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Based on record reviews and interviews, Hospital B failed to comply with 489.24 as follows:

1) Hospital B did not ensure the availability of on-call trauma specialty physicians on it's medical staff to meet the needs of the hospital's patients, in that, the hospital could not provide for a neurosurgical evaluation for 1 of 1 patient (Patient # 1), who had an emergency medical condition during the month of December 2011.

Patient #1 was accepted at Hospital B as a transfer from Hospital A on 12/27/11 to be evaluated and treated by an on-call neurosurgeon for identified spinal fractures received in a fall down 2 flights of stairs, 2 days prior.

The Trauma Physician Progress Notes from the medical record described the efforts to have either one of two neurosurgeons, who were on-call, to come to the ED to evaluate and treat Patient #1, without success.

Cross Refer to A-2404.

2) Hospital B did not ensure that necessary stabilizing treatment for an emergency condition was available, as they failed to provide the medical treatment that was needed for 1 of 1 patient (Patient # 1), and which was within their capacity as a Trauma Center, in that, the 2 neurosurgeons on-call refused to come to the hospital when called.

The ED Physician On-Call Schedule for 12/27/11 and 12/28/11 noted the following:
12/27/11: Primary on-call physician, Personnel #10; Backup physician, Personnel #9.
12/28/11: Primary on-call physician, Personnel #10; Backup physician, Personnel #9.

The Trauma Physician Progress Notes from the medical record described the efforts to have either one of two neurosurgeons, who were on-call, to come to the ED to evaluate and treat Patient #1, without success. Without neurosurgery support, the hospital was unable to provide the medical treatment that was within their capacity as a Trauma center.

Cross Refer to A-2407

Based on record reviews and interviews, Hospital B did not meet the requirements of 489.24(j)(1) to ensure the availability of on-call trauma specialty physicians on it's medical staff to meet the needs of the hospital's patients, in that, the hospital could not provide a neurosurgical evaluation for 1 (Patient # 1) of 3 patients, who had an emergency medical condition during the month of December 2011.

Findings Included:

Review of the medical record for Patient # 1, revealed he had been transferred from Hospital A to Hospital B on 12/27/11, to be evaluated and treated by a neurosurgeon for identified spinal fractures received in a fall down 2 flights of stairs, 2 days prior. An evaluation by Hospital B's Emergency Department (ED) physician (Personnel # 12), at 9:28 PM described specific neck and back pain, and a sensory deficit present (numbness and tingling to the left arm and slightly weaker grip in left hand).

The ED physician documented the following sequence of events related to obtaining a neurosurgery consult the evening of 12/27/11:
9:50 PM: Discussed with Personnel # 9 (backup neurosurgeon on-call), neurosurgery declining to see patient.
10:00 PM: Trauma surgeon (Personnel # 13), is in the ED to evaluate patient.
11:01 PM: Discussed with Personnel # 9 (backup neurosurgeon), still declines to see patient.
11:40 PM: Trauma surgeon is currently trying to coordinate with neurosurgery to have patient evaluated.
01:45 AM: It does not appear that we will be able to obtain a spine/neuro surgery consult. Trauma surgeon has been attempting to coordinate care of Patient #1 for the last few hours and has agreed to coordinate transfer to Hospital C if necessary.

The Trauma surgeon noted: "plan was to have neurosurgery consultation on the patient ...upon consultation with the neurosurgeon, the neurosurgeon on-call refused to see the consult ...I referred this to the chief of surgery, who had asked if I would consult the neurosurgeon on-call for spine, Personnel #9 ...I called his partner, Personnel #10....subsequently, Personnel #9 called back and reported that neither he or Personnel #10 would see the patient in the Emergency Room and they were not going to see him in the future ..."

Hospital B's ED Physician Call Schedule for Neurosurgery for the Month of December 2011, included the following on-call physicians:
12/27/11: Primary on-call physician, Personnel #10; Backup physician, Personnel #9.
12/28/11: Primary on-call physician, Personnel #10; Backup physician, Personnel #9.

Professional Services Agreement:
The written contract between Hospital B and the neurosurgeon (Personnel #10) included the following requirements to be fulfilled by the contractor (Personnel #10):
- "Contractor will provide Emergency Department call coverage in accordance with Facility's Bylaws, Rules and Regulations and Policies and Procedures and in accordance with the call schedule maintained by the Facility."
- "Contractor must provide timely and complete coverage services 24 hours per day, 7 days per week as assigned by ED call schedule as set forth by Medical Staff Bylaws and Rules and Regulations."
- "Contractor must respond to Facility Emergency Department in accordance with Trauma Team Activation Guidelines ..."
- "Contractor must be dedicated to the facility when on call. Contractor will have posted backup coverage in the event dedicated call surgeon is engaged in patient care and unavailable..."
- "Contractor will accept patient transfers requiring neurosurgical services within physician capabilities from all facilities which have been approved by Facility..."
- "Contractor will personally evaluate all ED patients requiring neurosurgical consultation..."

