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Based on interview and record review, the facility did not accept an appropriate transfer of a patient with an emergency medical condition even though the facility had the specialized capabilities to treat the patient (Patient 1) and failed to implement its policy and procedure regarding maintenance of an accurate transfer log as evidenced by:

Patient 1 presented to the Emergency Department of the transferring facility where it was determined that she needed to be transferred to another facility with specialized capabilities. The transferring facility did not accept Patient 1 and did not maintain an accurate and complete transfer log. (Refer to A2411)

Based on interview and record review, the facility did not accept an appropriate transfer of a patient with an emergency medical condition even though the facility had the specialized capabilities, which included an ENT (Ear, Nose, Throat) physician on call, to treat the patient (Patient 1). The facility also failed to maintain a complete and accurate transfer log as required by it policy.

Findings:

An interview was conducted on 2/2/11 at 10:05 am, with Physician A, who was the Emergency Department (ED) physician at the transferring facility who evaluated Patient 1. Physician A said Patient 1 had a peritonsillar abscess (swelling in the area of the tonsils) that needed to be treated right away and evaluated by an ENT physician. He further explained that there was a potential for airway and breathing problems if left untreated. Physician A called Physician B (the ED physician at the receiving facility) and was given the name and number of the ENT physician on call, Physician D. Physician A stated that he called Physician D who told him, "I don't take transfers." Physician A said he then made arrangements to send Patient 1 to another facility. Physician A then called Physician B to advise him that Physician D would not accept the transfer.

A review of Patient 1's record from the transferring facility disclosed that Physician A called the facility on 1/22/11 at 11:30 am, and was given the name and number of Physician D. The following was documented at 11:35 am in Physician A's ED note, "discussed with Physician D, doesn't take transfers." Physician A then made arrangements to transfer Patient 1 to another facility. A review of Patient 1's records from that facility disclosed that Patient 1 arrived in their ED at 1:35 pm and was transferred to the Operating Room at 3 pm.

During an interview on 2/3/11 at 3:05 pm, Physician B stated that he received a call from Physician A who requested the name and number of the ENT physician on call, Physician D. Physician B provided this information then later received another call from Physician A who stated that Physician D declined to accept the transfer. Physician B said he offered to take Patient 1 as a direct admit into the Emergency Department but Physician A said he'd already made other arrangements to send Patient 1 to another facility. Physician B said he wrote a note regarding the transfer request on the facility's transfer form.

The facility's policy titled, EMTALA - Patient Transfer, dated 8/09, was reviewed on 2/3/11. It read as follows: The facility will maintain a log of the inquiries and subsequent disposition for all requested patient transfers from other hospitals. This request for transfer log will include: name of hospital requesting transfer, time of request, name of individual requesting transfer, name of individual receiving request, patient name, patient condition, reason for transfer, disposition of transfer (accept or refuse) and if refused, reason for refusal.

A blank copy of the facility's transfer communication form was provided on 2/15/11. This form contained spaces in which to insert the information required by the facility's policy. The following was written at the bottom: If transfer must be denied: dictate a note giving details of why the transfer had to be denied, make specialist aware that they should do the same it they cannot accept the patient.

The transfer communication forms for 1/22/11 were reviewed and Patient 1's name was not on the list. On 2/3/11 at 3:35 pm, Administrative Staff F and Physician C, the medical director of the ED, confirmed that they also could not find a transfer communication form for Patient 1.

During a subsequent interview on 2/8/11 at 9:05 am, Physician A stated he was positive that Physician B did not offer to accept Patient 1 into the ED during their conversations.

During a subsequent interview on 2/15/11 at 4:55 pm, Physician B stated that he told Physician A he would accept Patient 1 during both the initial call and the second call. He again confirmed that he had completed the top half of the facility transfer communication form but did not know what happened to it.

During a subsequent interview on 2/14/11 at 1:20 pm, Administrative Staff B confirmed that the transfer communication form still had not been located.

During an interview on 2/16/11 at 4:15 pm, Physician D stated that he did not recall getting a call on 1/22/11. He stated that he did not have a set response but would suggest that the caller call the ED physician at the facility. He further stated that if he was on call and got a call from the facility's ED, then he would be obligated to come in.