HospitalInspections.org

Based on review of policies and procedures, hospital documents, clinical records, and staff interviews, it was determined the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR §489.20 and 42 CFR §489.24, responsibilities of Medicare participating hospitals in emergency cases.

Findings include:

Policy titled "Emergency Medical Treatment and Labor Act (EMTALA) Policy," revealed: "...HonorHealth will accept transfers of any un-stabilized person with an emergency medical condition from another hospital without regard to the person's ability to pay if: 1. The transferring hospital does not have the specialized capability and equipment to provide the necessary stabilizing treatment; 2. HonorHealth has the specialized capability (if HonorHealth has the required on-call physician and he is available, then HonorHealth has the specialized capability) to provide the necessary stabilizing treatment and a physician is able to accept the transferred patient; and 3. HonorHealth has the capacity to provide this treatment (including bed availability, staffing, equipment, etc.). All transfers will be initiated in the HonorHealth Transfer Center. A Transfer Center Coordinator will be responsible for: Determining if the HonorHealth hospital has bed capacity (including appropriate equipment) and hospital staff availability; Determining if the HonorHealth hospital has an accepting physician; Facilitating a conversation between the sending and receiving physicians. HonorHealth Transfer Center personnel will document the circumstances under which it refuses to accept a transfer from another hospital...."

Patient #1's medical records from Hospital #1, contained a note titled "Emergency Department Note," dated 05/21/24, which revealed: "...In summary the patient was involved in an MVC in which (Patient #1) sustained a right zygomatic fracture, large right subgaleal hematoma, closed head injury, concussion, first rib fracture, C5 on C6 injury, possible transverse process fracture, and possible pulmonary contusion. Dr (at Hospital #1) spoke with Dr. (at eventual receiving hospital) who had then requested a CTA of the neck to rule out vascular injury because of the mechanism suggested by the first rib fracture. I followed up when the report of the CTA neck returned and advised Dr. (at eventual receiving hospital) that no further pathology was radiographically evident, At that point the patient was accepted by Dr. (at eventual receiving hospital) for transfer to the emergency department at (eventual receiving hospital)...Patient with Presentation consistent with TBI, mild LOC, alcohol intoxicated, involved in a MVA...with large subgaleal hematoma on right forehead/temporal area, concerns for acute right 1 rib posterior fracture, T1 lef {sic} lateral process fracture, Spondylolisthesis on C5 over C6, concerns for being traumatic given rib fracture and tenderness on area. Also right zygoma fracture possible acute due ot {sic} tenderness on Area...Patient requires Trauma surgery/Neurosurgery evaluation and admission for observation...disposition is pending receiving facility acceptance. AZ reach contacted...."

Document titled "Transfer Center Activity," from Hospital #2, dated 05/21/2024, revealed: "...Level of Care Emergency Medicine; Reason: No specialty at sending facility...05/21 2124 Request Began...[Coleen] called from AZ Reach with a trauma pt for a MVA from (Hospital #1). Advised they reached out to (eventual receiving hospital) who did not decline but they wanted to send home pt and the referring provider didn't want to send (Patient #1) home. Let them know if the patient is a true trauma they need to go to the closest facility and if (eventual receiving hospital) did not decline they need to go there...2223: Transfer type set to Emergency Transfer...2234: Request Canceled Reason: Cancelled- inquiry only...."

