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Based on review of medical records, policies and procedures and hospital documents and interviews with hospital staff, the hospital failed to develop and enforce policies and procedures to ensure compliance with the requirements of 42 CFR 489.24. The hospital failed to:

Enforce its policies and procedures concerning recipient hospital responsibilities. This occurred for one (Patient #A) of twenty patients (Patients #A, 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 18), whose medical records were reviewed and a request for transfer from a referring hospital was received at the hospital.

Findings:

Acceptance of transfer policies:

A. The hospital's policy, 302-RI-201 with an effective date of April 24, 2013, on page 7 requires, "...OSU Medical Center will accept appropriate transfers of individuals with emergency medical conditions within the boundaries of the United States if OSU Medical Center has the specialized capabilities not available at the transferring hospital, and has the capacity to treat those individuals..."

B. Hospital policy, 302-CC-106 Inter-Facility Transfer to OSUMC, with an effective date of June 16, 2010, states the following, "...1. When the Transfer Coordinator receives a request from the transferring facility, the following information will be obtained using the "Transfer/Admission Worksheet" form:
a. What can OSUMC provide that sending facility can't provide?;
b. Is patient stable or unstable?; and
c. Does patient have medical emergency?

2. Verify reason for transfer:
a. The transferring hospital does not have an appropriate physician specialist;
b. The transferring hospital does not have appropriate equipment:
c. The transferring hospital does not have specialized capabilities or facilities to treat the patient.
The transfer coordinator will document the answer to these questions and all necessary medical and transferring facility information on the
"Transfer/Admission Worksheet"....

"...Administration will be notified at the time that a denial of a transfer at the time that a denial of transfer is being considered to ensure OSUMC is in compliance with CMS requirements related to EMTALA and safety of the transferring patient...."

"...If the patient has a medical emergency and the sending facility can not provide the service needed, then OSUMC will accept the transfer immediately, provided that the hospital has the capacity and the capability of the required service needed..."

C. On 06/23/2014 at 2205, a request for transfer of Patient #A was made to the hospital for possible surgery. The hospital did not follow its policy. Patient #A was not accepted for transfer due to the on-call physician refusing to operate or see the patient. Administration was not notified at the time of the denial of transfer.

D. On 07/02/2014 in the morning, Staff A told the surveyors the Transfer Coordinator took the calls requesting transfers from approximately 7 am to 7 pm. After 7 pm Staff A stated that the House Supervisor would take the calls. On the day of Patient # A's request for transfer, the House Supervisor did not take over these calls until approximately 9 pm according to Staff A.

E. A Transfer/Admission Worksheet was completed by the House supervisor on duty. The reason for denial was documented on the worksheet by the House Supervisor as "Dr E, refuses to operate on patient or see pt." There was no documentation of administration being notified of the denial. Dr. E was listed on the call schedule as the surgeon on call.

F. Review of the personnel file for the house supervisor receiving the request for transfer for Patient # A did not have documentation of EMTALA training.

G. Review of a personnel file of one of the transfer coordinators' did not have evidence of EMTALA training.

H. Staff A stated on 07/02/14 in the afternoon that there was no documentation of EMTALA training for staff or physicians.

Based on observation and interviews with hospital staff, the hospital failed to conspicuously post a sign (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor. During a tour of the emergency department on 07/02/14 at 1330 two surveyors did not observe the required signage in a place or places likely to be noticed by all individuals waiting for examination and treatment. Staff A stated they had had a flood a year ago and the emergency department had been completely remodeled. She stated they must have taken it down when they were doing the remodel. The only signage observed by the surveyors was in an area that would be unlikely for walk-in emergency traffic to see.

Based on review of medical records, hospital documents and other documents supplied to the surveyors, and interviews with hospital staff, the hospital failed to accept, from a referring hospital, an appropriate transfer of an individual who required the specialized capabilities and facilities of the hospital in one (Patient #A) of twenty patients (Patients #A, 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 21), whose medical records were reviewed and a request for transfer from a referring hospital was received at the hospital. On the date and time of the proposed transfer for one patient (Patient #A), the hospital had the capability and capacity to treat the individual.

Findings:

1. According to the hospital's Transfer/Admission Worksheet", on 06/23/2014 at 2205, the hospital received a call from a requesting hospital for transfer of a patient who needed possible surgery for a diagnosis of partial vs. (versus) complete small bowel obstruction. The nurse, who was the house supervisor, taking the call documented contacting the specialty physician on call, Dr. E. The nurse documented on the Transfer/Admission Sheet the request was denied and under reason, "Doctor E refuses to operate on patient or see pt. (patient)". There was no documentation that administration was notified concerning the denial as required by hospital policy.

2. According to documentation at the requesting hospital, the patient arrived at their emergency department (ED or ER) around 1818 as a walk in with complaints of abdominal pain. The patient was seen and examined by the ER physician. A CT (computerized tomography) with contrast of the abdomen was performed.

The ER physician documented, "...Disposition decision is transfer. Patient request transfer to (acute care hospital) because that is where her surgeon is (Dr. name withheld) - unable to accept at this time. SEE NOTE. Will transfer to (name of another acute care hospital)..." ..."Needs surgical intervention..." The patient was accepted by that hospital and transferred to that facility by ambulance at 01:55 on 06/24/2014.

"...NOTE: Discussed case with OSU Medical Center transfer coordinator- (name withheld). (Name withheld) called Dr. E and discussed case with him. (Name withheld) called me back and stated that at this time they were unable to accept this patient as a transfer (ER physician signature) 06/23/2014 22:10..."

The patient's history as recorded by the transferring hospital documented multiple surgeries as a result of a perforation during a colonoscopy. She underwent a bowel resection at that time and ended up with a very large abdominal wall hernia that did not heal. The patient had multiple surgeries to repair this area with minimal success. The patient is morbidly obese. These surgeries were performed by Dr E.

3. Staff A stated on 07/01/14 at 13:50 that Patient A had sued Dr E in the past.