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Based on record review, interview, document review and policy review the Critical Access Hospital (CAH) failed to ensure emergency medical treatment and labor act (EMTALA) requirements were met by failing to ensure the physician assistant (PA) followed policy and consulted with the physician prior to the transfer for 2 patients with un-stabilized emergency medical conditions (EMC), (Patient 8 and 17). Failure of the PA to follow policy and consult with the physician to arrange an appropriate transfer placed patients at risk for an unsafe transfer and deterioration of their un-stabilized EMC.


Findings Include:


Review of a document titled, " LANE COUNTY HOSPITAL RULES AND REGULATIONS OF THE MEDICAL STAFF" showed,

... 5. Emergency Medical Screening Examinations
Any individual arriving by himself or herself or with another person at the emergency room shall be provided an appropriate medical screening examination to determine whether or not an emergency medical condition exists. ...Individuals qualified to conduct such a screening include registered nurses, nurse practitioners, physician assistants, and physicians. These qualified individuals have ready access to the next level of provider, including on-call physicians ...

6. Transfers

The hospital shall admit patients suffering from all types of disease. Any patient whose condition might jeopardize that of other patients shall be transferred to an appropriate facility, following all requirements of law and regulations.

Review of the CAH policies titled, "Medical Record Documentation, "Emergency Room Transfer", "Transfer - [air ambulance]", and the medical staff Rules and Regulations, failed to indicate that if a physician is not physically present in the emergency department at the time an individual is transferred, the qualified medical person has signed a certification after a physician in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification.

Review of the a CAH document titled, "Lane County Hospital Legal Notice Patient Transfer Form" showed a line for the date and the transferring practitioner, the patient's condition and the following statement, "Based on my examination of the patient and the information available to me at the time of transfer, I certify that the risks of transfer are outweighed by the benefits reasonably anticipated form proper care at the receiving facility." There is a line for the practitioner to sign and time and a line for the Countersignature. Refer to tag C2409

Based on record review, policy review, document review and interview, the Critical Access Hospital (CAH) failed to arrange an appropriate transfer for 2 patients (Patient 8 and 17) out of 20 patients selected for review from January to June 2022. Failure of a qualified medical person to consult with a physician to determine, certify and countersign in the medical record, the medical risks and benefits of transfer, and to determine the appropriate mode of transport, placed patients at risk for an unsafe transfer and deterioration of their un-stabilized emergency medical condition.

Findings Include:


Review of a policy titled, " Medical Staffing of Emergency Room" with an effective date of 12/10/21, showed, ...The purpose of this policy is to ensure proper Medical Staff Coverage of the Emergency Room ... The Procedure of the policy showed Staff D, Doctor of Osteopathy (DO), Staff E, Physician Assistant (PA) and Staff F's, PA clinic and cell phone telephone numbers.

Review of a CAH document titled, "Contractual Agreement for Back Up Physician Services", with an effective date of March 22, 2022, showed, the employed physicians of Lane County Hospital and a neighboring CAH's physician, approximately 32 miles away, will agree to be back up physicians for each other in case an emergency arises with the mid-level practitioners in the event of an absence. Physicians will agree to be available by phone and the facilities will contact each other when these services need to be scheduled ...


Patient 8

Review of Patient 8's medical record showed Patient 8 presented to the emergency department on 05/14/22 at 1:21 PM and was seen by Staff E, PA at 1:25 PM. Patient 8 presented with burns from fighting a field fire. The record showed he had deep burn to hands and left upper extremity (LUE) to elbow, facial burns, suspects inhalation of fire/smoke an EMC. The Medical Decision-Making section of the provider note showed, 10%+ burn area (11% is apparent) facial burns and history of CLL (chronic lymphocytic leukemia)/blood disorder/co-morbidities patient requires burn center transfer." Patient 8 transferred to Hospital C's Burn Center on 05/14/22 at 3:15 PM by fixed wing aircraft.

Further review of the medical record lacked evidence Staff E, PA consulted with the physician prior to transferring Patient 8 with an unstable EMC.

Review of Patient 8's "Patient Transfer Form" showed Staff E, PA signed the document as the transferring practitioner, the signature line for the physician's countersignature was blank.

Review of a CAH document titled, "May 2022 Physician Calendar, 5PM-7AM On Call" updated 05/05/22, showed Staff E, PA was on call 05/14/22. The physician and PA's phone numbers were listed on the bottom right corner of the calendar.

During an interview on 06/29/22 at 12:58 PM Staff E, Physician Assistant (PA) stated that it is policy to consult with the physician for patient transfers. When asked about consulting the physician about the transfer, he stated that the electronic medical record (EMR) doesn't prompt for documentation of notification of the physician.



Patient 17

Review of Patient 17's medical record showed Patient 17, 95 years old, presented to the ED by ambulance on 02/02/22 at 2:37 PM, following a fall at home with complaints of left leg pain and was seen by Staff F, PA at 3:00 PM. The x-ray of her left hip showed she had a left sub capital femoral neck fracture (hip fracture) an EMC. Patient 17 transferred a higher level of care by ground ambulance on 02/02/22 at 5:56 PM.

Further review of the medical record lacked evidence Staff F, PA consulted with the physician prior to the transfer of Patient 17 with an unstable EMC.

Review of Patient 17's "Patient Transfer Form" showed Staff F, PA signed the document as the transferring practitioner, the signature line for the physician countersignature was blank.

Review of a CAH document titled, "February 2022 Physician Calendar, 5PM-7AM On Call" updated 02/08/22, showed Staff F, PA was on call 02/22/22. The physician and PA's phone numbers were listed on the bottom right corner of the calendar.

During an interview on 06/29/22 at 1:15 PM, Staff D, Doctor of Osteopathy (DO) stated that he was not aware of a policy that the physician is consulted or the need of the physician to countersign the certification for the PA's for patients they transfer.

During an interview on 06/29/22 at 1:30 PM, Staff F, PA, stated that if a transfer of a patient is initiated, she would call the physician "if they are around" and the physician would give ideas and suggestions of what to do for the patient before the transfer.