Transcript pf phone call between Referring Transfer Center and Transfer Center for Hospital #2, as follows:
Referring Transfer Center: Who has a trauma patient
Transfer Center for Hospital #2: Ok where are they coming form
Referring Transfer Center: (Hospital #1)
Transfer Center for Hospital #2: (Hospital #1) and they have a trauma patient?
Referring Transfer Center: Correct
Transfer Center for Hospital #2: Ok hold on one moment. Ok where is that at?
Referring Transfer Center: Ganado.
Transfer Center for Hospital #2: There should be closer traumas to that. They're not on our normal distance list. That seems further out. Have you tried (eventual receiving hospital) trauma?
Referring Transfer Center: Yeah, we tried (eventual receiving hospital), they couldn't accommodate so (Dr. at Hospital #1) said head to Phoenix and you're the first stop
Transfer Center for Hospital #2: So then it's not a true trauma. If (Patient #1's) a trauma, they can not, nobody can turn away a trauma
Referring Transfer Center: Oh ok
Transfer Center for Hospital #2: So if it's a true trauma then they have to take it, if not then finish the intake and I'll see if we can accommodate, but if it's a true trauma, they should not be refusing it
Referring Transfer Center: Ok, well my understanding is that (Dr. at Hospital #1) talked to them and they wouldn't take (Patient #1) so he said don't call (eventual receiving hospital), so you're the next stop and that's why I'm calling you. (Patient #1) was intoxicated and had a motor vehicle accident and had multiple fractures. (Patient #1) is stable.
Transfer Center for Hospital #2: Yeah, (Patient #1's) definitely a trauma. Do you have the provider who declined the trauma out of (eventual receiving hospital)?
Referring Transfer Center: I do not
Transfer Center for Hospital #2: Ok
Referring Transfer Center: I do not
Transfer Center for Hospital #2: Ok, if you could get that from (Hospital #1) we will need to document that because this trauma is coming way out of the closest trauma, for what the protocols are, they should go to the next closest. And (eventual receiving hospital) is their closest.
Referring Transfer Center: I understand. I have Dr. (at Hospital #1) on the line now, I can go back to (Dr.) and tell (Dr.) what you said.
Transfer Center for Hospital #2: Yeah, if you could please
Referring Transfer Center: Yeah, do you want to chat with (Dr.) or do you want me to tell (Dr.)
Transfer Center for Hospital #2: No, just let him know we will need that information because they are passing up a trauma center to come all the way to Phoenix. They shouldn't be doing that.
Referring Transfer Center: Ok, hold on
03:05-4:19: Call on hold
Referring Transfer Center: Thank you so much holding, I do apologize. Ok, so what (Dr.) said to me is they did not decline. What they said was do a CTA, if there's no vascular then (Patient #1) can go home. Dr. (at Hospital #1) is not feeling comfortable with sending (Patient #1) home. The CT was negative. So that's why (Dr.) said (Dr.) didn't bother calling (eventual receiving hospital) back or (Dr.) doesn't want to go to (eventual receiving hospital)
Transfer Center for Hospital #2: No, (Dr.) does need to attempt (eventual receiving hospital). If (Dr.) gets a true decline then (Dr.) can attempt us or New Mexico which may have a trauma center that's closer
Referring Transfer Center: Ok, I'll let (Dr.) know
Transfer Center for Hospital #2: But (Dr.) does need to try a closer trauma center.
Referring Transfer Center: OK Thank you
Transfer Center for Hospital #2: Thank you
Referring Transfer Center: Bye bye

Document titled "Transfer Center Activity," dated 05/21/2024, revealed: "...Level of Care Emergency Medicine; Reason: No specialty at sending facility...05/21 2124 Request Began...(Referring Transfer Center Employee) called from (Referring Transfer Center) with a trauma pt for a MVA from (Hospital #1). Advised they reached out to (eventual receiving hospital) who did not decline but they wanted to send home pt and the referring provider didn't want to send (Patient #1) home. Let them know if the patient is a true trauma they need to go to the closest facility and if (eventual receiving hospital) did not decline they need to go there...2223: Transfer type set to Emergency Transfer...2234: Request Canceled Reason: Cancelled- inquiry only...."

The transfer log for all transfer requests was reviewed and Patient #1 was not on the log.

Employee #4 confirmed in an interview conducted on 10/16/2024, that HonorHealth Deer Valley was the next hospital the Referring Transfer Center would attempt because it was the next closest to the hospital that eventually accepted the patient. Employee #4 aslo confirmed the transfer log contains all incoming transfer requests and if the request was cancelled or accepted. Employee #4 confirmed Patient #1 was not on the transfer log because the Transfer Center of Hospital #2 did not take the patient's information.

Employee #24 confirmed in an interview conducted on 10/16/2024, the complete transfer request record was not filled out for Patient #1 because they did not make it that far in the process, but they do have record of the call request. Employee #24 also confirmed the Transfer Center for Hospital #2 does not require a reason for a decline from another facility before they can accept the transfer. Employee #24 further confirmed that the normal processes were not followed.

