HospitalInspections.org

Based on findings from interviews, the facility failed to ensure that staff were educated in the requirements of the Emergency Medical Treatment and Labor Act (EMTALA). Also, EMTALA was not addressed in written policies and procedures (P&Ps).

Findings include:

-- During interviews on 02/21/13 of Nurse Administrator #1 at 12:00 pm, Psychiatrist #1 at 11:45 am and Psychiatrist #2 at 2:30 pm, each indicated awareness of EMTALA but could not discuss specific requirements. None of these staff had received any education or training about EMTALA.

-- During interviews of the Executive Director at 10:00 am on 02/21/13 and the Clinical Director (Psychiatrist #2) at 2:30 pm on 02/21/13, each indicated they were aware of EMTALA but acknowledged that staff do not receive education about its requirements. The Executive Director also indicated that EMTALA is addressed in the written transfer agreements SLPC has with acute care hospitals, but acknowledged EMTALA is not addressed in the facility's written P&Ps.

Based on findings from interview and document review, the facility failed to maintain a complete central log on each individual where a request for transfer from another facility was received. Sixteen (16) of 156 entries reviewed lacked the outcome of the transfer request.

Findings include:

-- Per interview of the Executive Director on 02/21/13 at 10:00 am, all referrals to the hospital are documented in a weekly log called the bed availability log.

-- Review of 13 weekly bed availability logs for 2012 identified 16 entries (Patients #1- #16) that lacked the following information: declined for transfer; accepted for transfer and screened, not admitted; or, accepted, screened, and admitted.

The following are examples of cases where outcomes of the transfers were not documented:

* Patient #4 - "Will send fax for review. 4/4/12 received fax at 6:24 am."

* Patient #8 - "Received referral"

* Patient #12 - "Will present to CY (Children and Youth) treatment team"

Based on findings from document reviews, in 2 of 2 cases reviewed, the facility failed to accept patients who required inpatient psychiatric services from a referring hospital despite having capacity.

Findings include:
St. Lawrence Pyschiatric Center (SLPC) documents information about transfer requests received in a form titled "CHILDREN / YOUTH SERVICE ADMISSION ALERT /REFERRAL FORM" (also called "the referral packet" by SLPC staff).

-- Patient #17:

Review of referral packets from SLPC and medical records from Hospital A reveals the following:

On 4/20/12 at 7pm, Patient #17 was brought into Hospital A's emergency department (ED) by police after assaulting and threatening staff at the children's home where he resided. A psychiatrist at Hospital A (Psychiatrist #3) evaluated the patient and diagnosed him with "mood disorder, rule out bipolar disorder and rule out conduct disorder." Psychiatrist #3 indicated the patient was a danger to others, and also, inadvertently, himself. He/she recommended inpatient pyschiatric hospitalization for further assessment and management of stability. Hospital A contacted SLPC for transfer of the patient for inpatient psychiatric services.

On 04/20/12, SLPC staff documented a discussion with the Clinical Director regarding circumstances involving a patient already on the adolescent male ward that would make it difficult to admit Patient #17 to that ward.

On 04/21/12, the Clinical Director told SLPC staff to tell Hospital A to refer Patient #17 to Psychiatric Hospital B or Psychiatric Hospital C, as there was conflict between this patient and another patient at SLPC.
Despite having capacity, SLPC did not accept the patient for transfer.

-- Patient #18:

Review of a referral packet from SLPC dated 09/18/12 reveals the following information:

On 09/18/12, ED staff at Hospital A contacted SLPC requesting transfer of a 14 year old male, Patient #18, to SLPC. Patient #18 had been brought to the ED on a pick up order as he kept running away from home. The circumstances of his presentation to Hospital A included "Leaves home without provisions, plan for shelter & sleeps on benches on the street. Homicidal thoughts directed toward stepfather - When mother stops him from leaving he becomes physical- Mom has bruises on her arms."

The SLPC adolescent male ward was full but "it will have to be decided to open another ward or double bunk ?"

SLPC Psychiatrist #4 performed a long distance evaluation of Patient #18 and, despite SLPC having capacity, declined to accept him for transfer.