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Based on medical record reviews, policy and procedure review, on-call schedule reviews, Medical Staff Rules and Regulations, and staff interviews, the facility failed to ensure that the Urologist who was on-call for duty responded to the Emergency Department (ED) physician's telephone calls after an initial examination, in order to provide further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition for 1 (Patient #9) of 20 sampled medical records reviewed.

Findings include:

Refer to findings in Tag A- 2404.

Based on medical record reviews, policy and procedure review, on-call schedule reviews, Medical Staff Rules and Regulations, and staff interviews, the facility failed to ensure that the Urologist who was on-call for duty responded to the Emergency Department (ED) physician's telephone calls after an initial examination, in order to provide further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition for 1 (Patient #9) of 20 sampled medical records reviewed.


The findings include:

Medical Record Review for Patient #9

Closed medical record review conducted on 11/21/2019 revealed Patient #9 was a 18-year-old male who presented to the Hospital A's Dedicated Emergency Department (DED) on 10/24/2019 at 0115 with a complaint of Groin Pain. Review of an ED Provider Note written by Medical Doctor (MD) #2 on 10/24/2019 at 0211 revealed, "...18 yo (year old) male presents to the ED via POV (Privately Owned vehicle) from home with his s/o (significant other) ... Pt was seen in the ED Monday and Dx (diagnosed) with epididymis (Inflammation of tube at the back of the testicle). Pt states pain and swelling have since increased. Pt has taken oxycodone and ibuprofen for pain ... I have attempted manual detorsion after 50 mics (micrograms) and then another 50 mics of fentanyl Intravenous (IV). External rotation 270 degrees ... Difficult due to swelling and indurated testicle ... 3:00 AM Telerads has read the case and shows that patient has torsion. Further review of the ED notes revealed that Radiology (Telerads) had called the ED physician with Critical values, "Critical: (L) Testicular Torsion (a true surgical emergency - a condition due to rotation of the testis and consequent strangulation of its blood supply) of Left testicular. Documentation in the ED notes also noted that at 0328, "Tried to call MD #1 (Urologist on call for Urology on 10/24/2019) at 0257 and 0305, about patient (#9) to call MD #2. No call back after leaving message. the ED physician also documented, I have not had a call back from the on-call (Wilkes Regional Medical Center -Hospital A) urologist. I have also not received a call back from the (Hospital B) urologist, so I called the ED attending at (Hospital B) who is expected (sic) the patient ..." Review of a radiology report written by MD #3 on 10/24/2019 at 0945 revealed, "...Left testis ...Absence of flow identified ... Absence of arterial and venous blood flow ... Heterogeneous avascular left testicle consistent with the acute testicular torsion and suspected infarction ..." A review of the electronic transfer certification dated 10/24/2019 specified in part, "Reason for transfer: Testicular torsion...On-Call Physician: failed to Respond...No call back despite attempts." Further review revealed Patient #9 was transferred to Hospital B on 10/24/2019 at 0402 via air ambulance, where his testicle was surgically removed.

Medical Staff Rules and Regulations

Review of Medical Staff Rules and Regulations, approved 02/2009 revealed, "...Each member of the Active Medical Staff is also expected to be available on a routine basis for emergency call in his specialty and to arrange coverage by a member of the Active Medical Staff if unavailable. An appointee within a Specialty group with three or fewer members shall be required to take a minimum of six unassigned call days per month, to include two weekend days (Saturday/Sunday) ..."

On- Call physician schedule:

A review of the October 2019 urology hospital coverage calendar (on-call list) documented Urologist #1 was on call 10/24/2019.

Interviews:

Telephone interview was conducted with Urologist #1 on 11/21/2019 at 1134. Interview revealed he was the Urologist on call on 10/24/2019 and he never received a call from the DED regarding patient #9. Interview revealed Urologist #1 was not certain why, and it may have been a phone glitch or poor cellular service signal.

Interview was conducted with the Senior Physician/Network Liaison on 11/21/2019 at 1030. Interview revealed the lack of response from Urologist #1 regarding Patient #9 was sent for peer review, and Urologist #1 received a verbal reprimand. Interview revealed the facility created a new phone list for all on-call physicians, including multiple cellular numbers, including significant others and home phone numbers, to ensure on-call physicians would not miss phone calls again.


Policy and procedure

The policy titled, EMTALA (Emergency Medical Treatment and Active Labor Act: Screening, Stabilization, and Transfer of individuals with Emergency Medical Condition) Original effective Date: 3/19... Date approved 3/7/2019. The policy revealed in part, "E. On Call Physicians WMC (Wilkes Medical Center) maintains a list of on-call physicians, including specialists and sub-specialty that are available for duty to screen, examine, and treat patients with potential Emergency Medical Conditions. On-Call physicians respond to WMC calls for emergency coverage within 30-60 minutes...after receiving communications indicating that their attendance required."

The facility failed to ensure their policy was followed as evidenced by failing to ensure the Urologist (Urologist #1) on duty on 10/24/2019 responded to the ED physician call as further evaluation and treatment was needed for Patient #9, who had an identified EMC.