in part, " Physicians On-Call 1. The hospital shall maintain a list of physicians who are on call for duty after the initial medical screening examination to provide further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition. The Hospital has the discretion to maintain the on-call list in accordance with the resources available to the hospital, including the availability of on-call physician."

Review of the (SP #1's) medical record revealed in part, " this 38 years old ...presents (12/23/2014) to the ER (emergency room) via walk-in with complaints of low blood sugar x today. Pt states that she has had recurrent episodes of weakness, feeling faint and diaphoresis. Pt states that she checked her blood sugar today and found it to be 39. Pt states that PTA (prior to arrival) she ate crackers with cream cheese and a soda. At the ER her blood glucose was checked twice and was found to be critically low both times. Patient denies taking insulin or diabetic pills. The Laboratory test results on 12/23/2014 at 10:50 AM showed that the patient's blood sugar level was 44 milligrams per deciliter (mg/dL) (hospital reference: normal is 70 to 125 mg/dL). .. The ED physician notes on 12/23/14 at 12:41 PM reported that the physician spoke to [name of Internal Medicine physician #1]who is here, he asked me to transfer to another facility as we have no endocrinologist in the hospital."

The hospital's on-call "Emergency Room Call Schedule for December 2014" was reviewed. The schedule verified that there was a physician (Physician #1) on call for Internal Medicine on 12/23/2014 when SP#1 presented to the hospital's ER.


Review of the Internal Medicine physician #1's privileges showed that the physician was privileged to admit, evaluate, diagnose, treat and provide consultation to adult patients with common and complex illnesses, diseases and functional disorders of the endocrine and metabolic systems. May also be able to assess, stabilize, and determine the disposition of patients with emergent conditions. The facility failed to ensure that the on call list was maintained in accordance with the resources available at the hospital including the availability of on call physicians (internal medicine) to provide further evaluation and treatment or physically assessed, and determine the disposition of SP #1 on 12/23/2014 with an identified emergency medical condition.

Review of the medical staff roster showed that there were two active endocrinologists, and one courtesy endocrinologist on staff who had privileges in endocrinology.

Review of the facility's license showed that endocrinology services are available at the facility.

On 01/08/15 at 11:40 AM, the Associate Medical Director stated that there is no longer an endo (endocrinology) on call. If we have a simple case, the internist is consulted. If it's complicated, we call the nearest hospital.


On 01/09/15 at 10:17 AM, the Internal Medicine Physician #1 stated that I was in the hospital, but I did not see her (SP#1). He (the Associate Medical Director) told me she came in with hypoglycemia. They gave her a bunch of D 50 (Dextrose 50) and D (Dextrose) 10. I said she needed endocrine. We can't admit on the floor because she needed an endocrinologist. What they (facility) have on paper and what is real are two different things. I know [named the two endocrinologists on staff]. I can't remember the last time they came here. The [named endocrinologist] told me they are not coming here. If I call they won't come. I manage my patients who have endocrine problems. However, when serious problems arise, it is difficult for us. The internal medicine physician failed to provide further evaluation for SP#1 on 12/23/2014 after being notified by the ED physician.

On 01/08/15 at 11:08 AM, Staff H, an ER Registered Nurse (RN), stated that there is no endocrine doctor. The patients are stabilized here and discharged with follow up or referral with a primary doctor. If they are not safe to go home, the patient is admitted and the Attending physician treats the sugar and monitor for DKA (diabetic ketoacidosis). I am not aware of any endocrinologist.

On 01/08/15 at 11:20 AM, Staff C, an RN (in ER), stated that there is no endocrinologist right now. Patients are managed by the Admitting. The Attending takes care of the patient. There used to be one endocrinologist. There hasn't been one for about one year.

On 01/09/15 at 1:30 PM, the endocrinologist stated that I go over there for the past five years. I was not notified for this patient. I change my mode. I see patients at nights. I prefer to see patients at night. I manage diabetic patients when I get consulted.

On 01/09/15 at 2:15 PM, the Chief Medical Officer stated, we have three endocrinologists. They come when called.

Based on interviews and reviews of medical records, Physician on-call schedules, facility license, policies and procedures and medical staff rosters, the facility failed to ensure that their policies and procedures were followed by failing to provide medical treatment that was within its capacity and inappropriately transferred one (SP #1) of twenty three (23) sampled patients.

The findings included:

Review of the policy "Emergency Medical Treatment and Active Labor Act (EMTALA) (review date: 7/14) stated in part, Transfer of Unstable Individuals ... when the hospital transfers an individual with an unstabilized emergency medical condition to another facility, the transfer shall be carried out in accordance with the following procedures. 1. A. The Hospital shall within its capability, provide medical treatment that minimizes the risks of the individual's Health."

