HospitalInspections.org

Based on record review, policy review, and interview, the hospital failed to comply with the provider agreement as defined in ?489.24(a) when the on-call orthopedic surgeon refused to come in and provide treatment necessary to stabilize one of one sampled patient (2) with an emergency medical condition. Findings include:

1. Review of patient 2's medical record dated 1/21/12 revealed he had reported to the emergency department (ED) with a comminuted fracture of the left thumb with tendon damage. After ED physician A's initial examination of patient 2 he requested orthopedic surgeon B to come in and evaluate the patient. Orthopedic surgeon B told ED physician A he did not do hands, and patient 2 would have to go to another provider that did hand procedures.

Review of orthopedic surgeon B's credential file revealed he had been granted privileges to perform hand surgery including tendon repair and internal fixation of fractures of the hand.

Interview on 1/31/12 at 12:15 p.m. with orthopedic surgeon B confirmed he had refused to come in and evaluate patient 2. He stated he probably had privileges to do the surgery patient 2 had required.

Based on record review, interview, and policy review, the provider failed to ensure on-call orthopedic surgeon B presented to the emergency department (ED) when requested by ED physician A for one of one emergency room patient (2) that required orthopedic consultation. Findings include:

1. Review of the 1/21/12 ED record for patient 2 revealed he had presented to the ED for treatment of an injured left thumb. After the initial assessment ED physician A examined patient 2. The patient had no movement of the distal thumb. The examination revealed extensive tendon involvement, and x-rays revealed a displaced transverse fracture of the proximal phalanx of the left thumb. Significant soft tissue injury also appeared to be associated with the fracture. The ED physician contacted orthopedic surgeon B who was on-call and requested he come in to consult with the patient. Orthopedic surgeon B stated he did not do hands, so the patient should be transferred to the care of a hand surgeon at another healthcare provider. The other provider's ED had been contacted and had accepted patient 2. After further cleaning and bandaging of the wound patient 2 was transferred by private vehicle to the other healthcare provider.

Interview with the director of emergency services on 1/31/12 at 11:15 a.m. revealed:
*She had been notified on 1/21/12 that orthopedic surgeon B had not come in to evaluate a patient, and the patient had been transferred to another healthcare provider.
*She stated that was not the first time orthopedic physician B had not come in for a consultation that had been requested by the ED physicians.
*She had received a total of two calls on 1/21/12 and a call on 12/25/11 regarding orthopedic surgeon B.

Interview with orthopedic surgeon B on 1/31/12 at 12:15 p.m. revealed he probably was privileged to do major hand surgery but had elected not to. He further said in those cases normally you would just wash the wound, stitch it, and send the patient to a hand surgeon.

Phone interview with patient 2 on 1/31/12 at 1:30 p.m. revealed:
* He had presented to the ED for treatment of an injured left thumb.
* He stated it would have been closer for him to have gone to another healthcare provider for treatment, but he wanted to have it treated at this ED. He said he had been told he would have to go to the other healthcare provider, since the hand surgeon was not available.
* He confirmed the wound was cleaned and bandaged, and he was transferred to another healthcare provider via private vehicle.

Review of orthopedic surgeon B's credential file revealed:
*His temporary privileges had been granted effective 8/15/11.
*Temporary privileges were in effect for one year.
*Orthopedic core privileges granted included:
-Major hand surgery for tendon grafts, joint implants, tendon transfers/repairs, nerve repairs/grafts, open and closed fracture/dislocations, and internal/external fixation.

Review of the provider's Medical Staff Bylaws reviewed 12/2/10 revealed when an orthopedic case was in the ED, the ED physician must clear the patient of all other injuries before requesting an orthopedic consult. The orthopedic surgeon was required to come to the ED and to assess the patient and decide on the admission status.