HospitalInspections.org

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure emergency physician coverage of the Emergency Department (ED) 24 hours a day, 365 days per year for one of 20 medical records reviewed (MR1).

Findings include:

Review on June 13, 2016, of the facility's "Rules and Regulations," dated 2015, revealed "... E. Emergency Services 1. The medical staff shall adopt a method of providing medical coverage in the emergency services area. This shall be in accord with the hospital's basic plan for the delivery of such services, including the delineation of privileges for all physicians who render emergency care. The President of the Medical Staff shall have overall responsibility for emergency medical care. The Medical Staff shall provide emergency coverage 24 hours per day, 365 days per year. a. The Emergency Medical Treatment and Active Labor Act (EMTALA) is part of these Rules and Regulations. Appropriate medical screenings as indicated in EMTALA regulations shall be provided by the Medical Staff Member assigned to emergency services at the time of arrival. If an individual comes to the emergency department and a request is made on the individuals [sic] behalf for examination or treatment for a medical condition, the individual will be provided an appropriate medical screening examination within the capability of the emergency department, including routinely available ancillary testing to determine whether or not an emergency condition exists. ... "

Review on June 13, 2016, of MR1 revealed the patient presented to the Emergency Department on February 10, 2016, at 12:50 with the chief complaints of cough, congestion, and fever. Laboratory data revealed Influenza Type A Ab and Influenza Type B Ab were negative at 13:10. The physical examination was documented as "Not done." Assessment/Plan documented 1) URI (upper respiratory infection). Patient left AMA (against medical advice). Nursing documentation electronically signed on February 10, 2016 at 14:03 revealed "patient upset about having to wait so long left ambulatory and refused to sign AMA form."

OTH1 was the Emergency Department physician on call on February 10, 2016. OTH1 returned to the ED at 14:19 on February 10, 2016.

Review on June 13, 2016, of the facility's quality data revealed surveys for the average wait time per Emergency Department doctor. The longest wait time for OTH 1 for 2016 was:
January 3 hours, 7 minutes.
February 3 hours, 35 minutes
March 5 hours 18 minutes
April 3 hours 13 minutes
May 2 hours 42 minutes.

Interview on June 13, 2016, with EMP2 confirmed OTH1 does not remain in the hospital building when on call as the ED physician. EMP2 confirmed OTH1 was the only on call ED physician that does not stay in the on call room in the hospital. OTH1 goes off site.

Interview on June 13, 2016, with EMP3 confirmed there were issues with OTH1 not coming into the hospital within 30 minutes when called.

Interview on June 13, 2016, with EMP1 confirmed the emergency service coverage was not provided in accordance with the facility's bylaws. EMP1 further confirmed MR1 was billed for an emergency room visit.