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Based on medical record review, staff interview and review of on call coverage schedules, facility policy and procedures and transfer logs it was determined the facility failed to accept incoming appropriate transfers that were within the receiving facility's capabilities and capacity for two of (#22, #23) twenty-three patients sampled. Refer to findings in tag A-2411.

Based on medical record review, staff interview and review of on call coverage schedules, facility policy and procedures and transfer logs it was determined the facility failed to accept incoming appropriate transfers that were within the receiving facility's capabilities and capacity for two of (#22, #23) twenty-three patients sampled.

Findings include:

An interview was conducted with the VP Quality/Patient Safety from Tampa Community Hospital (the receiving facility -Facility A) on 12/17/2014 at 12:28 p.m. She stated on 11/29/2014 an ER (Emergency Room) physician refused to accept transfers for two patients (#22, #23) from a transferring facility (Facility B- an acute care hospital). He stated had consulted with the GI (gastroenterologist) specialty physician on call. The GI physician stated facility B had GI coverage. Patient #22 was accepted at another facility. Patient #23 was accepted and transferred to another facility. The patients were refused for acceptance by the ER physician of facility A.

Review of the medical record from Facility B for patient #22 revealed the patient presented to facility's B ED (Emergency Department) on 11/29/2014 for complaints of abdominal pain with nausea and vomiting for 6 days. This was the 3rd visit to the ED for the same symptoms. The patient had ongoing emesis despite medication and a plan to admit for intractable emesis. The physician documented no GI (gastroenterology) services were available with a transfer needed. Review of the form "EMTALA/Memorandum of Transfer" revealed the patient required care unavailable at facility A.

Review of the medical record from Facility B for patient #23 revealed the patient presented to facility's B ED on 11/29/2014 for complaints of bloody sputum (hemoptysis) since 3:00 a.m. that day. Review of the ED physician documentation revealed the patient had a history of esophageal cancer. The patient would require admission for further evaluation. The ED physician documented they did not have GI on call and the hospitalist felt GI evaluation was needed. Review of the form "EMTALA/Memorandum of Transfer" revealed the patient required care unavailable at facility B.

On 12/17/2014 at 12:28 p.m. an interview with the VP Quality/Safety and review of the call center log revealed on 11/29/2014 an ER (Emergency Room) physician refused to accept a transfer for two patients (#22, #23) from facility B. He stated he had consulted with the GI specialty physician on call that stated facility B had GI coverage. Both patients were refused acceptance by facility A who had capacity and capability. The VP of Quality/Safety revealed only the AON (administrator on duty) had the authority to refuse a transfer per facility's A transfer policy and duty to accept.

Review of the transfer logs for facility A revealed no evidence of patient #22 or #23 being accepted for transfer on 11/29/2014. Interview with the Nursing Director of Emergency Services on 12/17/2014 at 9:00 a.m. confirmed the patients (#22 and #23) were not on the transfer log dated 11/29/2014 due to the patients not being accepted for transfer.

Review of the medical records for patient #22 and #23 and interviews with the VP Quality/Safety and the Nursing Director Emergency Services revealed both patients met the criteria for an individual with an Emergency Medical Condition that required specialized care for transfer by the ER physician of the Facility B to facility A. Review of Facility A's on call physician specialists Medicine Department On-Call Coverage Schedule for November 2014 revealed a Gastroenterologist was on call on 11/29/2014, the date of requested transfer but refused to accept patient #22 and #23.

Review of the EMTALA - Transfer Policy dated 2/2014 with a purpose to "establish guidelines for either accepting an appropriate transfer from another facility or providing an appropriate transfer to another facility of an individual with an emergency medical condition (EMC), who requests or requires a transfer for further medical care and follow-up to a receiving as required by the Emergency Medical Treatment and Labor Act (EMTALA)." The policy states that " a hospital with specialized capabilities or facilities shall accept from a transferring facility an appropriate transfer of an individual with an EMC who requires specialized capabilities if the receiving hospital has the capacity to treat the individual." Under Section 3 - Authorization to Accept a Transfer, the policy states that, "The Emergency Physician and the Hospital CEO or designee, such as the Administrator on Call (AOC) or the House Supervisor, are the ONLY individuals authorized to accept or refuse the transfer of an individual from another facility on behalf of the receiving hospital." Section 5 - Transfer Center Use, states that " At the Emergency Physician's request, the Transfer Center must facilitate a discussion between the Emergency Physician and the on-call physician of the receiving facility. The on-call physician does not have the authority to refuse an appropriate transfer on behalf of the facility "