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Based on record review and interview, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by failing to accept an appropriate patient transfer request for which the hospital had the capacity and specialized capability to provide the required stabilizing treatment. This deficient practice is evidenced by the failure of the hospital to accept a patient transfer (patient #1) from the transferring hospital Emergency Department's physician who had requested surgical services for patient #1. The hospital had an available on call general surgeon physician to evaluate and treat the patient, and had bed availability on the date the transfer was requested for 1 (#1) of 20 sampled patient records reviewed. (See findings A-2411).

Based on review of policies and procedures, and interviews, the hospital failed to accept an appropriate patient transfer for which the hospital had the capacity and capability to provide the stabilizing treatment required by the patient's condition. This deficient practice was evidenced by failure to accept a patient transfer (patient #1) from the transferring hospital Emergency Department's physician who had requested surgical services for patient #1. The hospital had an available on call general surgeon physician to evaluate and treat the patient, and had bed availability on the date the transfer was requested for 1 (#1) of 20 sampled patient records reviewed.


Findings:

Review of the ED medical record from Hospital (a) for patient #1 revealed the patient presented to the ED on 01/06/2021 at 7:03 p.m. after a fall at home with pain to low back and right hip/buttock. A patient evaluation was performed which included an all systems review, vital sign assessments, and laboratory tests. Patient #1 had a large peri-rectal abscess noted on her right buttock.

Review of Hospital (a) ED S9Physician's note dated 01/06/2021 revealed the following: Avoyelles Hospital ED was called to see if they had surgery on call and if they had a surgical bed available. The ED nurse said they had a bed and gave the nurse S7Physicians cell phone number to call. S9Physician said I called him and got his voice mail. He said I left a message for him to call me back about the patient we wanted to send. The ED nurse at Avoyelles hospital called back and stated that S7Physician refused to take patient #1 stating that he does not take call for Hospital (a) and he refused the patient. I asked the nurse to call them back to let them know that they were in clear violation of the EMTALA law. They had a bed, the service, patient was stable, and under the EMTALA they have to take the patient for a higher standard of care since we do not have surgery here at Hospital (a). S9Physician said the patient was refused again.

Review of Avoyelles Hospital policy titled EMTALA, Document Number LL.EM.001, revised 3/09 revealed in part: General Requirements: Accept appropriate transfers of individuals with EMC's if the hospital has the specialized capabilities not available at the transferring hospital and has the capacity to treat the individuals.

Interview on 01/13/2021 at 9:00 a.m. with S11RNED at Hospital (a) revealed patient #1 presented to the ED due to a fall and pain. A perirectal abscess was discovered and patient #1 needed surgical services that were not provided at this hospital, and so a hospital transfer was initiated with Avoyelles Hospital. S11RNED stated that we were told there was an available bed, but the on-call physician refused to take the patient.

In an interview on 01/13/2021 at 9:10 a.m. with S10RNCNO of Hospital (a), she stated that she was on call on the night of 01/06/2021 and was called by the ED staff that explained that they had called Avoyelles Hospital to see if they would take a patient requiring surgical services and was told that there was a bed available they would need to call and report to the surgeon on call. The ED staff reported attempting to call S7Physician but he did not answer. Avoyelles Hospital was again called back and were told that S7Physician stated that he was not on call for Hospital (a) and refused to take the patient. Patient #1 was later transferred to a hospital providing surgical services in New Orleans.

Interview by telephone on 01/13/2021 at 9:15 p.m. with S9Physician from Hospital (a) revealed patient #1 presented to the ED at hospital with pain from a fall at home. A peri-rectal abscess was discovered and patient #1 required surgical services that Hospital (a) did not provide. A call was placed to Avoyelles Hospital since they provide surgical services. S9Physician said patient #1did require transfer to a higher level of care due to the patient potentially developing sepsis as he recalled patient #1's WBCs were elevated. S9Physician stated that he tried to call S7Physician and was unable to contact him. S9Physician called and spoke to the nurse at Avoyelles Hospital and was told that S7Physician stated that he was not on call for hospital (a) and would not accept the patient. S9Physician stated that patient #1 was found placement for surgical services in New Orleans.

Interview on 01/13/2021 at 12:10 p.m. with S7Physician at Avoyelles Hospital revealed that he was aware of the incident that occurred 01/06/2021 with the possible transfer of a patient from hospital (a). He confirmed that he was on call the night of 01/06/2021. He further stated that he was a general surgeon for Avoyelles Hospital. S7Physician stated that he recalls the events on January 6 where he had been contacted about placement for a patient with a peri-rectal abscess. He further stated that in his clinical opinion based on limited information he made a clinical judgment to not accept the patient due to the fact that a peri-rectal abscess was not an emergency and it was not a life and death situation. He stated that he did not speak to a physician at the other hospital. He also stated that he did not know if there were available beds in the hospital because he did not ask. Surveyor asked S7Physician if the patient had presented to this hospitals ED what interventions he would do, S7Physician stated that he would have admitted the patient, given IV fluids and depending on availability performed surgical interventions the next day.

Interview by telephone on 01/13/2021 at 1:10 p.m. with S5RN stated that he recalled the events of January 6, 2021. S5RN had received a call from hospital (a) about a possible transfer and was inquiring if there was a bed and surgical consult available. S5RN stated after contacting the house supervisor to confirm that there was a bed available he contacted S7Physician and left a message on his phone. S5RN stated that he received a call from S7Physician stating that he did not take call for hospital (a). S5RN stated that he called hospital (a) back to explain that there was a bed available but that S7Physician stated that he was not on call for hospital (a) and would not accept the patient. S5RN stated that the physician at hospital (a) stated to let S7Physician know again about the transfer and to call to speak with him. S5RN stated that he spoke with S7Physician again and was told that he did not take call for hospital (a) and would not accept the patient.

Interview by telephone on 01/13/2021 at 7:30 p.m. with S6RN confirmed that she was the supervisor at Avoylles Hospital working the night of January 6. S6RN stated that she remember speaking with S5RN from the ED about if there was a bed available. She stated that she explained to S5RN that there was a bed available but if the hospital took the transfer, she would be responsible for that patient since they were at maximum capacity for staffing.S6RN stated that she told S5RN that the hospital did have one bed available. She further stated that she did not have any contact with the physician or hospital (a) about the transfer. She stated that she was only questioned about bed availability.