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Based on clinical record review, staff interview, policy review and facility document review it was determined the facility failed to comply with the requirement to accept an appropriate transfer of a patient requiring services that are available at the facility for 1 (#21) of 21 sampled patients. See A 2411.

Based on clinical record review, facility document review, staff interview and policy review, it was determined the facility failed to comply with the requirement to accept an appropriate transfer of a patient when services were available at the facility for 1 (#21) of 21 sampled patients. This practice may result in a delay in the provision of required care for the patient.

Findings include:

Patient #21 was seen and evaluated at facility #1 (transferring facility) emergency department (ED) on 1/21/13. A review of facility #1's Emergency Department (ED) physician's notes revealed the patient was evaluated at 7:34 am. Based on the CT results the patient was diagnosed with a Subdural Hematoma. A review of the Computerized Tomography (CT) of Brain revealed the patient had right frontal parenchymal as well as Subdural hemorrhage.

An entry at 10:17 am revealed the physician had decided to transfer the patient citing the reason as trauma, needing higher level of care, condition critical.

An entry made at 11:01 am revealed the physician had spoken to the facility #2's (receiving facility ED physician and presented him with the case and need to transfer. Facility #1 ED's physician documented that Facility #2's ED physician commented that he would have to clear it with the Neurosurgeon before he would accept the patient. ED Physician #1 informed ED Physician #2 that it is an EMTALA violation to contact him (neurosurgeon) and delay or refuse transport. ED physician #2 told him he didn't want the patient "shoved down his throat" and would not accept until he spoke with the neurosurgeon. ED Physician #1 had not received a call back from ED physician #2 and proceeded to transfer patient to facility #3 (facility that actually received the patient ). At 11:30 am the patient was transferred to facility #3.

A review of Facility #2's Transfer Request Form, dated 1/21/13 revealed initially the ED Physician had denied the transfer of patient #21. After the Administrator on Duty spoke to the physician than the patient had been accepted for transfer, but had already been transferred to Facility #3.

A review of Facility #2's policy, EMTALA- Duty to accept, policy #1.780.007, approved 2/6/12, revealed " a hospital with specialized capabilities or facilities shall accept from a transferring hospital an appropriate transfer of an individual with an emergency medical condition (EMC) who requires specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual". Further review of the policy page 2 of 3, revealed "only the chief executive officer (CEO) or his/her designee and the emergency physician in consultation with the appropriate hospital representative have the right to accept or refuse to accept the transfer of an individual on behalf of the receiving hospital".

An interview was conducted on 2/8/13 at 5:00 pm with the Chief Nursing officer (CNO), the Assistant Chief Nursing Officer (ACNO)/Interim ED Director and the Director of Risk Management. During the interview the above incident was confirmed. When questioned on the chain of events the CNO responded that on 1/21/13 the hospital had received a request for transfer from Facility #1. The Facility's ED physician did not want to accept transfer until he had spoken to the Neurosurgeon on call. The Neurosurgeon did not want to accept the patient because the facility was not the closest facility for transfer. The incident was escalated to the Administrator on call (AOC) who spoke to the Neurosurgeon. The facility than agreed to accept transfer but it was too late the patient had already been transferred to Facility #3.

On 1/22/13 The ED Medical Director spoke to the ED physician and physician was taken off duty until an EMTALA refresher course was completed. This was completed on 1/24/13.
On 1/23/13 the Neurosurgeon was taken off the call schedule until he spoke with the CEO and was reeducated on EMTALA on 1/25/13. On 1/24/13 the Facility self-reported the EMTALA violation. The facility is currently auditing all patients who have left without medical screening examination, transfers in and out.