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Based on review of documents, medical records and staff interview, it was determined the facility failed to effect an appropriate transfer of patients from the Emergency Department (ED) to a higher level of care in twenty (20) of twenty (20) medical records reviewed (#1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20) for appropriate transport methods. This has the potential to harm all patients by there not being medically trained personnel with appropriate medical equipment available in an emergency situation. Findings include:

1. Patient #1 presented to the ED on 9/29/10 with diagnosis of pregnancy and right lower quadrant abdominal pain. The physician performed a Medical Screening Exam (MSE), determined the patient needed to be transferred for a higher level of care and transferred via private owned vehicle (POV) to the accepting facility.

2. Patient #2 presented to the ED on 10/8/10 with a diagnosis of hepatic failure, renal failure, hypernatremia and anemia. The physician performed a MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

3. Patient #3 presented to the ED on 10/14/10 with a diagnosis of subluxation of right distal ulna. The physician performed an MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

4. Patient #4 presented to the ED on 10/19/10 with a diagnosis of Suicidal Ideation. The physician performed an MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

5. Patient #5 presented to the ED on 10/20/10 with a diagnosis of fracture of right fourth metacarpal. The physician performed an MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

6. Patient #6 presented to the ED on 10/25/10 with a diagnosis of rectal bleeding. The physician performed an MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

7. Patient #7 presented to the ED on 11/2/10 with a diagnosis of mandible fracture and left lower lateral incision fracture. The physician performed an MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

8. Patient #8 presented to the ED on 11/24/10 with a diagnosis of bilateral deep vein thrombosis. The physician performed an MSE, determined the patient needed to be transferred for a higher level of care and transferred via POV to the accepting facility.

9. Patient #9 presented to the ED on 12/4/10 with a diagnosis of fractured wrist and facial contusion. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

10. Patient #10 presented to the ED on 12/6/10 with a diagnosis of depression with suicidal ideation. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

11. Patient #11 presented to the ED on 12/16/10 with a diagnosis of suicidal and homicidal ideations. The physician performed and MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

12. Patient #12 presented to the ED on 1/4/11 with a diagnosis of right eye pain. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

13. Patient #13 presented to the ED on 1/7/11 wit a diagnosis of left knee trauma. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

14. Patient #14 presented to the ED on 1/18/11 with a diagnosis of corneal abrasion. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

15. Patient #15 presented to the ED on 2/1/11 with a diagnosis of suicidal ideation. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

16. Patient #16 presented to the ED on 2/2/11 with a diagnosis of an open fracture. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

17. Patient #17 presented to the ED on 1/1/11 with a diagnosis of thumb laceration with questionable tendon involvement. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

18. Patient #18 presented to the ED on 12/11/10 with a diagnosis of pregnancy and abdominal pain. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

19. Patient #19 presented to the ED on 2/3/11 with a diagnosis of wrist fracture. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

20. Patient #20 presented to the ED on 2/6/11 with a diagnosis of right greater tuberosity fracture. The physician performed an MSE, determined the patient needed a higher level of care and transferred via POV to the accepting facility.

21. Hospital policy titled Emergency Medical Treatment & Active Labor (EMTALA), last revised 7/2010, states in part: "Transfer must be by use of qualified staff and appropriate equipment. Includes the use of medically appropriate life support during transfer."

22. During an interview conducted with the ED Medical Director #1 in the morning and afternoon of 3/9/11 and the morning of 3/10/11, she revealed she was familiar with EMTALA, would not intentionally violate EMTALA, but at times felt the patient could transport themselves to the accepting facility quicker than waiting on an ambulance. She stated the county only has one (1) ambulance service with two (2) others that are volunteer and at times may have to wait hours for transport to become available.