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Based on findings at A2411, the facility failed to ensure compliance with Code of Federal Regulations (CFR) 489.24.

Based on interview and document review, the facility with specialized capabilities failed to accept an appropriate transfer of 1 of 20 sampled patients (Patient 20), who required such capabilities. The failure to accept an appropriate transfer had potential for further risk or harm due to delay in treatment.

Findings include:

Patient 20 presented to the Emergency Department (ED) via private vehicle on 05/23/2025 with a chief complaint of left-sided numbness and muscle spasms which have been present since early May 2025.

The ED Physician Notes dated 05/23/2025, revealed Patient 20 had a history of multiple sclerosis (MS) and epilepsy and presented with MS flare and incurred a seizure two days prior to this ED visit. It was noted that Patient 20 takes Keppra, and denied medication noncompliance, head trauma or injury following the seizure.

The Medical Decision Making (MDM) section of the ED Physician Note, described Patient 20 was experiencing MS flare, mildly hypertensive. Patient out of tPA (Tissue Plasminogen Activator) thrombectomy window and no code white called. It was determined the patient would not require a CT (computerized tomography) scan at the time, since findings from the physical were consistent with the patient's MS flare and an MRI (Magnetic Resonance Imaging) of the head from March 2025, which revealed lesions that were nonspecific but suggestive of MS.

The ED Physician Note revealed a documented timeline in regard to the transfer process for Patient 20.
05/23/2025 at 11:42 AM - transfer center called to initiate transfer.
05/23/2025 at 1:33 PM - calling transfer center to get update, they will try to get in contact with the physician at the accepting hospital.
05/23/2025 at 1:41 PM at 1:41 PM - transfer center reported that the Neurologist (Physician 1) refused the transfer due to Patient 20 having been "fired" by Physician 1. It was documented that the Attending ED Physician alerted the transfer center that refusing a transfer might fall under an EMTALA violation, and a call to Physician 1 was warranted.
05/23/2025 at 2:11 PM - Patient 20 now refused to go to the initial accepting hospital and would be transferred a different ED for further treatment.

On 07/09/2025 at 1:00 PM, Attending ED Physician confirmed that Physician 1 had refused to accept the transfer on 05/23/2025, due to Physician 1 had "fired" Patient 20. The Attending ED Physician reported a concern regarding the amount of time that passed and wanted to speak with Physician 1. The Attending ED Physician confirmed that Physician 1 did not call to discuss the refusal.

On 07/10/2025 at 9:45 AM, Physician 1 was asked what was meant when Patient 20 was "fired" and refused the transfer. Physician 1 stated, "I did not fire Patient 20" and "I have never fired a patient before." Physician 1 further acknowledged he spoke with the Attending ED Physician at the transferring hospital. Physician 1 mentioned that there was no indication that Patient 20 has MS.

On 07/10/2025 at 12:35 PM, 3rd year resident (Physician 2) confirmed receiving a message of a potential transfer on 05/23/2025. Physician 2 confirmed that a review of the clinical record was completed and the request for transfer of Patient 20 was for further workup by Neurology. Physician 2 acknowledged alerting Neurology of the requested transfer. Physician 2 confirmed that the response from Physician 1 was that Patient 20 was "fired" and would not accept.

On 07/16/2025 at 3:18 PM, Patient 20 confirmed that the initial diagnosis of MS was in 2009 at a local acute care hospital. Patient 20 indicated that the MS is remitting and apparently non-progressive and was considered stage 1 out of 4 stages. Patient 20 acknowledged that there was a clinical relationship with Physician 1 for several years and was not made aware of being "fired".

The Transfer Center's printout for 05/23/2025 confirmed that Physician 1 had not attempted to contact the Attending ED Physician in regards to the refusal to accept Patient 20. Only Physician 2 and the Attending ED Physician's communication was recorded on the printout.

The Administrative Procedure entitled, "Emergency Medical Treatment and Labor Act (EMTALA)" revealed a hospital must accept an appropriate transfer of an individual with an unstablized emergency medical condition if the following both exist:
a. The individual being transferred requires such specialized capabilities or facilities that the hospital possesses and that are not offered or not immediately available at the transferring hospital
b. The hospital has determined it has the capacity to treat the individual.

In Subsection B(3)(g) of the Administrative Policy "EMTALA", it further noted that an EMTALA violation or potential violation may occur when incidents of non-compliance include a "Refusal of an ED provider or an on-call physician to accept a patient the facility has the capability and capacity to care in the transfer from another facility."