Based on a review of hospital records and interview, it was determined the hospital failed to accept a transfer of an emergency patient who required specialized services not offered at the referring hospital.

Findings include:
Policy titled "Emergency Medical Treatment and Labor Act (EMTALA) Policy," revealed: "...HonorHealth will accept transfers of any un-stabilized person with an emergency medical condition from another hospital without regard to the person's ability to pay if: 1. The transferring hospital does not have the specialized capability and equipment to provide the necessary stabilizing treatment; 2. HonorHealth has the specialized capability (if HonorHealth has the required on-call physician and he is available, then HonorHealth has the specialized capability) to provide the necessary stabilizing treatment and a physician is able to accept the transferred patient; and 3. HonorHealth has the capacity to provide this treatment (including bed availability, staffing, equipment, etc.). All transfers will be initiated in the HonorHealth Transfer Center. A Transfer Center Coordinator will be responsible for: Determining if the HonorHealth hospital has bed capacity (including appropriate equipment) and hospital staff availability; Determining if the HonorHealth hospital has an accepting physician; Facilitating a conversation between the sending and receiving physicians. HonorHealth Transfer Center personnel will document the circumstances under which it refuses to accept a transfer from another hospital...."

Patient #1's medical records from Hospital #1, contained a note titled "Emergency Department Note," dated 05/21/24, which revealed: "...In summary the patient was involved in an MVC in which (Patient #1) sustained a right zygomatic fracture, large right subgaleal hematoma, closed head injury, concussion, first rib fracture, C5 on C6 injury, possible transverse process fracture, and possible pulmonary contusion. Dr (at Hospital #1) spoke with Dr. (at eventual receiving hospital) who had then requested a CTA of the neck to rule out vascular injury because of the mechanism suggested by the first rib fracture. I followed up when the report of the CTA neck returned and advised Dr. (at eventual receiving hospital) that no further pathology was radiographically evident, At that point the patient was accepted by Dr. (at eventual receiving hospital) for transfer to the emergency department at (eventual receiving hospital)...Patient with Presentation consistent with TBI, mild LOC, alcohol intoxicated, involved in a MVA...with large subgaleal hematoma on right forehead/temporal area, concerns for acute right 1 rib posterior fracture, T1 lef {sic} lateral process fracture, Spondylolisthesis on C5 over C6, concerns for being traumatic given rib fracture and tenderness on area. Also right zygoma fracture possible acute due ot {sic} tenderness on Area...Patient requires Trauma surgery/Neurosurgery evaluation and admission for observation...disposition is pending receiving facility acceptance. AZ reach contacted...."

Document titled "Transfer Center Activity," from Hospital #2, dated 05/21/2024, revealed: "...Level of Care Emergency Medicine; Reason: No specialty at sending facility...05/21 2124 Request Began...[Coleen] called from AZ Reach with a trauma pt for a MVA from (Hospital #1). Advised they reached out to (eventual receiving hospital) who did not decline but they wanted to send home pt and the referring provider didn't want to send (Patient #1) home. Let them know if the patient is a true trauma they need to go to the closest facility and if (eventual receiving hospital) did not decline they need to go there...2223: Transfer type set to Emergency Transfer...2234: Request Canceled Reason: Cancelled- inquiry only...."

