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Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000647), review of twenty closed records and three active records reviewed (R.R), policies/procedures manual, review of medical faculty by laws rules and regulations and documents related to complaint case, it was determined that the hospital failed to have policies and procedures in effect to ensure compliance with requirements of 42 CFR §489.20 and §489.24.

Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000647), review of twenty closed records and three active records reviewed (R.R), policies/procedures manual, review of medical faculty by laws rules and regulations and documents related to the complaint case, it was determined that the facility failed to report to Centers for Medicare & Medicaid Services CMS or the State survey agency any time it has reason to believe it may have received an individual who has been transferred in an unstable emergency medical condition from another hospital in violation of the requirements.

Findings include:

1.On November 22, 2018, RR#5 a 77 years old male patient went to Hospital Buen Samaritano in Aguadilla Puerto Rico due to pain on left leg. In this hospital patient was screened, triaged and begin to receive care and services with a diagnosis of calf pain with claudication and leg cramping due to blood clots.

2.On November 22, 2018 around noon the case was presented to the Professional Hospital in Guaynabo and case was accepted by the Professional Hospitals' physician. Professional Hospital physician inform Hospital Buen Samaritano to transfer the patient on November 25, 2018 Sunday because they did not have the vascular surgeon until and/or after November 25, 2018. The reason for the transfer was that hospital Buen Samaritano determined that patient needs a vascular surgeon examination.

3.On November 25, 2018 around mid-morning 9:10 AM paramedics from an ambulance company pick up the patient at the hospital's emergency room and drives him to the Professional Hospital. Patient arrive to the Professional Hospital emergency room on November 25, 2018 at 11:50 AM. After the 81 miles journey from Aguadilla to Guaynabo, and the Professional Hospital at Guaynabo refuse to accept the patient.

4. According to the emergency room at the Profesional Hospital physician, the medical services necessary to accept the patient transfer are unavailable upon arrival to the Professional Hospital so he returns the case to Aguadilla.

5. However facility did not present evidence of the report to CMS or the State survey agency of this case who may be transferred from another hospital in violation of the EMTALA requirements.

Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000647), review of twenty closed records and three active records reviewed (R.R), policies/procedures manual, interview with the facility operational manager (employee #2) and emergency room registry department and utilization manager (employee #4), it was determined that the facility failed to provide evidence of physicians who are on call for duty to evidence the availability of those on-call physicians.

Findings include:

1. During interview on 10/14/21 at 11:55 AM it was asked to the facility operational manager (employee #2) and emergency room registry department and utilization manager (employee #4) if facility had a policy in place who establish the procedure to file and maintain this information that it is not related directly with the medical record. The facility operational manager (employee #2) and emergency room registry department and utilization manager (employee #4) stated that the facility did not have this type or policy.

2. Review of the monthly specialty vascular surgery emergency room on call roster for the months of May 2021, June 2021, July 2021, August 2021 and September evidence days (average of 16 days per day) where there are no vascular surgery specialty available.

The facility operational manager (employee #2) stated on interview on 10/13/21 at 10:55 AM that for the days where a specialty is not available cases who need treatment of this specialty if received on the emergency room are screened, stabilized and transferred to other facility who had the specialty. However, the written evidence or procedures (policy, committee meeting info or memo) to be followed to respond to situations in which a particular specialty, is not available to be review.

Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000647), review of twenty closed records and three active records reviewed (R.R), policies/procedures manual, review of medical faculty by laws rules and regulations and documents provided by complaint case, it was determined that the facility failed to track the care provided to each individual who comes to the hospital seeking care for an emergency medical condition.

Findings include:

1.On November 22, 2018, RR#5 a 77 years old male patient went to Hospital Buen Samaritano in Aguadilla Puerto Rico due to pain on left leg. In this hospital patient was screened, triaged and begin to receive care and services with a diagnosis of calf pain with claudication and leg cramping due to blood clots.

2.On November 22, 2018 around noon the case was presented to the Professional Hospital in Guaynabo and case was accepted by a physician at the Professional hospital. Professional Hospital physician inform Hospital Buen Samaritano to transfer the patient on November 25, 2018 because they did not have the vascular surgeon until and/or after November 25, 2018. The reason for the transfer was that determines that patient needs a vascular surgeon examination.

