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Based on document review and interview, the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to document the risks and benefits of transferring a patient to another facility, see A 2409.

Based on document review and interview the facility failed to document the risks and benefits of transferring a patient to another medical facility for 6 out of 14 transferred patients (# 1, #3, #9, #10, #12 and #14) reviewed. Findings include:

On 6/3/14 at approximately 1030 during review of the medical records for patient's #1, #3, #9, #12 and #14 it was revealed that the risks of the transfer were not indicated on the "Patient Transfer Consent Form" under the "Risks and Benefits of Transfer" section.

On 6/3/14 at approximately 1100 during review of the medical record for patient #10 it was revealed that a "Patient Transfer Consent Form" was not completed.

On 6/3/14 at approximately 1130 during an interview with staff A, it was confirmed that the medical records (# 1, #3, #9, #12 and #14) failed to include the risks and benefits on the transfer forms or anywhere else in the medical records and patient #10's medical record did not include a transfer form at all or evidence of risks and benefits being documented in other areas of the medical record.