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Based on review of facility documents, medical records (MR) and staff interview (EMP), it was determined the facility failed to comply with 489.24(f) related to Recipient Hospital Responsibilities.

Findings include:

Review on January 31, 2025, of facility documents, review of medical record (MR1) and staff interview (EMP) revealed the facility's Emergency Department (ED) on-call Obstetrical and Gynecology (OBGYN) physician failed to accept a patient (MR1) requiring specialized OBGYN treatment which was within Geisinger Wyoming Valley Medical Center's capabilities to treat.

Cross reference:
489.24(f) Recipient Hospital Responsibilities.

Based on review of facility documents, medical records (MR) and staff interview (EMP), it was determined the facility's Emergency Department on-call Obstetrical and Gynecology (OBGYN) physician failed to accept a patient requiring specialized OBGYN treatment which was within Geisinger Wyoming Valley Medical Center's capabilities to treat for one of one applicable medical record reviewed (MR1) and the facility failed to ensure all Obstetrical and Gynecology (OBGYN) physicians were re-educated regarding compliance with the facility's Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. 1395 and subsequent federal interpretive guidelines and state regulations for one of one applicable Credential Files reviewed (CF1).

Findings include:

Review on January 31, 2025, of the Outside Hospital 1 (OSH1) memo to the Department of Health (Department) dated March 5, 2024, revealed this hospital ceased Emergency Department call coverage for GYN services at the facility effective May 5, 2024.

Review on January 31, 2025, of the facility's "EMTALA System Policy", last template version January 27, 2023, revealed "Purpose ... To comply with the Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. 1395 and subsequent federal interpretive guidelines and state regulations ... Definitions Capability mean that an organization provides the requested medical services ... Procedure ... Patient Transfers to Geisinger Facilities The hospital will accept transfers from other facilities to provide the specialized services when the requesting facility does not have the capability to provide such specialized service and the hospital has the capability and capacity to provide the needed emergency care ..."

1. Review on January 31, 2025, of MR1(medical record from transferring facility) revealed this patient was admitted to OSH1 on December 31, 2024, for vaginal bleeding, shortness of breath and acute anemia; MR1 required several blood transfusions to replace blood loss and on January 3, 2025, MR1 had a total laparoscopic hysterectomy with bilateral salpingectomies for abnormal uterine bleeding. MR1 was discharged to home on January 8, 2025.

Review on January 31, 2025, of MR1 revealed this patient presented to OHS1's Emergency Department (ED) on January 26, 2025, with a chief complaint of significant abnormal vaginal bleeding with large clots and this patient required a blood transfusion while in OHS1's ED.

Review of MR1 on January 31, 2025, revealed physician documentation by OTH1 at OSH1 dated January 26, 2025, at 1324, indicating OTH2 (the physician who performed MR1's total laparoscopic hysterectomy with bilateral salpingectomies) was out of town and this physician's partner was also out of town, leaving no coverage for this physician practice. At 1548, OTH1 documented the conversation with CF1 at Geisinger Wyoming Valley Medical Center that CF1 stated they were not able to see OTH2's patients per a Geisinger memo and declined the transfer of MR1 to Geisinger Wyoming Valley Medical Center. CF1 suggested OTH1 call Outside Hospital 2 (OSH2).

Further review of MR1 revealed documentation by OTH1 on January 26, 2025, at 1645 indicating OTH1 called OSH2; received instructions from the OBGYN to pack MR1's vagina with gauge to try and slow the bleeding and to transfer MR1 to OSH2. MR1 was transferred to OSH2 on January 26, 2025, at 1709 by ambulance accompanied by Advanced Life Support (ALS) and cardiac monitoring.

Review on January 31, 2025, of MR1 revealed OTH2 (ED physician at OSH2) assessed this patient and determined that MR1 continued to have abnormal vaginal bleeding accompanied with pelvic and back pain; a blood clot was removed from the vagina which resulted with bleeding bright red blood. OTH4, OTH5 and OTH6 determined MR1 required additional surgery; MR1 was taken to surgery on January 27, 2025, for vaginal cuff dehiscence after a recent hysterectomy with a suspected pelvic abscess / infected hematoma and foul-smelling drainage from the vaginal cuff. MR1 continued to be an inpatient in OSH2 at the time of the survey on January 31, 2025.

Review on January 31, 2025, of the facility provided audio recording from the Communications center dated January 26, 2025, revealed the conversation between OSH1 and CF1 indicating MR1 continued to have abnormal vaginal bleeding and the request for acceptance of this patient's transfer to Geisinger Wyoming Valley Medical Center. CF1 was heard to say they were not able to see OTH2's patients per a Geisinger memo and declined the transfer of MR1 to the facility and CF1 suggested OTH1 call Outside Hospital 2.

Interview with EMP1, EMP2, EMP3 and EMP4 on January 31, 2025, confirmed the above findings. EMP1 revealed CF1 was the on-call OBGYN physician on January 26, 2025.

Telephone interview with CF1 on January 31, 2025, at approximately 1230 confirmed this physician received a phone call from OTH1 at Outside Hospital 1 requesting transfer acceptance of MR1, who was bleeding following a hysterectomy; CF1 stated they were not able to see OTH2's patients per a Geisinger memo and declined the transfer of MR1. CF1 suggested OTH1 call Outside Hospital 2.

Interview with EMP1, EMP2, EMP3 and EMP4 on January 31, 2025, confirmed the above findings.

Review on January 31, 2025, of a facility provided documentation distributed by CF2 on September 2, 2024, at 1332 to all OBGYN providers revealed instructions to the OBGYN physicians to be mindful of the information they would disclose to OTH2 since this physician no longer had security clearance at Geisinger and to refrain from assuming the care of any of OTH2's private practice patients or assisting in any surgical cases.

Telephone interview with CF2 on January 31, 2025, at approximately 1320 confirmed the above instructions to the OB physicians to be mindful of the information they would disclose to OTH2 since this physician no longer had security clearance at Geisinger and to refrain from assuming the care of any of OTH2's private practice patients or assisting in any surgical cases.


2. Review on January 29, 2025, of the facility report to the Department revealed documentation the facility was reporting a potential EMTALA violation regarding a transfer of a GYN patient that was refused by the facility's GYN service for admission. The Transfer center reached out to the on call GYN provider who refused the patient due to surgery being done by a private practice physician. The provider recommended the patient be sent to another facility. The facility stated there would be a mandatory review of EMTALA policy with all of OBGYN physicians.

Review on January 31, 2025, of the facility provided education of all OBGYN physicians revealed no documentation that CF1 received the mandatory education or review of the facility's EMTALA policy.

Interview with EMP1 on January 31, 2025, revealed the facility forgot to include CF1 in the mandatory education and review of EMTALA policy.

Cross reference
489.20(l) Compliance with 489.24