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Based on medical record (MR) review, policy and procedure review, facility administrative document review and staff interview, the hospital failed to ensure compliance with 489.24 in that the hospital failed to accept an appropriate transfer of a patient (PT101) requiring the hospital's specialized capabilities.

Findings include:

1. See findings cited at 42 CFR 489.24(f).

Based on medical record (MR) review, staff interview, policy and procedure review, Medical Staff Rules and Regulations review and Behavioral Health Unit Central Log review, the hospital failed to ensure compliance with 489.24 in that the hospital failed to accept an appropriate transfer of a patient (PT101) requiring the hospital's specialized capabilities.

Findings include:

1. Review of emergency department (ED) medical record for patient PT101 from transferring hospital F1 indicated the following:
a. PT101 arrived at F1's ED on 09/10/12 at 1034 brought by family at patient's request with complaint of suicidal ideation. PT101 reported having severe depression since June 2012.
b. Behavioral health consult on 09/10/12 at 1205 indicated PT101 reported wanting to die, with no concrete plan, but contemplations. PT101 had jumped from a moving vehicle the previous day. PT101 requested help so doesn't hurt self or others.
c. Examination of PT101 determined emergency medical condition (EMC), medically stable. The patient was placed under emergency detention on 09/10/12 at 1442.
d. History of two admissions to F2 in June 2012. F1 faxed emergency detention papers and medical record of PT101 to F2 at 1513, then called F2 at 1530. Client acceptance was refused due to PT101 had not benefited from F2's previous inpatient care.

2. Interview on 10/02/12 at 1100 with S7 from F1 indicated F1 was without specialized psychiatric capabilities/facilities to treat PT101.

3. Review of the Behavioral Health Unit (BHU) Central Log at F2 for 09/10/12 indicated a call from F1 to F2 at 1530 regarding a referral for PT101. Disposition listed "R" (Refused Treatment).

4. Review of F2's Day and Night Shift Activity Reports for 09/10/12 indicated there were beds available and open to receive patients on the BHU. BHU nursing staffing for 09/10/12 was appropriate for census and acuity and followed staffing procedure and grid. The unit consisted of 18 beds and census ranged from 5-6 patients from 0800 on 09/10/12 through 2400 on 09/11/12.

5. On 10/02/12 at 1300, interview with S1, S2, S3, S4 and S6 indicated there were available behavioral beds on 09/10/12.

6. Interview with S5 at F2 at 1445 indicated PT101 had been a voluntary inpatient admission at F2 twice in June 2012, failing to be an active participant in therapy. It was a clinical call by S5 to not accept PT101 at F2 again because he/she had not benefited from their care and S5 believed they could not help him/her further.

7. Review of F2's policy titled EMTALA: Transfer, IPC.SUP.004, last reviewed/revised 5/10 indicated on Page 2 of 9, C.,1., "A receiving hospital with specialized capabilities or facilities that are not available at the transferring hospital.....must accept an appropriate transfer of an individual with an EMC who requires specialized capabilities or facilities if the hospital has the capacity to treat the individual." and Page 7 of 9, A., "A participating hospital that has specialized capabilities or facilities.....may not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual, from a transferring hospital....." and B., "The requirement to accept an appropriate EMTALA transfer applies to any Medicare-participating hospital with specialized capabilities....."

8. Review of F2's Medical Staff Rules and Regulations indicated on page 33, XV., B., Emergency Physicians shall not refuse to accept patient transfers from other hospital emergency department if the transfer is medically appropriate and the Hospital staff and facilities are available to provide care for the patient."