HospitalInspections.org

Based on review of facility policies and procedures and interview with staff (EMP), it was determined the facility did not adhere to facility policy by failing to accept a transfer of an individual, requiring surgical services, for lack of health insurance.

Findings include:

Review on June 12, 2015, of facility policy "Emergency Medical Treatment and Transfer," dated October 2010, revealed "INTRODUCTION AND OVERVIEW: This emergency medical treatment and patient transfer policy is based on federal law relating to the emergency medical treatment and medically appropriate transfer of individuals between hospitals. The treatment and transfer of an individual shall not be predicated upon arbitrary, capricious, or discrimination based upon race, religion, national origin, age, sex, physical condition or economic status. ... I. MEDICAL SCREENING EXAMINATION A. General ... 3. Inquiry for Insurance Status. Hospitals will follow reasonable registration procedures; however, a medical screening examination, stabilizing treatment, or appropriate transfer will not be delayed in order to obtain patient financial information. ... 5. Nondiscrimination. The hospital shall not refuse to accept an appropriate transfer of an individual with an emergency medical condition if the individual requires a specialized service (e.g., burn units, shock-trauma units, neonatal intensive care units) available at the Hospital. ... IV ENFORCEMENT The Hospital will enforce this Emergency Medical Treatment and Patient Transfer Policy in the same manner as it enforces the other policies and procedures for the governance of the Hospital. ..."

Review on June 12, 2015, of facility policy "Utilization of Patient Care Areas," dated January 2015, revealed "... 7. Admissions will be designated as: ... b. Direct Admissions to the ICUs-Will be considered when the patient is transferred from another acute care facility and a physician of the hospital medical staff has accepted the transfer of care. ..."

Interview on June 11, 2015, at 12:10 PM, with EMP3 revealed "[OTH2] called [EMP3] regarding a transfer of an individual from another acute care hospital. [OTH2] asked where the patient was. I (EMP3) called [the transferring hospital] to fax me demographics. I pre-admitted the patient. There was enough information for me to get started. The fax came. I was unsure of what the insurance code was. I went to [EMP2] regarding the insurance. I called [the transferring hospital] admissions and was informed it was [the transferring hospital's] "Charity Care" ( a code to indicate that a patient does not have covering health insurance and that the hospital will not be receiving/billing for rendered healthcare services) ... EMP2 said [the patient] is not coming because [the patient] doesn't have insurance." EMP3 was asked for clarification regarding this last sentence in the above quote and EMP3 said "I couldn't swear to that statement."

Interview on June 12, 2015, at 9:55 AM, with EMP6 revealed that EMP6 received a call from OTH2, on May 15, 2015, via voice mail. EMP6 confirmed the voice mail did not indicate any emergent issue so EMP6 did not immediately return the call but responded back later that evening. EMP6 confirmed OTH2 contacted EMP6 regarding OTH2 concerns over the fact that OTH2 had accepted a patient for transfer; but somehow it was cancelled by Easton Hospital. OTH2 was not aware as to why the Hospital cancelled the transfer.

Interview on June 11, 2015, at 10:03 AM, with OTH1 revealed that OTH1 is OTH2's practice partner. OTH1 confirmed that OTH2 contacted OTH1 regarding this patient. OTH1 indicated that the patient had "free air and the surgeon's there [at the transferring hospital] didn't feel comfortable doing bariatric surgery" on this patient. OTH1 indicated that "any general surgeon should have been able to handle this patient's surgery." OTH1 further indicated that "OTH2 had accepted the patient and arranged to receive the patient at Easton; and that OTH2 then was called by [EMP5] and told we (the Hospital) weren't going to accept the patient. No reason was provided." OTH1 confirmed EMP5 is Easton's Chief Financial Officer.

Interview on June 11, 2015, at 12:20 PM, with OTH2 revealed that the patient in question was a patient of OTH2's predecessor in OTH2's current practice. OTH2 indicated that "My practice received the call from [the transferring hospital.] I called back and spoke to [the transferring hospital's Emergency Department physician.] I was informed that the patient had free air, blood pressure and heart rate were stable and that the patient needed surgery. [The transferring hospital] started antibiotics and fluid resuscitation. I told [the transferring hospital's Emergency Department physician] this can be taken anywhere but I will gladly take the patient. I spoke to [EMP9], called the OR in anticipation of receiving patient and alerted the residents. I called (Easton's) bed management and was told the patient can't be transferred because [the transferring hospital] has a bariatric surgeon within its organization. I received a call from [the transferring hospital's bariatric surgeon] and [the transferring hospital's bariatric surgeon] said it was very inappropriate not to accept the transfer of this patient. I told [the transferring hospital's bariatric surgeon] that I accepted the patient and was waiting for the patient." OTH2 confirmed calling EMP5 regarding the scenario because the bed transfer was denied.

Interview on June 12, 2015, at 12:40 PM, with OTH2 revealed that OTH2 spoke to EMP5 and EMP5 said to OTH2 that "[the transferring hospital] was trying to dump the patient on Easton because [the patient] didn't have insurance."

Interview on June 12, 2015, at 3:00 PM, with EMP7 revealed that "EMP3 got the initial call from [the transferring hospital.] EMP3 asked for a face sheet. EMP3 received it. EMP3 noticed no insurance." EMP7 further indicated that "EMP2 spoke to EMP5 and that EMP5 told EMP2 that we couldn't accept the patient because the patient had no insurance. EMP2 told me (EMP7), per EMP5, not to accept the patient because [the patient] had no insurance. I (EMP7) called [the transferring hospital] and told [the transferring hospital's] unit secretary, that we were not able to accept the patient because of no insurance." EMP7 indicated that OTH2 called EMP7 to inquire about the status of the transfer. EMP7 told "OTH2,per my supervisor, we couldn't accept the patient because [the patient] had no insurance."