3.On November 25, 2018 around mid-morning 9:10 AM paramedics from an ambulance company pick up the patient at the hospital's emergency room and drives him to the Professional Hospital. Patient arrive at the Professional Hospital emergency room on November 25, 2018 at 11:50 AM. After the 81 miles journey from Aguadilla to Guaynabo, the Professional Hospital refuse to accept the patient. According to the emergency room Professional Hospital physician the medical services necessary to accept the patient transfer are unavailable upon arrival to the Professional Hospital so he returns the case to Aguadilla with a 81miles ride back.

There is no evidence at the Professional Hospital emergency room that this case was registered on the emergency room logbook before returning the case, to the Hospital Buen Samaritano that sent him to them.

Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000647), review of twenty closed records and three active records reviewed (R.R), policies/procedures manual, review of medical faculty by laws rules and regulations and documents provided by complainant, it was determined that the facility failed to provide appropriate medical screening examination within the capability of the hospital emergency department.

Findings include:

1.On November 22, 2018, RR#5 a 77 years old male patient went to Hospital Buen Samaritano in Aguadilla Puerto Rico due to pain on left leg. In this hospital patient was screened, triaged and begin to receive care and services with a diagnosis of calf pain with claudication and leg cramping due to blood clots.

2.On November 22, 2018 around noon the case was presented to the Professional Hospital in Guaynabo and case was accepted by a physician. Professional Hospital physician inform Hospital Buen Samaritano to transfer the patient on Sunday 25, 2018 because they did not have the vascular surgeon until and/or after November 25, 2018. The reason for the transfer was that determines that patient needs a vascular surgeon examination.

3.On November 25, 2018 around mid-morning 9:10 AM paramedics from an ambulance company pick up the patient at the Buen Samatritano hospital's emergency room and drive him to the Professional hospital. Patient arrive to the Professional Hospital emergency room on November 25, 2018 at 11:50 AM. After the 81 miles journey from Aguadilla to Guaynabo, Professional Hospital refuse to accept the patient. According to the Professional Hospital emergency room physician, the medical services necessary to accept the patients' transfer are unavailable upon arrival to the Professional Hospital so he returns the case to Aguadilla.

4. No evidence was provided at the time of the exit that the Professional Hospital perform an appropriate medical screening examination (MSE), or triage to determine if there is a medical condition.

Based on the Emergency Medical Treatment and Labor Act EMTALA complaint investigation (PR00000647), review of twenty closed records and three active records reviewed (R.R), policies/procedures manual, review of medical faculty by laws rules and regulations and documents provided by complainant , it was determined that the facility failed to ensure that emergency room screen and triage any individual who comes to the emergency room in order provide stabilization of the medical condition if identified and needed before transfer to another facility.

Findings include:

1.On November 22, 2018, RR#5 a 77 years old male patient went to Hospital Buen Samaritano in Aguadilla Puerto Rico due to pain on left leg. In this hospital patient was screen, triaged and begin to receive care and services with a diagnosis of calf pain with claudication and leg cramping due to blood clots.

2.On November 22, 2018 around noon the case was presented to the Professional Hospital in Guaynabo and case was accepted by a physician. Professional Hospital physician inform Hospital Buen Samaritano tto transfer the patient on Sunday 25, 2018 because they did not have the vascular surgeon until and/or after November 25,2018. The reason for the transfer was that it was determines that patient needs a vascular surgeon examination.

3. On November 25,2018 around mid-morning 9:10 AM paramedics from an ambulance company pick up the patient at the hospital's emergency room and drive him to the Professional Hospital. Patient arrive to the Professional Hospital emergency room on November 25, 2018 at 11:50 AM. After the journey from Aguadilla to Guaynabo, the Professional Hospital refuse to accept the patient. According to the emergency room physician the medical services necessary to accept the patient transfer are unavailable upon arrival to the Professional Hospital so he returns the case to Aguadilla.

4. There is no evidence in the professional hospital emergency room that this case was screened, triaged, registered on the logbook and stabilized if needed before transferring the case, to the hospital that sent him to them.

5. There is no evidence of the documentation of this case that the physician who transfer to another facility weighted the risk of benefits of the transfer and comply with documentation requirements established in EMTALA regulation related of an appropriate transfer.