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Based on reviews of clinical records, policies and procedures, Medical Staff Rules and Regulations, Patient Transfer Sheet, on-call schedules, and staff interviews it was determined the facility failed to accept a transfer for an individual presenting to the emergency department with an Emergency Medical Condition that was within the facility's capability for the specialized services of a hand surgeon for one (#21 ) of twenty one records reviewed.

Refer to findings in Tag A-2411.

Based on reviews of clinical records, policy and procedure, Medical Staff Rules and Regulations, Patient Transfer Sheet, on-call schedules, and staff interviews it was determined the facility failed to accept a transfer for an individual presenting to the emergency department with an Emergency Medical Condition that was within the facility's capability for the specialized services of a hand surgeon for one (#21 ) of twenty one records reviewed.

Findings include:

Review of the Emergency Department (ED) record for patient (#21) from the transferring facility revealed the patient presented to ED on 6/10/12. The patient was evaluated by the ED physician on 6/10/12 at 1:54 a.m. The ED physician documented the patient presented with right finger pain and bleeding for one day. The type of injury was listed as laceration from a piece of glass. The ED physician noted it was attempted to control the bleeding with a tourniquet and stitch but it was unsuccessful. The physician could not close the wound to help tamponage (is useful method of stopping hemorrhage) the bleeding since the injury was greater than 24 hours old. The ED physician documented the patient needed more definitive bleeding control then just a tamponage dressing. The ED physician's impression and plan was acute right 2nd digit laceration, greater than 24 hours old, acute arterial laceration to right second digit. . . The disposition was for transfer to another facility for hand surgeon services.

Review of the transferring facility's ED physician notes dated 6/10/12 at 5:14 a.m. revealed the physician had discussed the case with the hand surgeon on call at the intended receiving facility. The documentation noted the intended receiving physician did not believe it was an emergency issue. The ED physician explained to him the issue was controlling the bleeding, it had been tamponed with a bandage but would require more definitive care.

Review of the transferring facility's Patient Transfer Sheet for patient #21 dated 6/10/12 revealed the intended receiving facility was called at 4:31 a.m. A physician's name, phone number and comment "refused" was documented in outcome box.

A review of the intended receiving facility's ED on call schedule for June 2012 revealed the facility did have that hand surgeon available on 6/10/12. The facility failed to accept an individual from a transferring hospital who required the specialized services of the hand surgeon on -call that was within the capability and capacity of the hospital to treat patient #21 on 6/10/2012.

Review of the Medical Staff Rules and Regulations, 2011, reviewed and approved 5/2011, page 8 of 19, paragraph 3, revealed " if a practitioner takes call for another practitioner he or she is obligated to see all patients needing medical or surgical attention in Emergency Services, without regard to financial reimbursement or lack of membership in any health plan".

A review of the facility's policy, "EMTALA- Duty to Accept", policy #RM1216, approval date 4/2/12, revealed " a hospital with specialized capabilities or facilities shall accept an appropriate transfer of an individual with an emergency medical condition who requires specialized capabilities or facilities if the facility has the capacity to treat the individual". A review of page 2, paragraph 4, revealed "only the emergency physician and the Hospital Chief executive officer (CEO) or his or her designee have the right to accept or refuse to accept the transfer of a patient on behalf of the hospital".

An interview with the ED Medical Director was conducted on 6/21/12 at 10:10 a.m. The physician stated "if a facility calls to transfer the patient the secretary notifies the Charge Nurse or the ED physician. The patient is first seen by the ED physician, who determines if the on-call physician needs to see the patient."

A telephone interview was conducted on 6/21/12 at 4:40 p.m. with the Unit Secretary (US) that answered the phone call from the transferring facility on 6/10/12. The US was questioned if she recalled the conversation she had with the transferring facility. She stated yes. She stated the facility voiced they had a patient who needed a hand surgeon and did they have one on-call. She told them yes and proceeded to give them the on call hand surgeon's name and phone number. She instructed the facility to call the physician directly.

A telephone interview was conducted on 6/21/12 at 5:00 p.m. with the hand surgeon that was on-call 6/10/12. The physician stated he did recall the transferring facility calling him. The case was discussed. The physician stated he told the ED physician he did not feel this was an emergency and instructed him to put a pressure dressing on it and send the patient to his office.

A review of the patient #21's ED record from the receiving facility dated 6/10/12 revealed the patient presented to the ED at 6:47 a.m. per ambulance transfer. The chief complaint was "transferred from receiving facility with pulsating arterial bleed to the right index finger, lateral artery to proximal, involving joint capsule, cut on glass 36 hours ago". The ED physician's impression was "the finger has some swelling development; concern for Flexor tenosynovitis (that leads to a disrupted function of it), will start antibiotics to cover for staph aureous"(Staphylococcus aureus is a bacteria frequently part of the skin flora found in the nose and on the skin). The patient was seen by the hand surgeon at 9:05 a.m. The patient was admitted to the transferring facility on 6/10/2012 at 11:14 a.m., for definitive care.

Interview with the Chief Nursing Officer on 6/21/12 at approximately 3:00 p.m. revealed the facility did not have a protocol, policy, or procedure for how to accept a patient in transfer.

The facility failed to follow its policy and procedure for declining the acceptance of a transfer by not involving the ED physician or CEO or the designee.