Review of the facility's license showed that endocrinology services are available at the facility.

The hospital's on-call "Emergency Room Call Schedule December 2014" was reviewed. The schedule verified that there was a physician (Physician #1) on call for Internal Medicine on 12/23/2014 when SP#1 presented to the hospital's ER.

Review of the medical staff roster showed that there were two active endocrinologists, and one courtesy endocrinologist on staff who had privileges in endocrinology.

Review of Internal Medicine physician #1's privileges showed that the physician was privileged to admit, evaluate, diagnose, treat and provide consultation to adult patients with common and complex illnesses, diseases and functional disorders of the endocrine and metabolic systems. May also be able to assess, stabilize, and determine the disposition of patients with emergent conditions. There was no documentation in the medical record to indicate that the on-call internal medicine physician assessed, SP #1 to determine disposition of the patient's emergent medical condition on 12/23/2014.

Review of Sampled Patient (SP) #1 Emergency Department (ED) Physician Notes dated 12/23/14 at 10:16 AM revealed, the patient presented to the ER (emergency room) via walk-in with complaints of low blood sugar today. Her blood sugar was checked twice and was found to be critically low both times. The Laboratory test results on 12/23/2014 at 10:50 AM showed that the patient's blood sugar level was 44 milligrams per deciliter (mg/dL) (normal is 70 to 125 mg/dL). The ED physician notes on 12/23/14 at 12:41 PM reported, the physician spoke to [name of Internal Medicine physician #1] who is here, he asked me to transfer the patient to another facility as we have no endocrinologist in the hospital. The Disposition summary on 12/23/14 at 1:29 PM notes that a transfer was ordered to [hospital#2]. The Diagnosis - recurrent hypoglycemic episodes with refractory hypoglycemia, r/o (rule out) pancreatic insulinoma. Review of SP#1's Transfer Form showed that the reason for transfer: needs endocrinologist.


The medical record from the receiving hospital was reviewed. Medical record review revealed that SP #1 arrived at the receiving hospital on 12/23/2014. Review of the "Discharge Documentation" revealed in part, "Assessment and Plan. marked hypoglycemia, the patient was admitted for blood sugars in the 20's, managed with D20 and then D10 drip...Initially suspected to have insulinoma, which is ruled out by CT of the abdomen and also Endocrinology Service evaluated he patient, who had a low suspicion of insulinoma. At the same time, the patient was suspected to have sulfonylurea overdose----medication from her dad...The patient was trasnferred to the medical floor."

On 01/08/15 at 1:15 PM, the Associate Medical Director who was also the ER physician for SP#1 stated that she (SP#1) was transferred because of refractory hypoglycemia. She needed high doses of D 10 (dextrose 10% (percent). She also needed services we don't have. I spoke with the internist who said to transfer the patient (SP#1).

On 01/08/15 at 11:40 AM, the Associate Medical Director stated that there is no longer an endo (endocrinology) on call. If we have a simple case, the internist is consulted. If it's complicated, we call the nearest hospital. There is no endo on call because they have other practices outside.

On 01/09/15 at 10:17 AM, the Internal Medicine Physician #1 stated that I was in the hospital, but I did not see her (SP#1). He (the Associate Medical Director) told me she came in with hypoglycemia. They gave her a bunch of D 50 (Dextrose 50) and D (Dextrose) 10. I said she needed endocrine. We can't admit on the floor because she needed an endocrinologist. What they (facility) have on paper and what is real are two different things. I know [named the two endocrinologists on staff]. I can't remember the last time they came here. The [named endocrinologist] told me they are not coming here. If I call they won't come. I manage my patients who have endocrine problems.

The facility failed to ensure that their policy and procedure was followed to provide medical treatment within its capability (Internal Medicine and Endocrinology) to minimize the risk to an individual's health. As this resulted in an inappropriate transfer of SP#1 on 12/23/2014.

Based on reviews of medical records, policies and procedures, on-call schedules, medical staff roster, facility license, physician privileges, and interviews, the facility failed to ensure that their Physician on call policy and procedure was followed as evidenced by failing to ensure that the on-call physicians who are on the hospital ' s medical staff are available to provide treatment necessary after the initial examination to stabilize individuals with an emergency medical condition for 1 of (SP#1) of twenty three (23) sampled patients. Refer to findings in Tag 2404.

Based on interviews and reviews, of medical records, policies and procedures, Medical Staff Roster, facility license, Physician on call schedules and MD privileges, the facility failed to provide medical treatment for Endocrinology Services that was within its capacity, which resulted in an inappropriate transfer for one (SP# 1) of twenty three sampled patients. Refer to finding in Tag 2409.

