HospitalInspections.org

Based on review of facility documents, review of medical records (MR), and staff interviews (EMP) and others (OTH), it was determined that the facility failed to report to CMS or the State survey agency when it had reason to believe it may have received an individual who had been transferred in an unstable emergency medical condition from another hospital in violation of the requirements of ?489.24(e).(MR11)

Findings include:

Review of "Emergency Medical Treatment and Active Labor Act (EMTALA) Date: April 19, 2010" revealed "I. Policy It is the policy of UPMC to comply with all applicable laws and regulations relating to the provision of emergency services, including the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C.1395dd. II. Purpose The purpose of this policy is to set forth hospital's requirements under EMTALA. III. Scope This policy applies to all domestic UPMC hospitals. ... V. Procedure ... 8. UPMC physicians, professional or other staff shall report to the Hospital Compliance Officer and/or Risk Manager all suspected EMTALA violations arising from the transfer of a patient by another facility to a UPMC facility. The Hospital Compliance Officer shall investigate and report to the Corporate Compliance Officer and to the Centers for Medicare and Medicaid Services (CMS) or the Pennsylvania Department of Health or other appropriate government agencies any potential EMTALA violations, as may be required by law."

1) Review of an ambulance trip sheet, involving MR11, revealed "January 19, 2011 ... History of Present Illness ... dispatched emergency by 911 to above location for ... pt who fell down unknown number of steps and is in and out of consciousness. ... arrive [at other hospital], met at ER door by two ED techs at [other hospital]. [ED physician] refuse pt and evaluation stating [the patient] is to be transported to Pittsburgh trauma facility."

Review of a second ambulance trip sheet, involving MR11, revealed "January 19, 2011 ... History of Present Illness ... upon arrival at [other hospital] ED was met at ED doors by two ED techs and told the patient was not to be seen at [the other hospital] per [ED physician] but to go directly to Pittsburgh Trauma Center."

2) During interview with EMP6 on January 31, 2011, at approximately 10:45 AM, EMP6 confirmed that they were aware of MR11 being refused by another hospital. Further interview with EMP6 revealed "I was told by [EMP8] about the patient ... I told [OTH1] ... The patient was turned away at [another hospital] ... I spoke to [OTH1] at [a meeting] on January 19, [2011]." During additional interview, EMP6 was asked if they reported this issue to CMS or the Department and EMP6 stated "No."

3) During a telephone interview with OTH1 on January 31, 2011, at approximately 11:05 AM, OTH1 confirmed that they were aware of MR11 being refused by another hospital. Further interview with OTH1 revealed "Trauma had concerns that the patient had been denied by [another hospital] ... The ambulance was told you have to take the patient to Presby ... [OTH3] confirmed this with [employee at initial hospital]." During further interview, OTH1 was asked if this had been reported to CMS or the Department and stated "I do not know but I don't believe ... I believe that [OTH3] believed that this had been reported." During additional interview, OTH1 was asked if they were aware of EMTALA reporting requirements and OTH1 stated "I can't say that I know about both hospitals having to report."

4) During a telephone interview with OTH2 on January 31, 2011, at approximately 11:10 AM, OTH2 confirmed that they were aware of MR11 being refused by another hospital. Further interview with OTH2 revealed "I was notified by [EMP8] ... The patient was brought from [another hospital] ... They pulled into the ED [at the other hospital] and was told to go to Presby ... I contacted [employee at initial hospital] about the incident and [they] said there was a communication issue ... I received a follow-up call from [employee at initial hospital] that they were self reporting."

5) During interview with EMP8 on January 31, 2011, at approximately 11:15 AM, EMP8 confirmed that they were aware of MR11 being refused by another hospital. Further interview with EMP8 revealed "I was in the trauma bay when they were giving report ... EMS told me about the patient being refused and sent from [another hospital] ... We had a multi-disciplinary meeting that morning and I told [OTH1] about this report ... I followed up with [OTH2] ... The next day I got an email from [OTH1] requesting patient info, name and medical record number ... I was told that [the other hospital] had self reported the issue."

6) During a telephone interview with OTH3 on January 31, 2011, at approximately 11:25 AM, OTH3 confirmed that they were aware of MR11 being refused by another hospital. Further interview with OTH3 revealed "I had talked to [employee at initial hospital] ... They had self reported." During additional interview, OTH3 was asked if they reported this issued to CMS or the Department and OTH3 stated "No, the purpose and the spirit of the statute was fulfilled because [the other hospital] self reported." During additional interview, OTH3 was asked if they confirmed with CMS or the Department that the other hospital reported the issue and OTH3 stated "No, I did not discuss it externally. I only discussed it with [employee at initial hospital] because we have a good working relationship."