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The facility failed to comply with 42 CFR Part 489.24. See A2407.

Based on interview, policy review and record review, the facility discharged an unstable patient to a facility that did not have the capability to medically stabilize the patient. Findings include:

In 1 (pt. #1) of 25 medical records reviewed, there is documentation that the patient was not medically stabilized prior to transfer to another health care facility [the psychiatric care program at Green Bay Bellin Hospital].

The Emergency Department [ED] medical record documents that Pt. #1, a 15 year old male presented to the ED with a grandmother on 9/8/09 at 1226. Pt. #1 stated that he attempted to commit suicide and took 7 Catapres [possibly more] and drank some alcohol. An IV was started, stomach contents were checked for pill fragments and laboratory tests were ordered. Pt. #1 experienced fluctuating blood pressure [BP] and pulse over approximately the next 5 hours The BP ranged from 114/75 to 85/52; pulse ranged from 96 [beats per minute] to 48.

Family members wanted the patient seen at a psychiatric facility, declined to have the patient scheduled for treatment at Michigan facility in the region and expressed the desire to have the patient treated at the psychiatric program in Wisconsin.

Transfer arrangements were made. The medical record indicates that the patient discharge condition was not stable [it was recorded as "fair"] and that EMTALA forms were completed. The patient was further evaluated as having independent locomotion and that the transfer would include a RN [RN #1] to accompany the patient in the ambulance. At the time of transfer [1740] the patient had a BP of 89/54, was receiving oxygen via nasal cannula at 3 liters/minute and exhibiting sinus bradycardia in the upper 40s. Medical record notation states that the physician was made aware of these readings.

The Consent to Transfer form signed by the patient's mother at 1700 on 9/8/09 includes the language, "The potential benefits of such transfer, the potential risks associated with such transfer, and the probable risks of not being transferred have been explained to me and I fully understand them." The specific benefits/risks were not recorded.

The Emergency Medical Service ambulance service [Manistique EMS] recorded on the Standard Basic Services Report that the patient experienced a drop in blood pressure starting approximately 40 minutes into the transfer. Fluid resuscitation commenced at 1825.

Upon arriving at the psychiatric program facility in Green Bay at 2025, the EMS driver and RN #1 were notified by the a psychiatric staff nurse [PSN #1] that they had been told that they were receiving a stable patient and could not accept a patient that had an IV and further stated the expectation that the patient must be able to walk into the facility. RN#1 felt that removing the IV was medically contraindicated and after the supervisor for PSN #1 was contacted, it was determined that the patient would be taken to the Emergency Department of the facility for assessment and treatment prior to being seen in the psychiatric program. The patient was able to ambulate from the EMS stretcher to the ED stretcher and was subsequently admitted to the Bellin Hospital ED.