Based on reviews of medical records, policies and procedures, on-call schedules, medical staff roster, facility license, physician privileges, and interviews, the facility failed to ensure that their Physician on call policy and procedure was followed as evidenced by failing to ensure that the on-call physicians who are on the hospital's medical staff are available to provide treatment necessary after the initial examination to stabilize individuals with an emergency medical condition who for 1 (SP#1) of twenty three (23) sampled patients.

The findings are:

The hospital's policy entitled, " Emergency Medical Treatment and Active Labor Act, review date 7/14 was reviewed. The hospital policy specified in part, " Physicians On-Call 1. The hospital shall maintain a list of physicians who are on call for duty after the initial medical screening examination to provide further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition. The Hospital has the discretion to maintain the on-call list in accordance with the resources available to the hospital, including the availability of on-call physician."

Review of the (SP #1's) medical record revealed in part, " this 38 years old ...presents (12/23/2014) to the ER (emergency room) via walk-in with complaints of low blood sugar x today. Pt states that she has had recurrent episodes of weakness, feeling faint and diaphoresis. Pt states that she checked her blood sugar today and found it to be 39. Pt states that PTA (prior to arrival) she ate crackers with cream cheese and a soda. At the ER her blood glucose was checked twice and was found to be critically low both times. Patient denies taking insulin or diabetic pills. The Laboratory test results on 12/23/2014 at 10:50 AM showed that the patient's blood sugar level was 44 milligrams per deciliter (mg/dL) (hospital reference: normal is 70 to 125 mg/dL). .. The ED physician notes on 12/23/14 at 12:41 PM reported that the physician spoke to [name of Internal Medicine physician #1]who is here, he asked me to transfer to another facility as we have no endocrinologist in the hospital."

The hospital's on-call "Emergency Room Call Schedule for December 2014" was reviewed. The schedule verified that there was a physician (Physician #1) on call for Internal Medicine on 12/23/2014 when SP#1 presented to the hospital's ER.


Review of the Internal Medicine physician #1's privileges showed that the physician was privileged to admit, evaluate, diagnose, treat and provide consultation to adult patients with common and complex illnesses, diseases and functional disorders of the endocrine and metabolic systems. May also be able to assess, stabilize, and determine the disposition of patients with emergent conditions. The facility failed to ensure that the on call list was maintained in accordance with the resources available at the hospital including the availability of on call physicians (internal medicine) to provide further evaluation and treatment or physically assessed, and determine the disposition of SP #1 on 12/23/2014 with an identified emergency medical condition.

Review of the medical staff roster showed that there were two active endocrinologists, and one courtesy endocrinologist on staff who had privileges in endocrinology.

Review of the facility's license showed that endocrinology services are available at the facility.

On 01/08/15 at 11:40 AM, the Associate Medical Director stated that there is no longer an endo (endocrinology) on call. If we have a simple case, the internist is consulted. If it's complicated, we call the nearest hospital.


On 01/09/15 at 10:17 AM, the Internal Medicine Physician #1 stated that I was in the hospital, but I did not see her (SP#1). He (the Associate Medical Director) told me she came in with hypoglycemia. They gave her a bunch of D 50 (Dextrose 50) and D (Dextrose) 10. I said she needed endocrine. We can't admit on the floor because she needed an endocrinologist. What they (facility) have on paper and what is real are two different things. I know [named the two endocrinologists on staff]. I can't remember the last time they came here. The [named endocrinologist] told me they are not coming here. If I call they won't come. I manage my patients who have endocrine problems. However, when serious problems arise, it is difficult for us. The internal medicine physician failed to provide further evaluation for SP#1 on 12/23/2014 after being notified by the ED physician.

On 01/08/15 at 11:08 AM, Staff H, an ER Registered Nurse (RN), stated that there is no endocrine doctor. The patients are stabilized here and discharged with follow up or referral with a primary doctor. If they are not safe to go home, the patient is admitted and the Attending physician treats the sugar and monitor for DKA (diabetic ketoacidosis). I am not aware of any endocrinologist.

On 01/08/15 at 11:20 AM, Staff C, an RN (in ER), stated that there is no endocrinologist right now. Patients are managed by the Admitting. The Attending takes care of the patient. There used to be one endocrinologist. There hasn't been one for about one year.

On 01/09/15 at 1:30 PM, the endocrinologist stated that I go over there for the past five years. I was not notified for this patient. I change my mode. I see patients at nights. I prefer to see patients at night. I manage diabetic patients when I get consulted.