Transcript pf phone call between Referring Transfer Center and Transfer Center for Hospital #2, as follows:
Referring Transfer Center: Who has a trauma patient
Transfer Center for Hospital #2: Ok where are they coming form
Referring Transfer Center: (Hospital #1)
Transfer Center for Hospital #2: (Hospital #1) and they have a trauma patient?
Referring Transfer Center: Correct
Transfer Center for Hospital #2: Ok hold on one moment. Ok where is that at?
Referring Transfer Center: Ganado.
Transfer Center for Hospital #2: There should be closer traumas to that. They're not on our normal distance list. That seems further out. Have you tried (eventual receiving hospital) trauma?
Referring Transfer Center: Yeah, we tried (eventual receiving hospital), they couldn't accommodate so (Dr. at Hospital #1) said head to Phoenix and you're the first stop
Transfer Center for Hospital #2: So then it's not a true trauma. If (Patient #1's) a trauma, they can not, nobody can turn away a trauma
Referring Transfer Center: Oh ok
Transfer Center for Hospital #2: So if it's a true trauma then they have to take it, if not then finish the intake and I'll see if we can accommodate, but if it's a true trauma, they should not be refusing it
Referring Transfer Center: Ok, well my understanding is that (Dr. at Hospital #1) talked to them and they wouldn't take (Patient #1) so he said don't call (eventual receiving hospital), so you're the next stop and that's why I'm calling you. (Patient #1) was intoxicated and had a motor vehicle accident and had multiple fractures. (Patient #1) is stable.
Transfer Center for Hospital #2: Yeah, (Patient #1's) definitely a trauma. Do you have the provider who declined the trauma out of (eventual receiving hospital)?
Referring Transfer Center: I do not
Transfer Center for Hospital #2: Ok
Referring Transfer Center: I do not
Transfer Center for Hospital #2: Ok, if you could get that from (Hospital #1) we will need to document that because this trauma is coming way out of the closest trauma, for what the protocols are, they should go to the next closest. And (eventual receiving hospital) is their closest.
Referring Transfer Center: I understand. I have Dr. (at Hospital #1) on the line now, I can go back to (Dr.) and tell (Dr.) what you said.
Transfer Center for Hospital #2: Yeah, if you could please
Referring Transfer Center: Yeah, do you want to chat with (Dr.) or do you want me to tell (Dr.)
Transfer Center for Hospital #2: No, just let him know we will need that information because they are passing up a trauma center to come all the way to Phoenix. They shouldn't be doing that.
Referring Transfer Center: Ok, hold on
03:05-4:19: Call on hold
Referring Transfer Center: Thank you so much holding, I do apologize. Ok, so what (Dr.) said to me is they did not decline. What they said was do a CTA, if there's no vascular then (Patient #1) can go home. Dr. (at Hospital #1) is not feeling comfortable with sending (Patient #1) home. The CT was negative. So that's why (Dr.) said (Dr.) didn't bother calling (eventual receiving hospital) back or (Dr.) doesn't want to go to (eventual receiving hospital)
Transfer Center for Hospital #2: No, (Dr.) does need to attempt (eventual receiving hospital). If (Dr.) gets a true decline then (Dr.) can attempt us or New Mexico which may have a trauma center that's closer
Referring Transfer Center: Ok, I'll let (Dr.) know
Transfer Center for Hospital #2: But (Dr.) does need to try a closer trauma center.
Referring Transfer Center: OK Thank you
Transfer Center for Hospital #2: Thank you
Referring Transfer Center: Bye bye

Document titled "Transfer Center Activity," dated 05/21/2024, revealed: "...Level of Care Emergency Medicine; Reason: No specialty at sending facility...05/21 2124 Request Began...(Referring Transfer Center Employee) called from (Referring Transfer Center) with a trauma pt for a MVA from (Hospital #1). Advised they reached out to (eventual receiving hospital) who did not decline but they wanted to send home pt and the referring provider didn't want to send (Patient #1) home. Let them know if the patient is a true trauma they need to go to the closest facility and if (eventual receiving hospital) did not decline they need to go there...2223: Transfer type set to Emergency Transfer...2234: Request Canceled Reason: Cancelled- inquiry only...."

The transfer log for all transfer requests was reviewed and Patient #1 was not on the log.

Employee #4 confirmed in an interview conducted on 10/16/2024, that HonorHealth Deer Valley was the next hospital the Referring Transfer Center would attempt because it was the next closest to the hospital that eventually accepted the patient. Employee #4 aslo confirmed the transfer log contains all incoming transfer requests and if the request was cancelled or accepted. Employee #4 confirmed Patient #1 was not on the transfer log because the Transfer Center of Hospital #2 did not take the patient's information.

Employee #24 confirmed in an interview conducted on 10/16/2024, the complete transfer request record was not filled out for Patient #1 because they did not make it that far in the process, but they do have record of the call request. Employee #24 also confirmed the Transfer Center for Hospital #2 does not require a reason for a decline from another facility before they can accept the transfer. Employee #24 further confirmed that the normal processes were not followed.