HospitalInspections.org

Intakes: TN00027624

Based on interview, the facility failed to ensure documentation of an Emergency Medical Treatment And Labor Act log was maintained. Refer to A2403.

Based on review of the hospital on call schedule and interivew, the facility failed to ensure a physician was available for emergency situations for patients who required a higher level of care. Refer to A2404.

Based on interview, the facility that had specialized capabilities failed to accept from a referring hospital the transfer of a patient who required specialized services.
Refer to 2411.

Based on interview, it was determined the facility failed to ensure an Emergency Medical Treatment And Labor Act log was maintained for April 2010-March 2011.

The findings included:

During an interview in the administrative conference room on 4/5/11 at 3:50 PM, the Chief Nursing Officer stated, "...the EMTALA transfer log for April 5, 2010 to March 2011 are lost ...believe that when construction was done in ED, were lost then ..."

During an interview in the administrative conference room on 4/5/11 at 3:50 PM, the Director of the Emergency Department verified the logs could not be found.

During an interview in the Emergency Department's Medical Director's office on 4/6/11 at 2:36 PM, MD #2 stated he made notes of the different physicians he attempted to contact on July 14, 2010, concerning a patient who required a higher level of care. He does not know what happened to these notes since there was not chart on the patient and information had been misplaced with the renovations of the ED area.

Based on review of the cardiovascular-thoracic physician on-call schedule for July 14, 2010 and interview, it was determined the facility failed to ensure a physician was available to care for a patient who required a higher level of care.

The findings included:

Review of the [Name of facility] Division of Thoracic Cardiovascular Surgery Emergency Department On-Call List documented "...Date ...July [named physician]-Cardiovascular only ... [named physician] - thoracic only ..." These were the only physicians listed as on-call for the entire month of July 2010.

During an interview in the Risk Management office on 4/6/11 at 2:40 PM, the Chief Nursing Officer stated the only time (the hospital) would not accept a patient who needed a higher level of care would be "...if a surgeon [for that condition] was not available or there was no bed available ..."

During an interview in the Emergency Department's Medical Director's office on 4/6/11 at 2:36 PM, MD #2 (who was on duty on July 14, 2010) verified he was unable to provide a cardiovascular surgeon to accept a patient who required a transfer to a higher level of care. MD #2 stated MD #3 expressed concerns regarding the critical nature of the diagnosis and asked if Pt #3 could be sent to a medical center closer to his location. The MD #2 stated after further discussion with MD #1, he attempted to call approximately six other physicians.

Based on interview, it was determined the facility that had specialized capabilities, failed to accept from a referring hospital, a transfer of a patient who required the specialized services offered by this facility.

The findings included:

During an interview in the Risk Management office on 4/6/11 at 2:40 PM, the Chief Nursing Officer stated the only time (the hospital) would not accept a patient who needed specialized services would be "...if a surgeon [for that condition]was not available or there was no bed available ..."

During an interview in the Emergency Department's Medical Director's office on 4/6/11 at 2:36 PM, MD #2 (who was on duty on July 14, 2010) verified he was unable to provide a cardiovascular surgeon to accept a patient who required a transfer to a facility that offered specialized services for a Type 1 Aortic Dissection. MD #2 stated he called MD #3 who expressed concerns regarding the critical nature of the diagnosis and asked if Pt #3 could be sent to a medical center closer to the his location. MD #2 stated after further discussion with the MD #1, he attempted to call approximately six other physician. MD #2 was unable to obtain a physician, who specialized in the care needed, to accept Pt #3.