HospitalInspections.org

A0375

Based on review of documents and interviews with facility staff, the facility failed to accept an appropriate transfer of an individual who required specialized capabilities which the facility had the capacity to treat as the facility's on-call urologist refused to accept a patient who required emergency surgery. this was in violation of facility policy and potentially resulted in a delay in treating a patient with a condition requiring emergency surgery.

The findings were:
Selected facility policies and procedures were reviewed on 2/25/13. The facility policy entitled "EMTALA-duto to Accept" #P&P 2511 with a review date 4/11 reflected in part "policy: to the extent that the Hospital has specialized capabilities or facilities that are no available at a United States facility that has asked the Hospital to accept the transfer of an individual needing those capabilities or facilities, the Hospital shall accept appropriate transfers of such individuals if the Hospital has the capacity to treat the individual. "Capacity" mans the ability of the Hospital to accommodate an individual who has been referred or transfer from another medical facility, and encompasses such things as numbers and availability of qualified staff, beds and equipment..Procedure: 1.(The facility) shall accept the patient if it has the capacity to do and if the patient required the specialized capabilities for facilities of the Hospital...5. Only the hospital-designated personnel and the emergency physician may accept the transfer of individual's on the hospital's behalf. On-call physicians should not be permitted to accept or refuse transfers on the hospital's behalf."

The facility policy entitled "On-Call Specialists" #03 with a review date of 6/10 reflected in part "Statement of Purpose" To maintain a current formulation of on-call physicians responsible for providing consultations within their specialty. Statement of policy: 1. Schedules, 1.1 The Emergency Department (ED is provided with a monthly call schedule of credentialed physicians in a variety of specialties...1.3 It is his duty to provide coverage should he be unavailable...2. Response time The on-call specialists is expected to respond at least by telephone within 30 minutes...4. On-call Physician Evaluation in the emergency Department, 4.1 When requested by the Emergency Physician, on the on-call physician shall evaluate the patient in the Emergency Department."

The facility Medical Staff Bylaws dated 3/21/12 reflected in part "Active Staff members must: (a) assume all the responsibilities of membership on the Active Staff, including emergency call, care for unassigned patients...(ac) accept consultations where applicable." The Medical Staff Rules and Regulations dated 12/19/12 reflected in part "Section 8. Emergency Admissions: (b) Emergency admissions patient who do not have a personal physician with admitting privileges shall be assigned to an on-call Medical Staff member with privileges in the specialty to which the diagnosis indicates an assignment is appropriate...If the Medical Staff member on call is unable to take assignment when scheduled, it shall be that individual's responsibility to assist the arrangement of a qualified substitute."

The facility Emergency Department Call Schedule for February 2013 was reviewed on 2/25/13. On 2/16/13 and 2/17/13, Staff #6 was listed as on call on the Surgery Emergency Room Call Schedule for Urology.

The medical record of patient #21 from a local facility #1 was reviewed on 27/27/13. The Trauma Center Not by staff #9 dated 2/17/13 reflected in part "The patient is a 23-year-old-male who presented to the emergency department complaining of left testicular pain that began about 2 hours prior to his arrival here. He said that he had the severe onset of left testicular pain and pain in his left flank. He denies any trauma or injury to this region and no previous history of similar problems...STAT(immediate) testicular ultrasound was done which revealed no measurable vascular flow to the left testicle or left epididymis consistent with acute torsion and he did have a left hydrocele. The right testicle appeared to be normal. At this point it was about 3-1/2 hours from the onset of his symptoms. We had no urology coverage here a local facility #1 or at local facility #2. At 3:25 a.m. I talked to...urologist on call at the facility. he refused to take the patient and hung up on me. At 3:40 a.m. the situation was discussed with...Urologist on call at local facility #3 who very graciously accepted the patient in transfer."

Staff #5 was interviewed in person on 2/26/13 at 8:00 am in an office. Staff #5 was asked if he was the house supervisor during the early morning hours of 2/17/13 and he stated he was. He was asked if he recalled getting a request for transfer of an patient with testicular torsion. He stated that he got a call from the supervisor of local facility #1 regarding a young man in their ED with testicular torsion who needed a urology consult. He stated he gave administrative approval but advised the supervisor their physician needed to talk with the ED physician. Staff #5 stated his understanding was the facility ED physician had given approval for the transfer but wanted the locale facility #1 ED physician to speak with the facility's urologist on call to let him know about the patient.

Staff #6 was interviewed in person in his office adjacent to the facility on 2/26/13 at 8:35 am. He was asked if he was on call during the early morning hours of 2/17/13 for the facility ED and he stated he was. He was asked if he was called that night regarding a patient with testicular torsion. He stated he received a call around 2 am Sunday (2/17/13) from someone at local facility #1 regarding a patient with what sounded like testicular torsion and wanted to refer the patient for a urology consult. Staff #6 stated he did not accept the patient because it thought it was inappropriate to transfer a patient over 100 miles who needed emergency surgery. He further stated that there were at least three urologists in a local city but they do not ever cover call. He as asked if the patient' insurance status came up, and he stated that he did ask if the patient had insurance. He further stated that the patient's lack of insurance had no bearing on his decision not to accept the patient.