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Based on record review and interview, the hospital failed to ensure compliance with 42 CFR §489.20 (l) of the provider's agreement which requires hospitals to comply with 42 CFR §489.24, special responsibilities of Medicare hospitals in emergency cases as evidenced failure to ensure the medical record contained a signed physician certification of transfer (See Findings Tag A-2409).

Based on record reviews and interviews, the hospital failed to provide documented evidence to indicate an appropriate transfer was provided for 1 (#5) of 20 (#1-#20) patients who presented to the hospital's emergency department (ED) with an emergency medical condition. The deficient practice is evidenced by failing to ensure the medical record contained a signed physician certification of transfer.
Findings:

Review of hospital policy number CC-100, titled "Admission/Discharge/Transfer," last revised 08/2025, revealed in part: "POLICY: Patients will be admitted to, discharged from, or transferred from the Baton Rouge General Medical Center (BRGMC) facilities according to established guidelines and requirements set forth by regulatory agencies. 3. Transfers to Another Healthcare Facility: A. Patients may be transferred to another healthcare facility for the following reasons: a. Appropriate diagnostic or treatment capacity is not available within the BRGMC. b. Patient's medical condition is stable and the attending physician, patient, or his designee requests transfer. c. Medically unstable patients may be transferred only when appropriate diagnostic or treatment capacity is not available within the BRGMC, and the physician deems the benefits of transfer to outweigh any increased risk to the patient's life or limb. e. The receiving facility agrees to accept the patient and has diagnostic or treatment capacity required. f. Patient transfer disposition shall be accurately documented in the computer via discharge function. B. Prior to the transfer the patient and/or family will be informed of the reason for the transfer and alternatives if any. C. A copy of pertinent medical records will be sent to the receiving facility/unit for transferred patients, which include physical exam, discharge medications, diet, treatments, and any other follow-up instructions. D. Mode of transportation will be determined by the patient's physician. E. Report will be called to the receiving facility. F. Patient transfer disposition shall be accurately documented in the computer via discharge function. Procedure: 2. Transfers/Discharges to another healthcare facility: B. If the patient is transferring to the same or higher level of care, complete the External Transfer Record."

Review of Patient #5's medical record revealed Patient #5 arrived to the Emergency Department on 07/15/2025 for stroke symptoms. Patient #5 presented with aphasia. Workup included blood work, CT imaging, and TNKase (medication to treat the stroke). Patient #5's symptoms continued to progress, CT was repeated, and Patient #5 was intubated to ensure patent airway during transport. Patient #5 was transferred to another facility for higher level of care.

Further review of Patient #5's medical record failed to reveal documented evidence of a signed physician certification of transfer.

In an interview on 09/25/2025 at 1:27 PM, S2EDM confirmed that the signed physician transfer certificate for Patient #5 was not in the medical record.

In an interview on 09/29/2025 at 8:45 AM, S6DED confirmed unable to locate the signed physician transfer certificate in Patient #5's medical record, and believes it may have been sent with patient at the time of transfer.