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Based on record review and interview the facility failed to ensure that a medical screening exam was completed per facility policy in 1 of 20 Emergency Department (ED)medical records reviewed (Patient # 3) in a total of 30 medical records reviewed.

Findings include:

The facility policy titled "Emergency Medical and Treatment (EMTALA)" last revised on 8/13/2021 revealed: "IV. Guidelines/Procedures: A. Definitions: 3. Hospital Campus: is, for purposes of this policy, the hospital and hospital buildings and public areas such as parking lots, sidewalks, driveways that are contiguous to the hospital campus or are within 250 yards of the hospital's main building...4. Medical Screening Examination (MSE): is the process required to determine within reasonable clinical confidence whether an EMC (emergency medical condition) does or does not exist and whether a woman having contractions is in need of immediate medical attention. The MSE is an ongoing process and must be done with the facility's capabilities (e.g., equipment, technical resources) and the availability of qualified medical personnel."

Review of the facility document titled, "IRIS (Incident Reporting Information System) Event & Feedback Report" dated 12/6/2021 revealed: "Brief factual description: Email from ED charge nurse D on 12/03/2021 at 1644 (4:44 PM) 'Tonight at 1615ish (4:15 PM) I took a call from [name of ambulance service] regarding a patient [patient #3] with resolved stroke symptoms from earlier today, now with anxiety. I did not divert them on the phone. After I discussed with ED physician V we agreed that this would qualify as a stroke patient that should have been diverted due to our CT [Computed Tomography]scanner being out of service. EMS (emergency medical services) arrive within the minute. We meet [sic] ambulance in garage and inform [sic] them of diversion. They take patient to [facility name]. I called ED charge at [facility name] to inform them of the situation.' At this time ED was on stroke and trauma diversion. All dispatch and EMS was aware of this. Not sure why they called with stroke patient or why ED charge nurse D accepted. Coaching done with colleague on EMTALA. Follow-up comments: Adding risk. ED manager did follow up with the colleagues involved. Once the patient arrived the patient should have been care for our facility [sic]."

During an interview on 12/20/2021 at 2:00 PM, ED charge nurse D stated "I should of reminded the paramedic from [name of ambulance service] that we were on diversion status for trauma and stroke patients when they called the ED with arrival ETA (estimated time of arrival) and report instead of when they arrived at our hospital."

During an interview on 12/21/2021 at 8:45 AM, ED physician V stated, "I did not do a medical screening exam on [name of Patient #3]."

Based upon record review and interview the facility failed to follow their policy to ensure that a completed medical record and signed transfer from accompanied the patient; failed to ensure that a physician at the receiving facility had accepted the patient; and failed to confirm with the receiving facility that there was a bed available prior to transfer for 1 of 20 Emergency Department (ED) patient records reviewed (Patient #2) in a sample of 30 medical records reviewed.

Findings Include:

Review of the facility policy titled, "Emergency Medical Treatment and active Labor Act (EMTALA) last revised on 8/13/2021 revealed, "Purpose: To provided guidelines for the screening and transfer of patients with an emergency medical condition in accordance with the requirements for the Emergency Medical Treatment and Labor Act (EMTALA), " IV. Guidelines/Procedures, A. Definitions, J: The receiving hospital should be contacted prior to transfer. a: The receiving hospital should have available space and qualified personnel and agree to accept the transfer. b. A physician at the receiving hospital should also agree to accept the patient prior to transfer...K. Copies of all available medical records, along with a copy of the transfer form containing the physician certification and patient consent should be sent with the patient. L.: The transfer should be made with qualified personnel and transportation equipment deemed appropriate by the transferring physician."

Review of Patient #2's medical record revealed no evidence of physician to physician communication between Facility #1 and Facility #2 (receiving facility).

In an interview on 12/17/2021 at 11:20 AM, Complainant B (Risk Manager at Facility #2) stated, "We didn't have an accepting provider or bed assignment and (it) was a dangerous situation." Facility #2 was notified of patients arrival by the flight crew 10 minutes before he/she was to arrive in the ED (Emergency Department). No transfer forms or medical information were sent from Facility #1.

The transfer form present in the medical record was unsigned and revealed under accepting facility representative: "Flight for life arranged;" and under RN accepting report: "Flight team received from EMS (Emergency Medical Services)." This was confirmed in an interview with Staff R on 12/21/2021 at 11:10 AM during record review.

ED timeline reveals Pt. #2 arrived in ED at 12:23 PM, 12:30 PM care transitioned to Flight for Life team per their request, 1:25 PM Pt. left with flight crew, all medication and blood products given by flight crew, 1:33 PM patient discharged.

Review of facility document titled, "IRIS (Incident Reporting Information System) Event and Feedback Report: dated 11/18/2021 revealed: "Brief Factual Description: Patient #2 was involved in Motor Vehicle Crash. FFL (Flight for Life) was auto launched by EMS (Emergency Medical Service)." The plan was that this was to be an intercept EMS to FFL on the helipad related to a safe landing location. EMS brought the patient into the Emergency Department (ED) related to FFL being 7 minutes out. A medical screening exam was completed (by Medical Doctor (MD) X). 7 minutes after patient's arrival, FFL arrived. EMS gave report to the flight crew FFL stated that they were taking over care of the patient. They began switching the patient over to their monitors. The ED provider handed off care to the physician with FFL and left the room. FFL colleagues inserted a chest tube and intubated the patient. They then transported the patient to the helicopter. It was the understanding of the colleagues present that the FFL physician was from [Facility #3] and was the accepting physician. It was their understanding the patient was being taken to [Facility #3]. Upon leaving, it was communicated to the RN (Registered Nurse) that FFL was taking the patient to [Facility #2]. [MD X] was not aware that the patient was being transported to [Facility #2] until sometime after the patient left. [Facility #2] called asking why the patient was transferred to them without contacting them."

Further review of the same documents revealed under Attachments: "Interviewed [RN Y] RN Y stated that FFL called stating they were 13 minutes out. [RN Y] was confused by this as we had not requested FFL for any patients within the ED. [He/She] stated.....[ambulance] stated that they were coming to meet FFL on the pad but that they were worried about the patients airway. 7 minutes later FFL arrived. [RN Y] stated that FFL provider stated he was taking over and the team started disconnecting the patient from [Facility #1] monitors and transferring him/her over to theirs. [RN Y] stated that the team inserted a chest tube and intubated him/her. They then started rolling to the helicopter. [RN Y] stated that the crew stated they were going to [Facility #2]. [RN Y] stated that it sounded as if this was all pre-arranged and that they were expecting the patient. [RN Y] stated she didn't think to call report as she didn't provide any care for the patient-the flight crew did. [MD X] also stated that [he/she] was under the impression the physician that arrived was from [Facility #3] and knew the patient was coming. [He/she] stated that the flight physician dismissed him form [sic] care of the patient. [He/she] had no idea that the patient was being transported to [Facility #2]."

During an interview on 12/21/2021 at 9:00 AM ED [Emergency Department] Physician X stated, "The MD for FFL [Flight for Life] took over the patient and then they left. [Facility #2 ED MD] called me after the patient left and wanted report and what happened. I told them that FFL did all the treatments in the ED and all procedures were done by flight."

During an interview on 12/21/2021 at 10:00 AM ED RN (Registered Nurse) Y stated, "All I did was get supplies, FFL intubated and put in a chest tube, I saw them give blood, not sure how much. I asked them where they were going and told me [facility #2] I told [Dr. X] going to [facility #2]. I filled out my part on the EMTALA form, I didn't give report to anyone, I heard [ambulance name] give report to the flight crew."