On 01/09/15 at 2:15 PM, the Chief Medical Officer stated, we have three endocrinologists. They come when called.

Based on interviews and reviews of medical records, Physician on-call schedules, facility license, policies and procedures and medical staff rosters, the facility failed to ensure that their policies and procedures were followed by failing to provide medical treatment that was within its capacity and inappropriately transferred one (SP #1) of twenty three (23) sampled patients.

The findings included:

Review of the policy "Emergency Medical Treatment and Active Labor Act (EMTALA) (review date: 7/14) stated in part, Transfer of Unstable Individuals ... when the hospital transfers an individual with an unstabilized emergency medical condition to another facility, the transfer shall be carried out in accordance with the following procedures. 1. A. The Hospital shall within its capability, provide medical treatment that minimizes the risks of the individual's Health."

Review of the facility's license showed that endocrinology services are available at the facility.

The hospital's on-call "Emergency Room Call Schedule December 2014" was reviewed. The schedule verified that there was a physician (Physician #1) on call for Internal Medicine on 12/23/2014 when SP#1 presented to the hospital's ER.

Review of the medical staff roster showed that there were two active endocrinologists, and one courtesy endocrinologist on staff who had privileges in endocrinology.

Review of Internal Medicine physician #1's privileges showed that the physician was privileged to admit, evaluate, diagnose, treat and provide consultation to adult patients with common and complex illnesses, diseases and functional disorders of the endocrine and metabolic systems. May also be able to assess, stabilize, and determine the disposition of patients with emergent conditions. There was no documentation in the medical record to indicate that the on-call internal medicine physician assessed, SP #1 to determine disposition of the patient's emergent medical condition on 12/23/2014.

Review of Sampled Patient (SP) #1 Emergency Department (ED) Physician Notes dated 12/23/14 at 10:16 AM revealed, the patient presented to the ER (emergency room) via walk-in with complaints of low blood sugar today. Her blood sugar was checked twice and was found to be critically low both times. The Laboratory test results on 12/23/2014 at 10:50 AM showed that the patient's blood sugar level was 44 milligrams per deciliter (mg/dL) (normal is 70 to 125 mg/dL). The ED physician notes on 12/23/14 at 12:41 PM reported, the physician spoke to [name of Internal Medicine physician #1] who is here, he asked me to transfer the patient to another facility as we have no endocrinologist in the hospital. The Disposition summary on 12/23/14 at 1:29 PM notes that a transfer was ordered to [hospital#2]. The Diagnosis - recurrent hypoglycemic episodes with refractory hypoglycemia, r/o (rule out) pancreatic insulinoma. Review of SP#1's Transfer Form showed that the reason for transfer: needs endocrinologist.


The medical record from the receiving hospital was reviewed. Medical record review revealed that SP #1 arrived at the receiving hospital on 12/23/2014. Review of the "Discharge Documentation" revealed in part, "Assessment and Plan. marked hypoglycemia, the patient was admitted for blood sugars in the 20's, managed with D20 and then D10 drip...Initially suspected to have insulinoma, which is ruled out by CT of the abdomen and also Endocrinology Service evaluated he patient, who had a low suspicion of insulinoma. At the same time, the patient was suspected to have sulfonylurea overdose----medication from her dad...The patient was trasnferred to the medical floor."

On 01/08/15 at 1:15 PM, the Associate Medical Director who was also the ER physician for SP#1 stated that she (SP#1) was transferred because of refractory hypoglycemia. She needed high doses of D 10 (dextrose 10% (percent). She also needed services we don't have. I spoke with the internist who said to transfer the patient (SP#1).

On 01/08/15 at 11:40 AM, the Associate Medical Director stated that there is no longer an endo (endocrinology) on call. If we have a simple case, the internist is consulted. If it's complicated, we call the nearest hospital. There is no endo on call because they have other practices outside.

On 01/09/15 at 10:17 AM, the Internal Medicine Physician #1 stated that I was in the hospital, but I did not see her (SP#1). He (the Associate Medical Director) told me she came in with hypoglycemia. They gave her a bunch of D 50 (Dextrose 50) and D (Dextrose) 10. I said she needed endocrine. We can't admit on the floor because she needed an endocrinologist. What they (facility) have on paper and what is real are two different things. I know [named the two endocrinologists on staff]. I can't remember the last time they came here. The [named endocrinologist] told me they are not coming here. If I call they won't come. I manage my patients who have endocrine problems.

The facility failed to ensure that their policy and procedure was followed to provide medical treatment within its capability (Internal Medicine and Endocrinology) to minimize the risk to an individual's health. As this resulted in an inappropriate transfer of SP#1 on 12/23/2014.