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Based on document review and interview, Salina Regional Health Center (SRHC) failed to accept an appropriate transfer from hospital A's Emergency Room. Cardiologist C, on-call for SRHC, received 2 telephone calls from Hospital A requesting transfer for Patient #1 for an emergency medical condition. Cardiologist C refused to accept the patient. This deficient practice affected 1 of 1 patient with an emergency medical condition reviewed (#1).

Findings included:

Review of SRHC's multidisciplinary policy and procedure, EMTALA Transfer Guide (70-P), last revised 12/09, revealed the policy failed to address acceptance of requests for patient transfers to SRHC from another hospital's Emergency Room.

Review of a network agreement revealed the transfer and referral protocols for SRHC. This agreement included "IV. Resolution of Transfer Problems, C. 3. Administrator contacts the specific physician on call to determine reason for non-acceptance of transfer. "Explanation of SRHC responsibility as a supporting hospital to not refuse to accept transfer of an individual who requires the specialized capabilities and facilities at this hospital, if the hospital has the capacity to treat the transferred individual...".

Review of the SRHC Physician on-call schedule for 6/17-6/18/10 revealed Cardiologist C as the provider on-call for the Cardiology group. Interview with SRHC administrative staff F between 7/6/10 and 7/8/10 confirmed Cardiologist C provided on-call coverage for the overnight hours 6/17-6/18/10 at SRHC. Staff F confirmed SRHC had the capacity and capability to provide care for the patient.

Cardiologist C, interviewed on 7/7/10 at approximately 11:30 a.m., confirmed the on-call hours on 6/17- 6/18/10 and the two phone calls received during that night concerning patient #1. Cardiologist C confirmed Hospital A called twice that night and requested transfer of patient #1, which Cardiologist C refused.

Review of archived telephone calls received by the after-hours answering service, a contract maintained between the Cardiology clinic/providers and SRHC, confirmed calls were received from Hospital A and forwarded to Cardiologist C, on-call for SRHC. The calls occurred on 6/18/10 at 1:43 a.m. and 2:30 a.m. The transcribed calls confirmed Medical Staff Member B from hospital A spoke with Cardiologist C and confirmed the intent to discuss patient #1 during the two phone conversations.

SRHC had the specialized capabilities and capacity to provide care for patient #1. Cardiologist C, on-call for cardiology services at SRHC, received two calls from Hospital A requesting transfer. Cardiologist C refused to accept patient #1 for transfer.

Based on interview and document review, Salina Regional Health Center (SRHC) failed to accept the transfer of a patient when SRHC had the capability and capacity to treat the patient who required specialized care. The deficient practice affected 1 of 21 patients who required emergent care (#1).

Findings included:

Review of Hospital A's (transferring hospital) medical record revealed on 6/18/10, patient #1 called EMS (Emergency Medical Services) for transport from home to the Emergency Department due to complaints of chest pain. The patient arrived at Hospital A at 1:55 a.m. Medical Staff Member B performed a Medical Screening Examination (MSE) and obtained a medical history from patient # 1 including a recent hospitalization at SRHC for cardiac catheterization (a procedure to open blocked heart vessels) following a myocardial infarction (heart attack). Medical Staff Member B determined patient # 1 had an unstable emergency medical condition that required the specialized services available at SRHC.

At 2:10 a.m., after an ECG (electrocardiogram) was completed, Medical Staff Member B at Hospital A called the on-call cardiologist, Cardiologist C, with abnormal ECG results and the MSE findings. Medical Staff Member B requested patient #1 be transferred to SRHC. Cardiologist C at SRHC refused the transfer and directed the Medical Staff Member B to obtain laboratory results before calling again.

Medical Staff Member B obtained the laboratory results, which were abnormal. A second ECG revealed a decline in patient #1's heart function since the first ECG. Medical Staff Member B called Cardiologist C at SRHC 2:30 a.m. and reported the abnormal laboratory results and abnormal ECG report. Medical Staff Member B again requested to transfer patient #1 to SRHC. Cardiologist C at SRHC again refused the transfer.

Review of the SRHC Physician on-call schedule for 6/17-6/18/10 revealed Cardiologist C as the provider on-call for the Cardiology group. Interview with SRHC administrative staff F between 7/6/10 and 7/8/10 confirmed Cardiologist C provided on-call coverage for the overnight hours 6/17-6/18/10 at SRHC.

Review of archived telephone calls received by the after-hours answering service, a contract maintained between the Cardiology clinic/providers and SRHC, confirmed calls were received from Hospital A and forwarded to Cardiologist C. The calls occurred on 6/18/10 at 1:43 a.m. and 2:30 a.m. The transcribed calls confirmed Medical Staff Member B from hospital A spoke with Cardiologist C and confirmed the intent to discuss patient #1 during the two phone conversations.

SRHC had the specialized capabilities and capacity to provide stabilizing treatment for patient #1. Cardiologist C, on-call for cardiology services at SRHC, refused to accept patient #1 for transfer.