HospitalInspections.org

Based on record review and interview, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires that hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by:

Failing to accept appropriate emergency patient transfer requests for which the hospital had the capacity and specialized capability to treat as evidenced by refusing to accept individuals who are incarcerated as patients. (see findings at A2411).

Based on record review and interview, the hospital failed to meet the requirement for recipient hospital responsibilities by refusing to accept individuals that are incarcerated as patients into the hospital for 2 of 2 incarcerated patients (#1, #2) in outlying hospital EDs requesting transfer to the hospital. Findings:

Patient #1:
Review of the medical record for Patient #1 obtained from Hospital A revealed he was an individual who was incarcerated who presented to the ED of Hospital A on 08/31/18 at 3:27 p.m., after ingesting 52 capsules of Acetaminophen 500mg at 10:30a.m. Further review of the medical record revealed a note by the ED RN of Hospital A that this hospital was contacted at the request of the physician for the transfer of Patient #1, and was told that this hospital does not accept prisoners per direction of the administration of the hospital.

On 09/18/18 at 8:15 a.m., an interview with the ED RN from Hospital A confirmed she provided care for Patient #1 on 08/31/18 and made the call to this hospital to request his transfer. She stated she spoke with S4RN Transfer Coordinator, who told her that the hospital "does not accept prisoners per Administration, because the State has a contract agreement for prisoners with Hospital B."

Review of the hospital's EMTALA Policies for Transfers from Outlying Hospitals revealed, in part, the following:
According to federal EMTALA regulations and guidelines, hospitals with specialized capabilities, AND available capacity and resources must accept transfers from hospitals who cannot provide the needed services to the patient .... the payor status and/or ability to pay is not a consideration in the process by WKHS and therefore should never be discussed in the process of transferring a patient with an emergency medical condition who needs a higher level of care. All transfers require 2 levels of acceptance: Both an accepting physician AND administrative approval verifying the facility has both capacity and resources to accept the patient in transfer. Both must be met in order to meet the requirements of an EMTALA transfer.

Review of the hospital's SFD Hospital Categorization Chart revealed the categories of patients not accepted for treatment at the hospital included Major Trauma, Major Burns, and Obstetrics. The chart did not list overdose patients as an exclusion for admission.

On 09/18/18 at 12:30 p.m., an interview with S2RN ED Director revealed that not all transfer requests are MD to MD. She said requests may go to the transfer center or the house supervisor and never make it to the ED.

On 9/18/18 at 12:45 p.m., an interview with S3RN Administrator of Patient Logistics (Director of the Transfer Center) confirmed that the incoming transfer calls were centralized to utilize resources. Nurses and trained staff take calls. They are staffed Monday through Friday, 7:00 a.m. - 11:00 p.m. On the weekends they are staffed 11:00 a.m. - 11:00 p.m. When not staffed, the house supervisor takes the calls.

On 9/18/18 at 1:40 p.m., an interview with S4RN Transfer Coordinator, who works in the Transfer Center, revealed they do not deny or accept patients - that was up to the physician. He said if it is something they don't offer, they give other options. He confirmed they don't offer certain neurosurgery, large vessel strokes, trauma, and psychiatrics - and they don't take prisoners at any of their facilities. He said he believed Hospital B had a contract with law enforcement agencies. He said he has been told by administration not to accept prisoners. He said they are to be referred to Hospital B. He said he could not remember the last one that attempted to be sent here.

On 09/18/18 at 2:10 p.m., an interview with S5RN Transfer Coordinator, who works in the Transfer Center, confirmed that the hospital does accept and admit patients with drug overdoses into the ICU. She confirmed that the hospital does not accept prisoners, but refers them to Hospital B.

On 09/18/18 at 2:30 p.m., an interview with S6RN Transfer Coordinator, who works in the Transfer Center, confirmed that admission decisions are based on the reason the patient needs to transfer to the facility, which may include the patient request or need for a higher level of care. He confirmed that they do accept overdoses. He confirmed that they do not accept prisoners. He stated there is an agreement with Hospital B and the prison system, and that this hospital does not provide guarded security. He further stated this was based on a verbal directive from Administration. S6RN Transfer Coordinator confirmed he was working in the Transfer Center on 08/31/18 from 11:00 a.m. - 11:00 p.m. He said he got a call for a transfer request about a patient who was in the ED of another hospital with a Tylenol overdose. They said he was an incarcerated individual. He told them this hospital does not take incarcerated individuals. He confirmed that he did not check to see if they had available beds in the ICU. S6RN confirmed that he had EMTALA training during his orientation and has had ongoing training in EMTALA.

On 9/18/18 at 2:50 p.m., an interview with S3RN Administrator of Patient Logistics (Director of the Transfer Center) confirmed prisoners were not accepted because of lack of resources including guards, security, beds and staffing. He said when they get a call like that it should go through the Administrator. He confirmed that the Administration told them not to accept prisoners, and that is why the RN should be calling the Administrator. He stated he did remember being notified of a call a couple of months ago about a prisoner, after the staff talked to Administration. He reviewed the log and said there was no documentation of a request for a prisoner admission on 8/31/18, and he was not made aware of it. He confirmed that all staff in the Transfer Center had EMTALA training. He further confirmed that all of their facilities take overdosed patients.

Patient #2:
Review of a memo sent from S5RN Transfer Coordinator to S1 Senior Vice President/Administrator with cc to S3RN Administrator of Patient Logistics (Director of the Transfer Center) dated 07/05/18 revealed: Transfer requested for prisoner in ER at Hospital C. They have already called Hospital B, which has the contract to take prisoners, but they are on diversion. Spoke with S1 and S2 (hospital administration). I was told WKHS does not take prisoners as security is not available and Hospital B should be contacted by Hospital C ER about this patient. Spoke with Hospital C, informed them that WK Administration said WKHS cannot accept prisoner transfers because security is not available for this type of patient. Instructed her to contact Hospital B again. Contact was made with Hospital B, and explained that WK does not have the security available to guard a prisoner and that hospital administration has denied the transfer.

On 09/18/18 at 3:12 p.m. an interview with S1 Senior Vice President/Administrator confirmed that the hospital does treat overdose patients. He confirmed that it was his understanding that Hospital B had the resources and contracts to handle prisoners. He stated he does not get notified of every request for transfers involving prisoners. He said he had only been notified once about a prisoner admittance. He said they do not have a written policy on refusing prisoner patients, but stated they did not have the resources to take care of prisoners. When asked what resources they would need, he said he was not sure.