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Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined the facility failed to ensure the on call urologist provided care for the medical condition that developed during the hospitalization for one of seven medical records reviewed (MR1).

Findings include:

Review of the facility's "Medical Staff Bylaws," dated reviewed March 2, 2010, revealed "4.4 Responsibilities of Membership. Each Practitioner who is granted membership on the Medical Staff shall: ... Assist CMC in fulfilling its responsibilities for providing emergency and charity care; Assist other Practitioners in the care of their patients when asked; Act in an ethical, professional, and courteous manner. ... 4.7.5 Chief Medical Officer The CEO (Chief Executive Officer) may appoint a CMO (Chief Medical Officer) who shall be an administrative officer of CMC (Community Medical Center). The selection process for as well as annual evaluation process of the CMO shall include the input and recommendation of the MEC (medical executive committee). The duties of the CMO shall include the following: Provide executive leadership and management services to the medical staff. ... Article 12.1 Departments and Sections Departments The medical staff shall be organized into two departments Medicine and Surgery. 12.1.1 Each department shall have a director with overall responsibility for the supervision and satisfactory discharge of assigned functions of the department."

Review of MR1 revealed the patient was admitted on May 15, 2011, to the psychiatric unit with a diagnosis of schizophrenia. The patient was administered Risperdal (an antipsychotic) and developed priapism (a prolonged erection of the penis) as a side effect of the Risperdal. The on call urologist (OTH2) was consulted and presented at approximately 10:10 AM to perform a corporal irrigation. The consultation report revealed the procedure was performed at the patient's bedside without sedation or topical anesthetic. The procedure was unsuccessful, as the patient became agitated. Nursing documentation revealed the patient requested to be seen by a physician other than OTH2 for the painful erection at 5:58 PM. At 8:05 PM the nursing documentation noted the patient was now willing to have the procedure performed by anyone, including OTH2. Nursing documentation in MR1 revealed OTH2 refused to return and provide care to the patient. Continued review of MR1 revealed surgical intervention was completed on May 16, 2011, at approximately 11:00 AM, greater than 24 hours after the painful erection began. The surgical intervention occurred when OTH6 became the on call urologist on May 16, 2011.

Review of the medical records and facility documents revealed eight physicians and one certified nurse practitioner were aware of MR1's continuing painful erection, starting May 15, 2011, at 07:45 AM, that continued thru May 16, 2011, until approximately 11:00 AM.

Interview with EMP2 on June 14, 2011, by phone at 11:50 AM confirmed the chain of events stated above. EMP2 further stated that OTH4 "did not make any one come into do the surgery, and felt it was because the patient was a psychiatric patient."

Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined the facility failed to protect and promote each patient's right for one of seven medical records reviewed (MR1).

Findings include:

Review of the facility's "Patient Rights and Responsibilities," dated revised February 2011, revealed "Community Medical Center is committed to providing quality health care to you, our patient, and to making your stay at the Hospital as pleasant as possible. This 'Statement of Patient Rights and Responsibilities' has been endorsed by CMC's administration and staff and applies to all patients. In the event you are unable to exercise these rights on your own behalf, these rights are applicable to your designated legal representative or support person. Patient Rights: The Right to be Treated as an Individual A patient has the right to respectful care given by competent personnel, which reflects consideration of a patient's personal value and belief systems and which optimizes the patient's comfort and dignity. ... The Right to Prompt Emergency Care A patient has the right to expect emergency procedures to be implemented without unnecessary delay."

Review of the facility's "Medical Staff Rules and Responsibilities," dated reviewed March 2, 2010, revealed "Coverage of Patient Each attending physician must assure timely, adequate professional care for his/her patients in the hospital by being available or having available through his/her office an eligible practitioner with whom prior arrangements have been made and has, at least, comparable staff privileges at Community Medical Center. In the absence of the attending practitioner, the appropriate consultant who is actively seeing the patient should be called on the case and the covering practitioner should be notified of the problem."

Review of MR1 revealed the patient was admitted to the Behavioral Unit on a voluntary commitment on May 15, 2011. MR1 revealed the patient stopped taking Risperidone (Risperdal) because of priapism (a persistent, usually painful, erection for more than four hours). Continued review of MR1 revealed that on May 15, 2011, at 7:45 AM the patient had an erection when they woke up and was concerned that it was not abating. The nursing staff reassured the patient and informed the patient to let them know if the patient felt it was getting worse or if the patient experienced any pain. The physician was immediately notified. Continued review revealed the Certified Registered Nurse Practitioner (CRNP) was made aware of the patient's situation at approximately 8:30 AM. The CRNP notified her supervising physician. A Urology consult was ordered. Nursing documentation revealed the patient was checked at 9:40 AM. MR1 noted discomfort.

Continued review of MR1 revealed the on call urologist called the Behavioral Unit at 9:35 AM to inform staff to have supplies available when they arrived. The urologist presented to the Behavioral Unit at 10:10 AM to drain the patient's penis. There was no documentation MR1 received sedation or a local anesthetic prior to the procedure. Midway thru the procedure, the patient became agitated, verbally abusive, and the procedure was terminated. The erection was not relieved.

Continued review of MR1 revealed nursing documentation that the patient requested to be seen by a physician for the painful erection at 5:58 PM. The patient requested a physician other than OTH2. At 8:05 PM the nursing documentation noted the patient was now willing to have the procedure performed by anyone, including OTH2. Nursing documentation in MR1 revealed OTH2 refused to return and provide care to the patient. Continued review of MR1 revealed surgical intervention was completed on May 16, 2011, at approximately 11:00 AM, greater than 24 hours after the painful erection began. The surgical intervention occurred when OTH6 became the on call urologist on May 16, 2011.

Interview with EMP1 on June 14, 2011, at approximately 11:00 AM confirmed that they had been called at home by staff on the evening of May 15, 2011, and made aware of the patient's situation. EMP1 confirmed that they reviewed the documentation in MR1, noted the timeline of events was correct, and facility policy on documentation had been followed correctly by the nursing staff. EMP1 further confirmed that the patient did not receive surgical intervention until May 16, 2011, when OTH6 became the on call urologist.