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Based upon document review and interview, the facility did not comply with all of the provisions of recipient hospital responsibilities. Please reference findings under Tag A2411.

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

Findings include:

Review of the transferring hospital's medical record for Patient #1 revealed the patient was a 29-year-old female who presented to the Emergency Department (ED) on 7/14/14 at 2:23 PM with abdominal pain and difficulty breathing related to swallowing the blade from a paring knife. Imaging identified a new linear metallic density in the left upper quadrant of the abdomen. The decision was made to transfer the patient due to the lack of gastroenterology services at the transferring hospital. The ED physician at the transferring hospital contacted the on-call gastroenterologist at the potential recipient hospital. The gastroenterologist declined to accept the patient and requested the ED physician call the on-call general surgeon, who declined the case. The patient was ultimately transferred at 8:45 PM to another area hospital with gastroenterology services.

Review of the recipient hospital's "Health On Demand - Physician Transfer Line Form" dated 7/14/14 revealed an ED physician at the transferring hospital called at 5:26 PM to request transfer of Patient #1 to the intended recipient hospital. The transferring hospital ED physician stated that the patient had swallowed a knife blade and he requested to speak with the on-call gastroenterologist. The gastroenterologist responded to a page and was connected to the ED physician. The ED physician at the transferring hospital called back on the recipient hospital's transfer line and said that the gastroenterologist deferred to the general surgeon. The general surgeon on-call was contacted and was connected to the ED physician. Approximately one-half hour later, a staff member from the transfer line called the transferring hospital and was told that Patient #1 was being transferred to a different hospital. The staff member from the transfer line called the general surgeon, who said that for Patient #1, the outcome would be better if the procedure was done by a gastroenterologist with a scope, than if surgery was done. The gastroenterologist had already deferred the case to a surgeon. The patient would be sent to a different hospital where a gastroenterologist could do the procedure with a scope.

Interview with Risk Management Staff #1 on 8/4/14 and review of the recipient hospital's investigation of Patient #1's potential transfer on 7/14/14 confirmed the above findings. During discussion of the case with Chief Medical Officer Staff #2, a hospitalist stated that the patient could have been on the surgical service, but the appropriate management was endoscopy. Staff #2 discussed the case with the involved on-call surgeon, who stated that he had been under the impression that without gastroenterology's willingness to care for the patient, and surgery not being a reasonable option absent perforation, the patient needed to be transferred elsewhere. Staff #2 then discussed the case with the involved on-call gastroenterologist, who indicated that it would have been a difficult case and he did not want to accept the patient.

Despite having the specialized services of gastroenterology that Patient #1 required and the capacity to treat the patient, the transfer of Patient #1 was refused by the intended recipient hospital.