By Phil Galewitz, The Palm Beach Post, Fla. Knight Ridder/Tribune Business News
May 6--WEST PALM BEACH, Fla. -- St. Mary's Medical Center, already cited by state and federal government health officials for a lack of emergency neurosurgical care, now faces allegations that it doesn't provide adequate neurological treatment in the emergency room either, according to state inspection reports recently obtained by The Palm Beach Post.
The lack of specialists to treat emergencies has resulted in delays in patient care, state officials say in the documents sent last month to St. Mary's officials.
Even though St. Mary's has at least 11 neurologists on staff, it has neurologists working in the emergency room only two weeks a month, spokesman Don Chester said Tuesday. On the other days, emergency neurology patients are seen by internists. Neurologists, who treat injuries to the brain such as strokes, are then consulted and come to treat the patients if they are admitted.
Most neurologists prefer to 'consult' to the hospital rather than work in the emergency room because they can be 'selective' in which patients they treat, an assistant to West Palm Beach neurologist Russell Wilson said, allowing them to avoid the higher risk patients.
Doctors at Palm Beach Neurology, central Palm Beach County's largest neurology group with seven doctors, no longer provides emergency room coverage at St. Mary's, a receptionist confirmed Tuesday. Doctors in the group refused to comment.
State regulations require hospitals that provide elective medical services in a specialty such as neurology to provide around-the-clock emergency care through an agreement with their doctors or a transfer agreement with a nearby hospital. If a hospital does not meet that criterion it must seek an exemption from the rule through the state Agency for Health Care Administration.
Neurologists are among a number of specialists that have reduced emergency room treatment in Palm Beach County as a result of soaring medical malpractice insurance rates. The higher premiums have forced many specialists to drop the coverage and avoid treating emergency patients.
When a Post reporter recently asked state health officials for a list of Palm Beach County hospitals cited for violating the state's hospital emergency care regulations, the state provided records showing St. Mary's was the only hospital cited over the past year.
St. Mary's is not the only county hospital without neurologists treating emergency patients around the clock, however. JFK Medical Center in Atlantis also does not have that level of care in the emergency room, a hospital spokeswoman said.
State officials conducted a surprise inspection at St. Mary's on March 31, after getting a complaint that the hospital is 'dumping patients to other hospitals when they have the capability in house to provide services for neurology and neurosurgery,' according to state inspection reports.
State officials confirmed the complaint through interviews with hospital officials and review of medical records.
A review of 20 neurosurgery or neurology patients at St. Mary's in February and March revealed five cases in which patients faced delays in getting care, state records show. The hospital is trying to recruit more neurologists to treat emergency patients, spokesman Chester said.
St. Mary's rectified its neurosurgical care problem on April 1, by having neurosurgeons in the trauma center also provide care to non-trauma patients.
That was a month after St. Mary's received notice from the U.S. Centers for Medicare and Medicaid Services that it would be ejected from the Medicare program in April if it did not fix procedures that led to the hospital refusing to provide emergency neurosurgical care to a patient in February.
The notice was later lifted.
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(c) 2004, The Palm Beach Post, Fla. Distributed by Knight Ridder/Tribune Business News.
