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Based on observations, staff interviews, clinical record and policy reviews the Transferring Hospital (TH)'s noncompliance with the requirements under EMTALA presented when-

1. Signage was not located in the ambulance entrance, hallway and in patient treatment rooms [A 2402]; and
2. Documentation for transfers to the Receiving Hospital (RH) did not clearly indicate there had been communication between-
a. the TH's physician and the RH's physician,
b. the TH's nurse and the RH's nurse.

In addition, there was no indication that 1 of 51 Sampled Patients had signed a transfer form. [A 2409]

Based on observations, staff interviews and review of the hospital's policy, the hospital failed to post signs for those patients gaining access to the Emergency Department through the ambulance entrance with respect to-

1. Patients' rights for examination and treatment of emergency medical conditions and for women in labor, and
2. The hospital's participation in Medicare or Medicaid program.

This failure has the potential for patients and families of not being aware that they could receive care and treatment in an emergency without the fear of the inability to pay for the services they receive.

Findings:

During a tour of the Emergency Department's ambulance entrance, adjacent hallway and two patient rooms on 7/2/15 at 9:10 a.m., there was no signage as specified by the Department of Health Services that indicated patients have rights to a medical screening exam as necessary to stablize treatment (including treatment for an unborn child). This includes an appropriate transfer to another facility even in the event one cannot pay or does not have medical insurance or is not entitled to Medicare or MediCaid.
During an observation of the ambulance entrance and adjoining area with concurrent interview on 7/3/15 at 1:45 p.m., the Manager of the Emergency Department corroborated there were no signs available to allow patients to be aware of their rights with regards to EMTALA if they entered the Emergency Department through the ambulance entrance.

Review of the hospital's policy on 7/3/15 titled, "Transfer: Provision of Emergency Services and Care Prior to Patient Transfer (COBRA /EMTALA) with Board approval 2/13 indicated: "Under D. Additional Requirements # 3. Signs. The hospital shall post conspicuous signs in the emergency department and other places in which emergency patients may be waiting for examination and treatment (e.g. entrance, admitting area, waiting room, treatment area) in a form specified by the Department of Health Services, which specifies the rights of individuals under COBRA to examination and treatment for Emergency Medical Conditions and women in labor and indicating whether the hospital participates in the Medi-Cal Program."

Based on staff interviews; document, clinical record, and hospital policy reviews the Transferring Hospital (TH) failed to document conversations acknowledging acceptance of patient transfers for 3 of 51 Sampled Patients (Patient 105, 107 and 108) with regards to TH Physician to Receiving Hospital (RH) Physician, and TH nurse to RH nurse.

In addition, 1 of 50 patients (Patient 104) did not sign his Transfer Consent which included an understanding and acknowledgement of Patient 104's right to receive a medical screening examination and evaluation by a physician, or other appropriate personnel, without regard to my ability to pay, prior to any transfer from the hospital and the right to be informed of the reasons, risks, and benefits of the transfer. These failures had the potential to not meet the needs of patients requiring emergent, urgent or acute medical care when being transfered between hospitals.


Findings:


During patients' clinical record reviews with concurrent interviews on 7/3/15 at 8:30 a.m., ED Nurse Staff E corroborated with the following information from the clinical records:

Patient 104's clinical record did not include a signed "Patient Consent to Transfer" form.

Patient 105 - The TH's Ward Clerk documented the acceptance of the patient by the RH's Physician; however there was no documentation indicating there was a TH Physician (Physician B) to RH Physician communication and acceptance of Patient 105. Also, the TH's ED Nurse F documented "Report to ER staff at RH"; however did not document the name of the RH staff receiving the Patient 105's report.

Patient 107 - There was no documentation indicating there was a TH Physician (Physician B) to RH Physician communication and acceptance of the patient.

Patient 108 - There was no documentation indicating there was a TH Physician (Physician C) to RH Physician communication and acceptance of the patient. Also, the TH's ED Nurse G documented "Report to ER staff at RH"; however did not document the name of the RH staff receiving the patient report.


Review of the TH's policy on 7/3/15 titled, "Transfer: Provision of Emergency Services and Care Prior to Patient Transfer (COBRA /EMTALA) with Board approval 2/13 indicated: "Under 4. Mechanisms - Applies to all Transfers (1) Patient / Family... "The patient, or the patient's representative, if any is present, must be notified of the transfer and of the reasons for transfer. Written acknowledgement of such notification by the patient or legal representative should be documented on the 'Patient Transfer Acknowledgement' form."
(4) Medical Report Communication... "Transferring physician to receiving physician"
(5) Nursing Report Communication... "Transferring Registered Nurse (RN) to receiving RN before transfer and update on arrival if RN accompanies patient in transfer."