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Based upon interview, medical record review and document review, it was determined that the facility failed to accept Patient #1 in transfer despite the availability of the specialized services and the capacity to treat the patient ensuring compliance with 42 CFR 489.24(f) and the related provisions at 42 CFR 489.20.

Findings include:

Medical record review, interview and document review revealed the recipient hospital refused to accept Patient #1 in transfer despite the availability of the specialized services and the capacity to treat the patient. Please reference findings under Tag A-2411.

Based on medical record review, interview and document review, the recipient hospital refused to accept Patient #1 in transfer despite the availability of the specialized services and the capacity to treat the patient.

Findings Include:

Telephone interview on 5/14/14 with Staff # 1, Systems Coordinator for Risk Management revealed Patient #1 presented to the sending hospital on 5/1/14. She was diagnosed with an ectopic pregnancy. They do not have Obstetrics (OB)/Gynecologic (GYN) services. Staff # 12, Physician Assistant from the sending hospital contacted Staff #9, OB/GYN Physician at the receiving hospital, who accepted Patient #1 as a transfer. Staff #9, OB/GYN Physician called the facility back indicating he had changed his mind and would not accept Patient #1 in transfer. Patient #1 was eventually transferred to another hospital.

Telephone interview on 5/14/14 at 10:30AM with Staff #9, OB/GYN Physician at the receiving hospital revealed Patient #1 presented to the sending hospital on 5/2/14 with a complaint of pain. She had a positive pregnancy test but was very early. No pregnancy was seen in the uterus. He initially said he would accept the transfer but realized he wasn't covering for OB, only GYN at the receiving hospital. He called the practitioner at sending hospital back and refused the transfer. " To me, it didn't look like an emergent problem and did not require a transfer. There was a miscommunication of who was covering (OB). " The covering OB physician/practitioner was not consulted.

Review on 5/14/14 of the sending hospital ED medical record revealed Patient #1 was triaged on 5/1/14 at 10:27PM with complaint of lower, middle abdominal pain. Patient #1 states she had her tubes tied a few years ago. Patient #1 was examined by Staff # 12, Physician Assistant. Testing revealed a positive pregnancy. A transvaginal ultrasound shows no intrauterine gestation and ectopic pregnancy. On 5/2/14 at 2:00am Staff #12, Physician Assistant spoke to Staff # 9, OB/GYN physician at receiving hospital who accepted Patient #1 in consultation and requested she be sent directly to the emergency room at the receiving hospital for evaluation. At 2:09am Staff #12, Physician Assistant documents " The patient was initially accepted by Staff #9, OB/GYN Physician. However, he called me back and advised me that he has no responsibility to take this patient and that he does not have to take coverage from the sending hospital. He is only responsible for patients who present to his facility, a sister facility and his own patient population. He flat out refused to take this patient and advised me to find another provider." Another facility was contacted and accepted the transfer of Patient #1.

Review on 5/14/14 of the on-call provider schedules revealed the following:
- The Arnot Medical Services (AMS) OB/GYN On-call Schedule for May 2014 indicates Staff #9, OB/GYN physician is on-call Thursday May 1, 2014.
- The OB/GYN Services Schedule for 2014 dated April 30 to May 6 revealed the following on-call services: Birth N Beyond (BNB) midwifery services for obstetrics (OB) and Arnot Medical Services (AMS) for gynecology (GYN).