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Based on review of twenty emergency department records, a review of the hospital's bylaws, and review of the policies and procedures for patients who present to the emergency department, it was determined that in one (patient #1) of twenty records reviewed of patients who presented to the hospital requesting emergency services, the hospital failed to ensure compliance with 489.24. A physician's certification request for transfer form was not completed for patient #1, and patient #1 was not provided with an appropriate transfer to the receiving hospital on 3/27/11. This resulted in deficient practice cited at 42 CFR 489.24, C2409.

Based on review of twenty emergency department (ED) records involving transfers to other hospitals and staff interviews, the hospital failed to complete an appropriate transfer for one (patient #1) of twenty patients reviewed. Review of patient #1's transfer revealed that the receiving hospital was not notified of the transfer and there was no evidence to indicate that the receiving hospital agreed to accept the transfer. In addition, the hospital did not complete the form which includes the physician certification and lists the risks and the benefits of the transfer of patient #1 to the receiving hospital on 3/27/11. Findings include:

The hospital's EMTALA policy and procedure was reviewed. The policy stated an appropriate transfer of a patient to a medical facility is the responsibility of the transferring physician and the transferring facility. The policy stated the physician requesting the transfer will contact the receiving facility's physician and communicate pertinent information regarding the patient's status and will assure that the receiving facility consents to the transfer and will accept the patient. The policy further stated the physician requesting the transfer will complete the Authorization to Transfer Form and the Inter-Facility Transfer Form for all patients transferred to another facility. In addition, the form will identify the name of the receiving facility and the accepting physician.

Patient #1's ED record was reviewed and indicated patient #1 was transported to the ED via ambulance from a local hotel because he was having chest pain. Patient #1 arrived at the ED on 3/26/11 at 11:43 p.m. Prior to arriving at the ED, the paramedics defibrillated the patient and called for a helicopter/air ambulance from the scene (hotel). The paramedics transported patient #1 to the ED to be monitored (medical screening examination was performed) and to wait for the helicopter/air ambulance to transport patient #1 to the receiving hospital because he needed a higher level of care related to his cardiac condition. The patient was transferred from the ED to the receiving hospital via air ambulance. A copy of patient #1's medical record was sent with him, and he left the ED at 12:30 a.m. There was no evidence to indicate that the receiving hospital agreed to accept the patient prior to the transfer. The patient's ED record did not reveal that the ED physician communicated with the receiving hospital's ED physician prior to transferring patient #1 from the ED to the receiving hospital. Review of patient #1's ED record revealed that the physician certification form that lists the risks and benefits of the transfer of patient #1 to the receiving hospital was not completed.

Patient #1's ED record from the receiving hospital was reviewed. The record indicated patient #1 was seen at Winona Hospital prior to being transported by helicopter to the receiving hospital. According to the receiving hospital's ED record, Patient #1 arrived at the receiving hospital's ED via helicopter at 1:02 a.m. on 3/27/11. The ED record indicates that the receiving hospital did not receive any information on patient #1 and they "did not have any warning that he was en route to our hospital." Upon arrival to the receiving hospital ' s ED, the patient was alert, had a blood pressure of 139/80 and heart tones were regular. The patient was identified as a priority 1, and was immediately sent to the cath lab. Patient #1's diagnoses were determined to be acute myocardial infarction and resuscitated V-Fib arrest.

Physician (E) was interviewed by phone on 4/12/11, and he stated he was working in the transferring hospital's ED when patient #1 arrived via ambulance on 3/26/11. He stated he provided treatment to patient #1 related to his heart condition. The treatment included conducting a medical screening examination, monitoring his vital signs and pain level, ordering/administering heparin and nitroglycerin drips and ordering an electrocardiogram for patient #1. Physician (E) decided to transfer patient #1 to the receiving hospital due to patient #1's need for extensive, ongoing treatment related to his heart condition. Physician (E) acknowledged that he failed to communicate with the receiving hospital's ED physician prior to transferring patient #1 from the ED to the receiving hospital and did not complete the required risk and benefits physician certification form prior to transferring patient #1 to the receiving hospital.