HospitalInspections.org

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Based on observation, interview, and document review, the hospital failed to implement their policies and procedures for posting of signs in the emergency department and accepting the transfer of a patient requiring specialty provider care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to post required signage violates the patient's rights to be informed of their rights to care and treatment under the Emergency Medical Treatment and Labor Act. Failure to accept patient transfers causes delays in treatment and risks poor health outcomes, injury, and death.

Findings included:

1. The hospital failed to post signs notifying patients with an emergency medical condition or in active labor, their rights to receive a medical screening exam and stabilizing medical treatment.

2. The hospital failed to accept the transfer of a patient from a facility that had no urologist available to provide specialty care (Patient #1).

Cross-reference: Tags A-2402, A-2411
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Based on observation, interview, and review of hospital policies and procedures, the hopstial failed to post signs specifying the rights of individuals under section 1867 of the Act and its participation in the Medicaid program in all emergency department treatment areas.

Failure to post such signage violates the patient's right to be informed of their rights under the Emergency Medical Treatment and Active Labor Act (EMTALA).

Findings included:

1. Review of the hospital's policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)," policy #6544838, effective 04/23/20, showed that the hospital would post EMTALA policy signs at all ED entrances, admitting areas, waiting areas, and treatment areas throughtout the hospital.

2. On 09/17/20 at 10:00 AM, the investigator toured the hospital's ED. During the tour, the investigator inspected the main ED entrance and lobby, two ED admission stations, three adult and two ED triage rooms, the ED ambulance entrance, three ED exam rooms, and two ED trauma rooms. The investigator observed that there was no evidence of EMTALA signage in the main ED entrance, the ED lobby, any ED triage rooms, any ED exam rooms, or any ED trauma rooms.

3. During an interview with the investigator at the time of the investigation, the ED director (Staff #1) confirmed that there was no EMTALA signage in the areas observed.
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Based on staff interviews, record review and review of hospital policies and procedures, Providence Sacred Heart Hospital refused to accept the transfer of a patient with an emergent urological medical condition and sepsis from a requesting hospital that had no urology medical staff available to provide care (Patient #1).

Failure to accept the transfer of patients with emergent medical conditions requiring specialty care risks patient health and safety by delaying access to a higher level of care and violates EMTALA regulations.

Findings included:

1. Document review of the hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)," policy #6544838, effective 4/23/20, showed that Providence Sacred Heart Hospital will accept from referring hospitals the appropriate transfer of individuals who require specialized capabilities or facilities that are available at the time of the request.

2. Medical record review showed that at 12:47 PM on 8/30/20 a provider from Lourdes Hospital requsted to consult and transfer a 70 year-old male with prostate and penile abscesses and sepsis (Patient #1). Documentation showed that hospital staff contacted the urologist on-call for Providence Sacred Heart Hospital on 8/30/20 at 1:00 PM, and the provider on-call denied the transfer because urology did not take call or transfers from the Tri-Cities area.

3. Review of the Providence Sacred Heart Hospital Admit Transfer Center (ATC) audio recording from 8/30/20 showed that:

A physician assistant (PA) from Lourdes hospital called the ATC requesting to transfer Patient #1 from Lourdes to Providence Sacred Heart Hospital for urology services. The audio recording showed that the ATC staff member asked the PA if he had checked to see if the patient could transfer somewhere in the Tri-Cities. The PA informed her that the patient was "too sick" to stay at Lourdes, and there was nothing available for him in the Tri-Cities area.

The ATC staff member stated that the hospital had several discharges pending, the hospital should have an available bed for the transfer, and she would call him back after speaking with the on-call provider. The ATC staff member phoned the urologist on-call and stated, "I think I know the answer to this, but I need to check. You aren't accepting call from Tri-Cities, right?" The provider on-call stated that she was correct, and they did not have an on-call agreement with Tri-Cities. The call ended, and no patient information was given to the provider.

The ATC staff member phoned the PA and informed him that the on-call provider would not consult for Tri-Cities or accept any direct admits. When asked what that meant, the ATC staff member informed the PA that "the Tri-Cities area is so big, they should have their own coverage." The PA informed her that he would look to send the patient elsewhere, and the call ended.

4. The investigator interviewed the Chief Medical Officer (Staff #2) on 9/17/20 at 4:08 PM. Staff #2 stated that a provider should not refuse the transfer of a patient based on geography, and that was "clearly an EMTALA violation if that is what happened."

5. During an interview with the investigator, the ED director (Staff #1), confirmed that the hospital violated EMTALA regulations when they refused to accept a patient transfer because Lourdes, the transferring hospital, was a Tri-Cities area hospital.