HospitalInspections.org

Based on interviews and document review, the facility failed to comply with the Medicare provider agreement as defined in §489.20 and §489.24 related to Emergency Medical Treatment and Labor Act (EMTALA) requirements.

FINDINGS

1. The facility failed to meet the following requirements under the EMTALA regulations:

Tag 2409: Restricting Transfer Until the Individual Is Stabilized §489.24(e) (2) A transfer to another medical facility will be appropriate only in those cases in which - (iv) The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. Based on interviews, and document reviews, the facility failed to comply with the Emergency Treatment and Labor Act (EMTALA). Specifically, the facility failed to ensure patients were transported to an acute healthcare facility by qualified personnel with access to emergency equipment during transfer. This failure was identified in one of two records reviewed for patients who presented to the emergency department for medical care and were transferred to another facility. (Patient #4)

Based on interviews and document reviews, the facility failed to ensure patients were transported to an acute healthcare facility by qualified personnel with access to emergency equipment during transfer. This failure was identified in one of two records reviewed for patients who presented to the emergency department for medical care and were transferred to another facility. (Patient #4)

Findings include:

Facility policy:

The Emergency Medical Treatment & Active Labor Act (EMTALA) policy read, the purpose of the policy is to describe the policies and procedures for the treatment and transfer of individuals in need of emergency medical services. The transfer will be accomplished through appropriately trained professionals and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer. If the individual does not consent to transfer: If the hospital offers an appropriate transfer and informs the individual or the person acting on the individual's behalf of the risks and benefits to the individual of the transfer, but the individual or the person acting on the individual's behalf does not consent to the transfer, the hospital will take all reasonable steps to have the individual or person acting on the individual's behalf sign the Transfer Refusal portion of the EMTALA Transfer Form. In addition to completing the Transfer Refusal document, the medical record will contain a description of the proposed transfer that was refused by or on behalf of the individual.

1. The facility failed to ensure patients were transported to an acute healthcare facility by qualified personnel with access to emergency equipment during transfer.

A. Document Review

i. A review of Patient #4's medical record revealed Patient #4 presented to the emergency department (ED) on 5/10/25 at 1:06 a.m. with a chief complaint of seizures. Patient #4 was 25 weeks pregnant, and a family member reported Patient #4 had a four-minute tonic clonic seizure (a type of seizure that involves a loss of consciousness and violent muscle contractions) prior to arrival. Patient #4 had a history of one prior seizure during pregnancy. Nursing documentation on 5/10/25 at 2:41 a.m. revealed Patient #4 was on seizure precautions (a room set-up that typically includes padded side rails, suction equipment, supplemental oxygen, and cardiac monitoring) in the ED.

The ED provider's note revealed Provider #2 consulted with obstetrics at another facility who recommended the patient be transferred for ongoing fetal monitoring. The transfer form revealed the patient was being transferred for a higher or specialized level of care in obstetrics at the receiving facility. The risks of transfer were deterioration and death. The ED provider's note and transfer form revealed the patient would go by private vehicle.

On 5/10/25 at 3:39 a.m., nursing notes revealed Patient #4 was transferred to another facility by private vehicle.

There was no documentation that Patient #4 had been offered or refused transfer by ambulance.

This record review was in contrast to the EMTALA policy which read, transfer would have been accomplished through appropriately trained professionals and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer.

B. Interviews

i. An interview was conducted on 7/16/25 at 9:26 a.m. with registered nurse (RN) #1. RN #1 stated it was necessary to monitor patients who presented to the ED for seizures. RN #1 stated it was necessary to monitor a patient's airway, breathing, circulation, and neurological status following a seizure. RN #1 stated it was important to have emergency equipment, such as suction, supplemental oxygen, cardiac monitoring, pulse oximetry, and seizure pads, available in case a patient had another seizure. RN #1 stated it would not have been appropriate to transfer a 25-week pregnant patient who presented to the facility for seizures by private vehicle. Additionally, RN #1 stated the risk of transferring a pregnant patient who recently had a seizure without medical personnel or emergency equipment available included deterioration in condition, harm to the baby, and another seizure.

ii. An interview was conducted on 7/16/25 at 2:30 p.m. with ED provider (Provider) #2. Provider #2 stated the decision regarding the method of transportation for a patient to another facility was dependent on many factors including the acuity of the patient, concern for potential decompensation, and if medication was required or anticipated. Provider #2 stated a patient who was 25 weeks pregnant with a medical history of seizure prior to arrival to the ED should not have been transferred by private vehicle. Provider #2 stated Patient #4 met the facility's eclampsia (a condition in which one or more convulsions occur in a pregnant woman often followed by coma and posing a threat to the health of mother and baby) criteria and it was inappropriate to transfer by private vehicle without medical personnel and emergency equipment available. Provider #2 stated the risk of transferring Patient #4 by private vehicle was decompensation and further seizure activity while in a private vehicle without medical personnel or emergency equipment available. Provider #2 stated transfer by private vehicle was only appropriate if Patient #2 had refused transfer by ambulance, however, Provider #2 stated they would have documented the refusal and a conversation with Patient #4 about the risks of transportation by private vehicle in the medical record.

This was in contrast to Patient #4's medical record review which revealed no evidence Patient #4 had refused to be transferred by ambulance.