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Based upon record review and interview, the facility failed to accept an appropriate transfer of 1of 30 (#1)patients reviewed.

Review of medical record for patient #1 from the transferring facility revealed on 4/29/10 at 10:52 am, patient was admitted to the emergency room of the transferring facility who was a 15 year old male who had overdosed on Benzodiazepine recreationally. Patient had fallen asleep in class and unarousable so patient was taken by private auto to the emergency room(ER). Upon arrival to the emergency department of the transferring facility, patient was alert and answering questions. Patient stated "I was trying to get high." Patient denied suicidal thoughts. Urine drug screen was done and was positive for benzodiazepines and negative for all other drugs. Patient also had diagnosis of Attention Deficit Hyperactivity Disorder. Review of the ER physician's (Physician #1) notes timed 11:10 am. revealed patient's symptoms had increased over the past 4-6 hrs. and patient was confused, lethargic and sleepy but easily aroused. ER physician(Physician #1) prescribed Romazicon 0.2 mg IV(medication used to reverse the effects of sedative like medications). Patient was given the medication at 11:30 am, 12:42 pm, and 2:43 pm. ER Physician's(Physician #1) notes revealed patient was observed ambulating unsteadily at 4:00 pm. and remained lethargic. Notes also revealed note that patient was stable for transfer.

Review of the physician's(physician #1) notes contained the following: "Spoke with pediatrician(physician #2) at receiving facility-accepted to receiving facility emergency room. Further review of physician's (physician #1)notes revealed an addendum note dated 4/29/2010 at 4:15 pm. "Receiving facility pediatrician (Physician #2) called back and declined transfer of patient-stating no intensive care unit bed. Discussed with pediatrician (Physician #2) but still declined."

Review of nurse's notes revealed the receiving facility was notified of need to transfer @ 3:47 pm. Physician #1on phone with Physician #2 who accepts patient for transfer to receiving facility@ 3:58pm. At 4:11 pm, the receiving facility called back and physician #2 declined the admission due to no pediatric intensive care unit(ICU) available. Physician #1 explained to Physician #2 that the transferring facility did not have a pediatrician and patient did not need ICU but needed to be monitored overnight under the care of a pediatrician, possibly 23 hour observation and then discharged home. Physician #2 still declined the transfer.

Voice recordings of the telephone conversations between the transferring and receiving facilities were reviewed for content. The voice recordings confirmed that Physician #1 explained to Physician #2 why patient needed to be transferred to be treated by a pediatrician and it was not necessary that patient be in a pediatric ICU.

An interview was conducted with the Vice President over Emergency Services on 5/18/2010 at 1:30 pm. The Vice President listened to the voice recordings with this surveyor and confirmed the transfer was declined.

Review of policy and procedure manual revealed Policy 50-003 titled "Patient Transfers-Emergency Department to Emergency Department. The receiving facility has a department that coordinates the transfer of emergency department patients by expediting phone calls between the transferring Emergency Department and the receiving Emergency Department and between the physicians. The policy stated that the Administrator on call will be contacted immediately if any consulting physician refuses to accept a patient.

A telephone interview was conducted with the Emergency Department Director on 5/27/2010 @ 2:30 pm. The Emergency Department Director reported she had reviewed call logs and voice recordings and found no evidence that the Administrator on call had been contacted about the refusal to accept the patient.