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Based on a review of facility documentation and medical records (MR) and staff interview (EMP), it was determined that the facility failed to report another hospital suspected to be in violation of the Emergency Medical Treatment and Labor Act (EMTALA).


Findings include:


Review of facility policy "EMTALA-Emergency Medical Treatment & Labor Act" last reviewed in March 2015, revealed, "... Definitions: Appropriate Transfer occurs when: ... (4) the transfer is effected through appropriate personnel, transportation and equipment, as required, included the use of necessary and medically appropriate life support measures during the transfer. ... Procedure/Guidelines: ... 3. Transfers ... d. The transfer must be carried out through the use of appropriate personnel, land transportation and equipment, including those life support measures that may be required during transfer. The physician at the sending hospital has the responsibility of determining the appropriate mode, equipment and attendants for the transfer. ... ii. For Transfer on Patient Request. The individual or the legally responsible person acting on the individual's behalf must first be fully informed of the risks and benefits of the transfer, the alternatives (if any) to the transfer, and of the Health Center's obligations to provide further examination and treatment sufficient to stabilize the individual's Emergency Medical Condition, and to provide an appropriate transfer. Also: 1. The request must be in writing and indicate the reasons for the request. 2. The request must indicate that he or she is aware of the risks and benefits of the transfer. 3. The request must contain a statement of the Health Center's obligations under EMTALA and the benefits and risks that were outlined to the person signing the request. 4. If a request is made and a certification is provided, the individual must still be informed of the risk versus benefits of the transfer. 5. The request must be made part of the individual's medical record, and a copy of the request should be sent to the receiving (recipient) facility when the patient is transferred. ... g. The Health Center, through its designated personnel and/or emergency department physicians must obtain the consent of the receiving or recipient hospital and the receiving physician before the transfer of the patient and must make the appropriate arrangements for the patient transfer with the receiving hospital and physician. h. The Physician at the transferring Hospital has the responsibility to determine appropriate mode of transportation, equipment and attendants necessary to affect a transfer to a receiving or recipient facility. ...I. ... The Hospital has a duty to report an EMTALA violation within 72 hours to the Centers for Medicare and Medicaid Services and/or the State Survey agency any time it has a reason to believe it may have received an individual who has been transferred in an Emergency Medical Condition form another hospital in violation of the requirements. ..."

1. Review of MR1 on November 7, 2017, at approximately 2:00 PM revealed that the patient presented to an emergency department at another facility and was told that the facility was busy and to select another facility. MR1 indicated, "... rolled over in bed yesterday morning and felt crunching on left side of ... neck. ... Does have a history of congestive heart failure with recent admission. ...Past Surgical History and Major Procedures Splenectomy ... Social History Patient is single. Patient lives alone. ..."

2. Interview with EMP3 on November 7, 2017, at approximately 1:00 PM confirmed that the facility did not report the other facility suspected to be in violation of the EMTALA. EMP3 stated, "The [St. Vincent] physician did not feel that the patient needed to be stabilized when he/she left the other facility."