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Based on review of the Hospital's Emergency Department's (ED) policies and procedures, observations, review of medical records, and staff interviews, it was determined the Hospital failed to comply with the provider agreement as defined in 489.20 and 489.24. Findings included:

The Hospital failed to provide an appropriate transfer and transfer procedure/information for patient who presented to the Emergency Department (ED) seeking emergency medical treatment, specifically the staff failed to document that the offer of a complete screening examination and stabilizing treatment was made for 1 (#18) of 24 sampled patients, and that the refusal of further examinations and treatment was properly explained and documented in the record.

Based on interview, patient #18, a 31 year old male presented to the emergency room on 11/28/2010 at 7:08 p.m.. The on call physician was simultaneously on call at another hospital in the geographic area. The hospital policies and procedures failed to define the responsibilities of the on call physicians to respond, examine and treat individuals with emergency medical conditions. The hospital lacked policies and procedures to address the inability of the on call physician to respond because of situations beyond his control. The hospital offered the patient transportation to the other hospital rather than direct the on call physician to respond to the patient for examination and treatment.

Based on document review and staff interview, the facility staff failed to document that the offer of a complete screening examination and stabilizing treatment was made to 1 (# 18) of 24 sampled patients, and that the refusal of further examinations and treatment was properly explained and documented in the record. Findings include:

Patient # 18, a 31 year old male presented to the emergency room on 11/28/2010 at 7:08 p.m., with complaints of abdominal pain, back pain and nausea. Initial attempts were made to obtain vital signs.
The patient was shaking due to pain and unable to remain still for basic assessments to be completed. The emergency room physician was contacted and orders for laboratory studies and a medication were obtained. The staff was unable to obtain the requested blood samples for testing and could not complete the screening examination because of the distress that the patient was having. The parents of the patient made the decision to take the patient to another facility for care as the provider was in house at that facility.

Review of the emergency room record for the initial visit failed to reveal documentation that efforts to complete the medical screening examination and stabilizing treatment were offered and an explanation of the risks and benefits of the examination and treatment were provided to the patient and family. There was no documentation of efforts to obtain a signature for refusal of care and treatment, or the offer of an ambulance transfer to the other facility, before the patient was taken by private vehicle to the other facility.

In an interview with the facility director of nursing on 12/15/10 beginning at 9:25 a.m., the director stated that the family of the patient made the decision to transport the patient themselves and did not wait to sign an Against Medical Advice form.