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Based on policy and procedure review, medical record review and interview, the hospital failed to adhere to the provider's agreement that required a hospital to be compliant with §42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases. The hospital was not in compliance with the EMTALA (Emergency Medical Treatment and Labor Act) requirements. See A2411 for details.

Based on policy and procedure review, medical record review, and interview, it was determined the facility failed to accept an appropriate transfer for one of one (#1) patient requiring specialized Gastroenterology (GI) services not offered by the transferring facility. By not accepting Patient #1 the facility delayed the specialized treatment needed for Patient #1. The failed practice had the likelihood to affect any patient needing the specialized services provided by the facility. Findings follow:

A. Review of Policy and Procedures of the University of Arkansas for Medical Sciences (UAMS), "EMTALA Compliance," dated 03/24, showed the following:
1) UAMS shall accept the transfer of patients covered by EMTALA for other facilities when the individual being transferred requires specialized capabilities that are not offered or not available at the transferring facility, if UAMS has the current capacity and capability to provide necessary treatment to the patient in accordance with its normal accommodation processes.
2) UAMS will defer to the transferring physician's judgement with respect to the need for transfer when the transferring physician identifies Emergency Medical Condition (EMC) that the transferring hospital does not have the capacity or capability to stabilize.

B. During an interview on 04/29/25 at 1:30 PM, ARC Program Manager confirmed the findings in A.

C. Review of Patient #1's Clinical record from the transferring facility CHI St. Vincent Hospital Hot Springs ED (Emergency Department) showed the following:
1) Admission was from 03/23/25 at 7:14 PM to 03/23/25 at 11:38 PM.
2) Provider Note dated 03/24/25 at 10:09 PM, by Physician #1 showed "63 y/o (year old) F (Female) here for evaluation of GI (Gastrointestinal) bleeding left lower quadrant abdominal pain, shortness of breath, and chest pain. Patient woke up last night around 130 (1:30 AM) and had bright red rectal bleeding. She states this happened 2 more times. She developed lower quadrant abdominal pain and states that she had diverticulitis in the past with similar symptoms. She also noticed that she was having some mild chest pain and shortness of breath which is atypical for her. She is on Xareltoper her report. On arrival she is satting(oxygen saturation) 88% on room air and does not wear oxygen at baseline. Patient has a past medical history (PMH) of Anemia, Blood disorder, CAD(coronary artery disease), Cancer (CMS/HCC), Depression, , Diverticulitis, GERD (gastroesophageal reflux disease), Headache, HTN (hypertension), Hyperlipidemia, IBS (irritable bowel syndrome)."

3) Review of Laboratory results dated 03/23/25 at 7:40 PM showed the following: Hematocrit 28.2% (reference range 36%-48%), Hemoglobin POC (Point of Care): 8.2 g/dl (grams per deciliter).

4) Review of ED Medical Decision Making and Plan of Care dated 03/23/25 showed "63-year-old female here for evaluation of left lower quadrant abdominal pain rectal bleeding. Differential diagnose includes diverticular bleed, lower GI bleed of other cause, among other causes. Patient is hypoxic 88% on arrival and this is a new finding for her. She was started on 2 L nasal cannula. She is left lower quadrant abdominal pain on exam. Protonix given as well as a small dose of Ativan as she was very hesitant to go to the CT scanner. Labs show that her hemoglobin has gone down to 8 from a baseline of around 10, her CMP is unremarkable, her BNP is 348, her troponin is minimally elevated at 42. CT abdomen/pelvis was completed with unremarkable firndings and CTA chest revealed possible pulmonay edema and pulmonary hypertension.. We do not have GI coverage at this facility at this time. I discussed with (Named Physician #5) with internal medicine who does not feel comfortable keeping the patient given that we do not have GI coverage. I discussed this with UAMS Medical Center by phone and discussed it with Physician #2 with gastroenterology. He indicates it is very unlikely that she would receive intervention overnight by gastroenterology but he was okay excepting [sic] the patient through internal medicine. The transfer center operator (Named) then discussed this with internal medicine who then refused the patient because they felt that the patient would not likely get GI intervention overnight. I confirmed with the transfer coordinator that they did currently have capacity and capability to take care of this patient but were refusing to transfer. Patient was subsequently transferred to North Little Rock Baptist after discussion with her transfer center."

D. Review of UAMS Medical Center Patient #1 Medical Record dated 03/23/25 from 9:18 PM to 9:54 PM showed the following phone call communication with CHI St Vincent Hospital Hot Springs: Entered by RN (Registered Nurse)#1
03/23 at 2118(9:18PM) Ownership Claimed by RN #1.
03/23 at 2118(9:18PM) Request type set to Hospital Transfer - ED to Inpatient
03/23 at 2121(9:21PM) Call from CHI St Vincent Hospital Hot Springs Physician #1 calling for ED-IP (Inpatient) transfer of 63/f( 63 year old female)
03/23 at 2131(9:31 PM) Call to UAMS Medical Center Physician #2
03/23 at 2132(9:32 PM) Transfer type set to ED to Inpatient
03/23 at 2137(9:37 PM) Call UAMS Medical Center Physician #2
03/23 at 2143(9:43 PM) Call to UAMS Medical Center Physician #3
After Informing him of pt's presentation, hx and plan from GI, Physician #3 does not wish to accept this pt at this time. If the pt begins to bleed or has a significant change in status, he wishes for OSH to call back and we can involve GI and/or IR.
03/23 at 2150(9:50 PM) Call to CHI St Vincent Hospital Hot Springs Physician #1, RN#1 called to notify of UAMS Medical Center Physician #3 decision. Will call back if pt has any change in status
3/23 at 2154(9:54 PM) Request Canceled Reason: Transport Denied due to Medical Necessity"

E. Review of Patient #1's Clinical record from the receiving facility Baptist Health Medical Center North Little Rock ED (Emergency Department) showed the following:
1) Review of Admissions demographics showed Patient #1 was admitted to the ED on 03/24/25 at 12:57 AM and admitted to Inpatient on 03/24/25
2) Review of Laboratory results showed the following:
a) On 3/24/2025 at 01:55 (1:55 AM) Status: Hematocrit 27.1% (reference range 36%-48%) (a decrease of 1.1% from 03/23/25 at 7:40 PM), Hemoglobin POC: 7.4 g/dl (a decrease of 0.8 g/dl since 03/23/25 at 7:40 PM).
b) Repeat Hemoglobin post 1 unit PRBC (Packed Red Blood Cells) given on 03/24/25 at 8:31 AM was 8.2 g/dl.
c) On 03/24/25 at 2:25 PM, the Hemoglobin was 8.3 g/dl.