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Based on review of medical records and hospital documents, and interviews, the hospital failed to accept from a transferring hospital an individual who required the specialized capabilities and facilities of the hospital in one of four medical records (Patient #A, 10, 13 and 14) reviewed of patients with hip fractures. On the date and time of the proposed transfer for one patient (Patient #A), the hospital had the capability and capacity to treat the individual.

Findings:

1. Patient #A was an 86-year old man brought to the ED of the transferring hospital by ambulance following a fall at 23:02 on 01/13/2012. Patient #A had a previous history of bilateral hip repair and total joint arthroplasty. The emergency department (ED) physician examined the patient. The x-ray showed that the man had a periprosthetic fracture of the left hip. The ED physician consulted with the hospital's orthopedic surgeon on-call. The on-call orthopedic surgeon informed the ED physician that the needed surgery was not within his scope of practice. The "patient's surgeon" was on vacation. The ED physician called St. Anthony Hospital (SAH) and requested to transfer the patient. SAH refused the transfer.

2. Review of SAH on-call specialty roster for the dates in question showed SAH had orthopedic coverage. St. Anthony Hospital had an orthopedic resident and an orthopedic surgeon on call during January 2012, including January 13 and 14, 2012 - the date of the incident mentioned in the complaint. Medical records reviewed showed the hospital accepted transfers from other hospitals of patients needing orthopedic services. The medical records reviewed, of patients admitted from the ER with fractures, showed the patients were admitted to internal medicine services and an orthopedic consult was obtained and the patient was taken to surgery at a later time when it had been determined the patient could undergo the surgical procedure. In some of these medical records, the orthopedist or orthopedic resident provided the first consultative visit while the patient was still in the ED.

On 01/30/2012 at 1545, the surveyors interviewed Dr. #P. He stated he remembered the incident clearly and that his resident had contacted him about the patient. He stated Dr. King stated it was a patient from Norman with a periprosthetic fracture. During the interview with Dr. #P, he stated he talked with the referring ED physician and with the referring on-call orthopedic surgeon (Dr. V). He stated that both physicians (ED and Dr. V) described the patient's condition and fracture. Dr. #P agreed he was the orthopedist on-call for SAH and stated he had the capabilities to perform the needed surgery for Patient #A. He stated he refused the transfer because he felt it was not a situation that needed immediate/emergency surgery and the requesting hospital had the same capabilities/specialties. The medical record of Patient #A at the transferring hospital showed that the transfer was refused by the orthopedic surgeon at SAH was that "it would be a lateral transfer."

3. Patient #A was subsequently transferred to another hospital and surgical repair was performed the following day.