Hospital B's "Medical Staff By-Laws," which also included a section of "Medical Staff Rules & Regulations," last revised 09/04/08, required that physicians: "when on call to the Emergency department for the respective department/specialty, members of the staff shall accept responsibility for emergency service care of their own patients as well as those patients determined to be unassigned to any physician ...the on-call physician must respond to the Emergency Department within 30 minutes of being paged; and arrive at the hospital within one hour if the clinical situation warrants the presence of the on-call physician as determined by the Emergency Department physician."

The Physician Re-credentialing File of both Personnel #9 and Personnel #10's revealed each of these neurosurgeons signed a statement that they "agreed to abide by the Medical Staff Bylaws, Rules & Regulations and Policies & Procedures of (Hospital B), if reappointed to the Medical Staff."

In an interview at 3:45 PM on 02/27/12 with the Director of Medical Staff Services(Personnel #8), she stated that Hospital B had addressed this lack of response from the neurosurgeon (Personnel #9), by following the Medical Staff By-Laws, and it's process as documented in the Medical Executive Committee (MEC) minutes on 01/18/12. Personnel #8 verified that the lack of response from Personnel #10,was being addressed according to his contract with the facility, and the issue had been referred to administration for contractual enforcement.

In a telephone interview at 4:00 PM on 02/28/12 with the Chief of Medical Staff (Personnel #11), he confirmed that Hospital B had proceeded according to the Medical Staff By-Laws, and that he had been personally involved in this process.

Hospital B's "Trauma Patient Evaluation, Admission, transfer in the Emergency Department" policy, last revised 09/2011, noted: "Trauma patients with a High Risk of serious injury who, during or after evaluation by the ED, have been determined to require hospitalization and immediate surgical evaluation will receive a surgical evaluation in the Emergency Department (ED) by the appropriate surgical service prior to admission to the hospital...physicians, Admitting and/or Consulting, shall arrive within 30 minutes of notification as requested by the ED physician ...the ED physician will determine if a patient is considered to be at High Risk for serious injury ...and may use this list as part of their evaluation in determining if a patient is at high risk...and, includes...Falls over 10 feet."

Based on record review and interviews, the facility (Hospital B), under 489.24(d)(1),
failed to provide the necessary stabilizing medical treatment that was needed for 1 of 1 patient (Patient # 1), and which was within their capacity as a Trauma Center, in that, the 2 neurosurgeons on-call refused to come to the hospital when called.

Findings Included:

Review of the medical record for Patient # 1, revealed he had been transferred from Hospital A to Hospital B on 12/27/11, to be evaluated and treated by a neurosurgeon for identified spinal fractures received in a fall down 2 flights of stairs, 2 days prior. An evaluation by Hospital B's Emergency Department (ED) physician (Personnel # 12), at 9:28 PM described specific neck and back pain, and a sensory deficit present (numbness and tingling to the left arm and slightly weaker grip in left hand).

Hospital B's ED Physician Call Schedule for Neurosurgery for the Month of December 2011, included the following on-call physicians:
12/27/11: Primary on-call physician, Personnel #10; Backup physician, Personnel #9.
12/28/11: Primary on-call physician, Personnel #10; Backup physician, Personnel #9.

The Trauma surgeon noted: "plan was to have neurosurgery consultation on the patient ...upon consultation with the neurosurgeon, the neurosurgeon on-call refused to see the consult ...I referred this to the chief of surgery, who had asked if I would consult the neurosurgeon on-call for spine, Personnel #9 ...I called his partner, Personnel #10....subsequently, Personnel #9 called back and reported that neither he or Personnel #10 would see the patient in the Emergency Room and they were not going to see him in the future ..."

The ED physician documented the following in the medical record, regarding the lack of response from the 2 neurosurgeons on-call the early morning of 12/28/11:
01:45 AM: It does not appear that we will be able to obtain a spine/neuro surgery consult. Trauma surgeon has been attempting to coordinate care of Patient #1 for the last few hours and has agreed to coordinate transfer to Hospital C if necessary.

In a telephone interview at 4:00 PM on 02/28/12 with the Chief of Medical Staff (Personnel #11), he confirmed that Hospital B had not been able to provide the medical treatment necessary to stabilize Patient # 1, and which was within the hospital's capacity, as neither of the 2 on-call neurosurgeons had responded when called.

Evaluation, Admission, transfer in the Emergency Department" policy, last revised 09/2011, noted: "Trauma patients with a High Risk of serious injury who, during or after evaluation by the ED, have been determined to require hospitalization and immediate surgical evaluation will receive a surgical evaluation in the Emergency Department (ED) by the appropriate surgical service prior to admission to the hospital...physicians, Admitting and/or Consulting, shall arrive within 30 minutes of notification as requested by the ED physician ...the ED physician will determine if a patient is considered to be at High Risk for serious injury ...and may use this list as part of their evaluation in determining if a patient is at high risk...and, includes...Falls over 10 feet."