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Based on records review and personnel interviews, the facility failed to comply with 42 CFR §489.20 (l) in that under EMTALA (Emergency Medical Treatment and Labor Act) the hospital was required to accept appropriate transfer of individuals with an emergency medical condition if the hospital had specialized capabilities and had the capacity to treat those individuals. Hospital A denied the request of Hospital B to transfer (Patient #1) who sustained a hip fracture and required surgical intervention on 5/18/24. (Refer to Tag A-2411)

Based on a review of documentation and interviews, the facility, a participating hospital that has specialized capabilities or facilities, failed to accept from a referring hospital an appropriate transfer of an individual who required such specialized capabilities or facilities when the receiving hospital had the capacity to treat the individual. On 5/18/24, Hospital A denied the request of Hospital B to transfer (Patient #1), who sustained a hip fracture and required surgical intervention.

Findings included:

Review of Patient #1's medical record for Hospital B revealed an emergency department "ED Provider Note" dated 5/18/24 at 1:19 PM, documented in part: "...Medical Decision-Making: called for transfer to nearest facility capable of stabilizing patient's acute injury (Hospital A) per EMTALA rules. Spoke with (Personnel #3, Hospital A physician). (Personnel #3) wants to get (Personnel #5, Hospital A orthopedic surgeon) involved. Spoke with (Personnel #5). (Personnel #5) refuses transfer as (Personnel #5) 'does not cover (Hospital B)'. Explained that the patient would be transferred to (Hospital A) and would therefore be (Hospital A's) patient and (Personnel #5) would be able to help. (Personnel #5) states that is not fair as [there are] multiple orthopedic surgeons at (Hospital B) that can handle the patient. Re-emphasized that there is no orthopedic coverage [at] (Hospital B) this weekend. (Personnel #5) refuses and subsequently (Personnel #3) now refuses.
...Differential Diagnoses: ...Hip fracture. No orthopedic coverage over the weekend at this facility. Called for transfer to nearest facility. Unfortunately they were unable to facilitate this emergency. Ultimately able to transfer to (Hospital C).
...Care significantly affected by the following Social Determinants of Health: psychosocial: anxious about health
Poor access to healthcare (rural) ..."

Review of Hospital A Transfer Log dated 5/18/24 at 12:56 PM, documented in part: "(Hospital A) ortho declined. No ortho on call at (Hospital B)."

During a telephone interview on 6/5/24 at 10:15 AM, (Personnel #5) stated, "Call service contacted me and connected me with (Hospital B), [Personnel #6, Hospital B physician]... patient with hip fracture... I don't cover (Hospital B)... I currently cover three hospitals..."

In interview on 6/4/24 at 11:25 AM, in a facility conference room, when asked how notified of potential transfer from another facility, Personnel #2 (Hospital A ED Medical Director) stated, through a "regional transfer system - calls go through center to find appropriate, available beds. Doctor-to-doctor through transfer center should confirm that we have bed available, and services appropriate to what is needed. Go through hospitalist first, generally, and then specialist is pulled into call... We (Hospital A) get a lot of transfers from (Hospital B)... Appropriate to transfer from (Hospital B) Level IV trauma center to (Hospital A) Level IV trauma center. The conversation going to Personnel #3 was appropriate. They (Hospital B) normally has ortho on-call, [they have] occasional gaps. We (Hospital A) do have ortho on-call. Ortho should have been able to take care of hip fracture. We (Hospital A) should have accepted (Patient #1) ..."

Review of a facility Policy titled "Patient Transfer (EMTALA)" last revision date 4/20/22 stated in part, "The Governing Board, in consultation with the medical staff, has adopted this Policy according to the Federal and state laws and regulations regarding the medical screening examination/evaluation, stabilizing treatment, and Transfer of Patients from a (Facility) medical center to another medical center in a medically appropriate manner...

Patient Transfers - In
1. A medical center with specialized facilities (e.g., burn units, shock-trauma units, neonatal intensive care units, etc.) may not refuse to accept from a referring medical center an appropriate Transfer of an individual who requires such specialized capabilities or facilities if the receiving facility has the capacity to treat the individual ..."