HospitalInspections.org

Based on record review and interview the on call Health Care Provider failed to follow policy and EMTALA regulations by failing to come to the Emergency Department when requested necessitating transfer of a patient that the facility had capability and capacity to admit in 1 of 7 patients (Pt. #1) in a sample of 20 records reviewed

On Call Health Care Provider failed to respond to request to evaluate a patient in the ED. See Tag 2404.

Based on interview and record review the facility, with capacity and capability to admit, found it necessary to transfer a patient in need of orthopedic care when the on-call orthopedic surgeon failed to come to the hospital when requested to evaluate and treat the patient for 1 of 7 patients (Pt. #1) in a sample of 20 records reviewed.

Findings include:

The facility policy titled, "EMTALA (Emergency Medical Treatment and Labor Act) On-Call" dated December 14, 2020 revealed under Guidelines/Procedures, "G. Physician's Responsibility: The hospital must have a process to ensure that when a physician is identified as being "on-call" to the DED (dedicated Emergency Department) for a given speciality, it shall be that physician's duty and responsibility to assure the following: 1. Immediate availability, at least by telephone, to the DED physician for his or her scheduled "on-call" period, or to secure a qualified alternate if appropriate. 2. Arrival or response to the DED within a reasonable timeframe (generally, response is expected within 30 minutes). The DED physician, in consultation with the on-call physician, shall determine whether the individual's condition requires the on-call physician to see the individual immediately. The determination of the DED physician or other practitioner who has personally examined the individual and is currently treating the individual shall be controlling in this regard."

Review of Pt. #1's medical record revealed that on 6/5/2021 at 9:00 PM ED (Emergency Department) Health Care Provider T accepted transfer of Pt. #1 from an area Critical Access Hospital. The medical record revealed that the patient arrived at 11:17 PM and was immediately assessed by ED (Emergency Department) Health Care Provider T. The record revealed that Trauma Surgeon I was at the bedside at 11:38 PM. Further review of the medical record revealed that ED Health Care Provider T spoke with On-call Orthopedic Surgeon J at 11:45 PM "regarding trauma transfer pt. injuries".

Further review of Pt. #1's medical record "ED Provider Note" from ED Health Care Provider T, revealed, "I spoke with on-call orthopedic surgeon (J) as patient has significant orthopedic injuries to the left lower extremity including comminuted (a bone that is broken in more than 2 pieces) and displaced (the bone is out of alignment) left proximal tibia/fibula (bones in the lower leg) fracture. Dr. (Orthopedic Surgeon J) refused to see patient in this hospital as he was not notified by access one about patient prior to patient arrival, and stated that he would not see, evaluate or treat patient at this facility as patient was already here, and he was not notified prior to patient being transported here or been accepted for transfer. I spoke with (Trauma Surgeon I) who again contacted (Orthopedic Surgeon J), who still refused to see the patient. As patient has significant orthopedic injuries requiring evaluation of left lower extremity, and monitoring for compartment syndrome (a condition resulting from increased pressure within a confined body space, especially of the leg or forearm), was forced to transfer patient to Aurora Health..." The record revealed Pt. #1 was transferred to Aurora BayCare on 6/7/2021 at 2:38 AM.

Record review of the Access One (the phone call center for transfers and consults) Trauma Protocol revealed, "All Adult Trauma calls (including falls) go directly to ED and accepted through ED. Specialties will be contacted by ED provider if requested..."

On 6/13/2021 at 7:30 AM in interview with ED RN K, ED RN K stated, "We don't call the speciality until we know what the need is."

On 6/13/2021 at 1:00 PM during interview with Trauma Surgeon I when asked about her interactions with on call Orthopedic Surgeon J the evening of 6/6/2021 stated, "I sent a text message to him asking if he was sure that he wanted him transferred. It was a complex fracture but I thought that we could have cared for the patient here. I was surprised that we were sending him out so that is why I reached out to Orthopedic Surgeon J and his reply to 'Are you sure we should transfer? Was yes.' I did go and talk with the patient because he was not happy about being transferred again."