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PALMETTO GENERAL HOSPITAL 2001 W 68TH ST HIALEAH, FL 33016 Aug. 29, 2017
VIOLATION: MEDICAL STAFF BYLAWS Tag No: A0353
Based on record review, Bylaws review, and interview the facility failed to make available by request of the attending physician a cardiac consultation for 1 out of 10 Sample Patients (SP) #1.

Findings include:

Review of the ED record revealed that (Sampled Patient) SP#1 came to the Emergency Department (ED) on 6/19/17 with complaints of chest pain for 2 weeks with associated shortness of breath as noted on the ED (Emergency Department) Physician Notes. His chest pain is on and off and he has not experienced this complaint before. He had associated shortness of breath for one week. The pain is aggravated by exertion and running. Pt (patient) was recently seen in an urgent care and was sent to the emergency room of the hospital. Pt has not been seen by a cardiologist. Diagnosis: Myocardial Infarction-non ST elevation (a type of a heart attack), congestive heart failure.

Review of the Consultation Report on 6/20/2017 at 13:47 PM authenticated by cardiologist physician- J revealed that patient was seen and examined at bedside this morning with family present about 10:30 am. He (the patient) stated he felt better and no longer was complaining of chest pain or SOB (shortness of breath). However about 1 (one) hour later a code blue was called as patient went into v-fib (arrhythmia). ACLS (Advanced Cardiac Life Support) (resuscitation) was done. The patient expired.

Review of the Emergency Department (ED) Physician Notes date 6/19/2017, at 21:01 PM, authored by Physician Assistant - M showed: Spoke to MD - I the Attending Physician, who states he wants the cardiologist to be called before he gives any orders.


Review of the Emergency Department (ED) Physician Orders date 6/19/2017, showed an order for a Consult for physician- L the Cardiologist on call ordered on 6/19/2017 at 21:02 PM which showed no return call on 06/19/2017 at 22:57 PM.

Review of the emergency room Call Schedule for June 2017 showed On call Cardiologists MD -L was the on-call Cardiologist scheduled for 6/19/2017.

On 06/20/2017 at 09:00 am SP #1 nursing notes showed patient stated that he had mild shortness of breath at this time. House Intern notified of patient complaints. Unable to reach Attending Physician MD - I residents at this time. At 10:00 am, SP # 1 was noted with episodes of Bigeminy (irregular heart rate) at this time. The 2nd cardiologist called to update on the episodes.

Review of the Discharge Summary dated 06/20/2017 showed SP #1 troponins level was critically elevated. He was diagnosed with a NSTEMI (Non Segment Elevation Myocardial Infarction) and a cardiologist was called from the ER (emergency room ). Calls were placed to the On call Cardiologist MD-L and to 2nd Cardiologist MD -J. The 2nd Cardiologist was called and he advised he would see the patient in the morning for Cardiac Catherization. The patient was short of breath in the ER and his ABG (Arterial Blood Gases) revealed hypercapnic respiratory failure. The following morning his cardiac enzymes were still critically elevated but trending downward. A rapid response was called that rapidly turned into a code blue when the patient was found unresponsive. Based on the telemetry monitoring it appeared that he was in V-fib (Ventricular Fibrillation). The patient was coded and the patient expired.

On 8/29/2017 at 10:00 am, the Chief Quality Officer stated that the consult with MD - L the Cardiologist on call is not a STAT (immediate) call. It is a courtesy call. He does not have to return the call. He does not have to show up.


Review of the "Medical Staff Bylaws and Rules and Regulations",( revised: December 2016) under " Emergency Services"( page 10, R - 11.02.05) states that in the event a physician is unable to cover his/ her scheduled emergency room call, he/she shall be responsible to provide coverage by a physician with his/ her subspecialty and who is currently a member in good standing of the Hospital's Medical Staff.