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Based on interviews and record reviews, it was determined the facility failed to comply with 42 CFR 489.24(f) in regard to accepting an appropriate transfer of a patient, who required specialized capabilities, and the facility had the capacity to treat the patient, for one patient (#1) in the selected sample of 20. The facility failed to follow their policies "EMTALA Transfers" and "EMTALA On-Call Coverage." Findings include:

Review of the policy "EMTALA On-Call Coverage" revealed if a physician was identified as being on-call to the Emergency Department (ED), it was the physician's duty and responsibility to assure immediate availability. Arrival time or response to the ED was expected within 30 minutes. Review of the policy "EMTALA Transfer" revealed a hospital with specialized capabilities may not refuse to accept an appropriate transfer of an individual who required specialized capabilities and the facility had the capacity to treat the individual, from a transferring hospital within the boundaries of the United States.

Review of the medical record of Patient #1 from the transferring hospital revealed he/she presented to the ED, on 07/07/10 at 8:45 AM, with right jaw pain and a broken tooth. The "clinical impression" was "Acute Trismus" (inability to normally open the mouth) "secondary to dental abscess." Patient #1 required transfer to a facility that provided the services of an oral surgeon.

An interview, on 08/16/10 at 12:10 PM, with the Registered Nurse at the transferring hospital revealed Patient #1 was seen in their ED on 07/07/10 for jaw pain. Attempts were made to transfer Patient #1, who required the specialty services of an oral surgeon, to the facility. The transfer was refused by the oral surgeon and the facility.

An interview, on 08/17/10 at 10:15 AM, with the facility House Supervisor revealed she received a telephone call from the transferring hospital on 07/07/10. The transferring hospital was attempting to transfer Patient #1, who required the specialized services of an oral surgeon. She stated there was an oral surgeon on-call and the facility had the capacity to care for Patient #1. The House Supervisor called the Oral Surgeon's office and asked the nurse if the physician was accepting Patient #1 and she was told no. The House Supervisor informed the transferring hospital that they could not accept Patient #1.

The facility failed to follow their polices "EMTALA Transfers" and "EMTALA On-Call Coverage" for Patient #1. The failure resulted in Patient #1 being refused at the facility, which had specialized capabilities, and the capacity to treat Patient #1. Additionally, it resulted in the transferring hospital having to seek care for Patient #1 elsewhere.

Based on interviews and record reviews, it was determined the facility failed to ensure one patient (#1) in the selected sample of 20 was accepted from a referring hospital as a transfer. The facility failed to follow their policies "EMTALA Transfers" and "EMTALA On-Call Coverage" resulting in the facility failing to accept Patient #1, who required specialized services, that the facility offered and the facility had the capacity to treat Patient #1.
Findings include:

Review of the policy "EMTALA On-Call Coverage" revealed if a physician was identified as being on-call to the Emergency Department (ED), it was the physician's duty and responsibility to assure immediate availability. Arrival time or response to the ED was expected within 30 minutes. Review of the policy "EMTALA Transfer" revealed a hospital with specialized capabilities may not refuse to accept an appropriate transfer of an individual who required specialized capabilities and the facility had the capacity to treat the individual, from a transferring hospital within the boundaries of the United States.

A review of the facility's physician on-call schedule revealed an oral surgeon was on-call to provide care for ED patients on 07/07/10.

Review of the medical record of Patient #1 from the transferring hospital revealed he/she presented to the ED on 07/07/10 at 8:45 AM with right jaw pain and a broken tooth. The "clinical impression" was "Acute Trismus" (inability to normally open the mouth) "secondary to dental abscess." Patient #1 required transfer to a facility that provided the services of an oral surgeon. The Physician certified that Patient #1 had an emergency medical condition that was stabilized at the time of the transfer.

An interview, on 08/16/10 at 12:10 PM, with the Registered Nurse (RN) at the transferring hospital revealed Patient #1 was seen in their ED on 07/07/10 for jaw pain. Patient #1 required care from an oral surgeon and attempts were made to transfer to the facility. The RN stated she tried to facilitate the transfer through the surgeon and the ED. The surgeon refused to take Patient #1. She was informed by the ED that since the surgeon was refusing to take Patient #1, the facility would not take Patient #1. They made arrangements to transfer Patient #1 to another facility.

An interview, on 08/17/10 at 10:15 AM, with the facility House Supervisor revealed she received a telephone call from the transferring hospital on 07/07/10. The hospital was attempting to transfer Patient #1, who required the specialized services of an Oral Surgeon. She stated there was an Oral Surgeon on-call and the facility had the capacity to care for Patient #1. The facility's House Supervisor called the Oral Surgeon's office and asked the nurse if the physician was accepting Patient #1 and she was told no. The House Supervisor informed the transferring hospital that they could not accept Patient #1.

An interview, on 08/17/10 at 11:10 AM, with the Oral Surgeon revealed she was on-call on 07/07/10 for the facility ED. She was in her office on 07/07/10 and her nurse asked if she had accepted Patient #1 as a patient. She replied no, but she did not know who was calling her office to inquire.

Review of Patient #1's medical record from the facility he/she was transferred to, revealed Patient #1 was transferred to the ED on 07/07/10, from the transferring ED where Patient #1 had originally presented. Patient #1 required the services of an Oral Surgeon. Patient #1 was examined by an Oral Surgeon on 07/07/10 at 6:32 PM and was taken to surgery.

An interview, on 08/18/10 at 10:00 AM, with the facility's Chief Nursing Officer revealed Patient #1 should have been accepted at the facility. The facility had the specialty service of Oral Surgery on-call and the facility had the capacity to treat Patient #1.

The facility failed to follow their polices "EMTALA Transfers" and "EMTALA On-Call Coverage" for Patient #1. The failure resulted in Patient #1 being refused at the facility, which had specialized capabilities, and the capacity to treat Patient #1. Additionally, it resulted in the transferring hospital having to seek care for Patient #1 elsewhere.

Although the incident occurred, the facility identified the problem prior to the investigation. The facility notified the State regulatory agency of the violation and took corrective action to prevent any further occurrence. Re-education was provided to all house supervisors related to the acceptance of EMTALA related transfers. The Chief Executive Officer reviewed the incident with the on-call surgeon and re-educated the surgeon regarding the responsibility of the facility and the surgeon to accept transfers. The transfer policy was reviewed with all ED physicians, ED staff, and house supervisors to ensure that each had a clear understanding of the transfer policy. All ED physicians, ED staff members, House Supervisors and Administrators on-call would complete the appropriate web-based EMTALA course by 10/01/10. Additionally, there had been no reported EMTALA violations at the facility since January 2004.