HospitalInspections.org

Based on interview and record review the hospital failed to follow their own Emergency Medical Treatment and Labor Act (EMTALA) policies with regard to accepting the appropriate transfer of one of 28 patients reviewed (Patient #28) from April to October 2009. The hospital had the capability and capacity to treat Patient #28 at the time of the transfer request.
Findings Included:
Review of Freeman hospital ' s EMTALA policy (last revised on 9/09) revealed on page 10 under the section titled "Accepting Patient Transfers" that "The patient will be accepted by the emergency department physician if necessary, arrangements will be made for specialty care by the emergency department physician ... " The hospital failed to follow this policy and Physician B (the ED physician) did not accept Hospital # 1's request to transfer patient # 28 on 9/26/09 at 3:29 PM.

Review of Freeman hospital's "Direct Call Admission Intake" form revealed the ED physician (Physician A) at Hospital # 1 (a small hospital without trauma capabilities) phoned the Direct Call line at 3:22 PM on 9/26/09. The Direct Call operator (Staff C) documented on the form next to "Diagnosis": "Trauma pelvic/femur injury - ran over leg tractor sled 4000 # (pounds) @ tractor pull + lac (laceration)of groin." Under the section for documenting vital signs, staff C documented that patient # 28 was hemo(dynamically) stable (meaning patient # 28 did not require medications or other therapies to maintain a normal blood pressure) and that "Dr (Physician A) was unsure of the degree of patient # 28's pelvic injury - due to pelvic injury Dr. (Physician B) requested Dr. (Physician A) speak with Dr. [name of Freeman's on call orthopedist] to make sure he will accept." Staff C documented on the form which specified the patient's "mode of arrival" that Physician A would contact another hospital for transfer.

During an interview on 10/15/09 at 10:31 AM Physician A stated she called Freeman three times (first two times got the answering machine) before she was able to speak with the ED physician. Physician A stated she told Physician B that patient # 28 had a trauma injury but she did not have all the information to determine if patient # 28 had a pelvic fracture. Physician A stated she knew patient # 28 had other serious injuries she could not treat so she was seeking a transfer. Physician A confirmed she transferred patient # 28 to Hospital # 2.

Review of a recorded call between the ED at Hospital # 1 and the ED physician at Hospital # 2 revealed patient # 28 had severe pain from an extensive laceration to the upper thigh. The ED at Hospital # 1 stated that Patient # 28's family had requested transfer to Freeman but when Physician A contacted Freeman she was told that they "can't take care of any kind of pelvic fractures." The recorded call specified that the ED physician at Hospital # 2 accepted Physician A's request to transfer patient # 28.

Review of Hospital # 2's medical record revealed patient # 28 presented to the ED on 9/26/09 at 4:15 PM. Hospital # 2 admitted Patient # 28 to their intensive care unit for stabilizing treatment of his severely lacerated thigh wound. Review of Hospital # 2's services revealed it had capabilities equal to those provided at Freeman hospital.

Refer to tag A2411 for further details.

Based on interview and record review the hospital failed to accept an appropriate transfer of one of 28 patients reviewed (Patient #28) from April to October 2009. At the time of the transfer request, the hospital had the capability and capacity to treat patient # 28. The Emergency Department census at the time of the referral was 18 (out of 41).
Findings Included:
Review of EMTALA related policies and procedures revealed the hospital will accept an appropriate transfer of a patient, who requires the specialized care available if the hospital has the capacity to treat the patient. Transfers from another facility shall be accepted providing we have the capability to treat the patient with regard to space, qualified, personnel and technology. The patient will be accepted by the ED physician, and if necessary arrangements will be made for specialty care by the ED physician.

Review of the Medicare Database Worksheet, completed by hospital staff on 10/7/09,
revealed Freeman hospital has a cardiac, medical and surgical intensive care unit, provides
orthopedic surgical services, diagnostic and therapeutic radiology services, and is a certified
Trauma Center.

During an interview on 10/7/09 at 9:59 a.m., and review of an email correspondence dated 10/27/09, the Risk Manager, Staff E said that Freeman hospital has orthopedic surgeons on-call seven days a week, 24-hours a day, and confirmed the hospital had 22 beds available in the intensive care unit, five beds available in the orthopedic unit, and 18 beds available in the ED on the day (9/26/09) Hospital # 1 requested acceptance to transfer patient # 28.

Review of the (Orthopaedic Surgery) Privilege Form signed by the Orthopedist on-call for Freeman Hospital on 9/26/09 specified the following capabilities (core privileges such as, but not limited to) "1. Closed and open reduction of fractures; 2. Elective repair of orthopaedic conditions; 3. Management of trauma of the musculoskeletal system."

Review of Freeman hospital's "Direct Call Admission Intake" form revealed the ED physician (Physician A) at Hospital # 1 (a small hospital without trauma capabilities) phoned the Direct Call line at 3:22 PM on 9/26/09. The Direct Call operator (Staff C) documented on the form next to "Diagnosis": "Trauma pelvic/femur injury - ran over leg tractor sled 4000 # (pounds) @ tractor pull + lac (laceration)of groin." Under the section for documenting vital signs, staff C documented that patient # 28 was hemo(dynamically) stable (meaning patient # 28 did not require medications or other therapies to maintain a normal blood pressure) and that "Dr (Physician A) was unsure of the degree of patient # 28's pelvic injury - due to pelvic injury Dr. (Physician B) requested Dr. (Physician A) speak with Dr. [name of Freeman's on call orthopedist] to make sure he will accept." Staff C documented on the form which specified the patient's "mode of arrival" that Physician A would contact another hospital for transfer.

During an interview on 10/15/09 at 10:31 AM Physician A stated she called Freeman three times (first two times got the answering machine) before she was able to speak with the ED physician. Physician A stated she told Physician B that patient # 28 had a trauma injury but she did not have all the information to determine if patient # 28 had a pelvic fracture. Physician A stated she knew patient # 28 had other serious injuries she could not treat so she was seeking a transfer. Physician A confirmed that she transferred patient # 28 to Hospital # 2.

Review of a recorded call between the ED at Hospital # 1 and the ED physician at Hospital # 2 revealed patient # 28 had severe pain from an extensive laceration in his upper thigh. The ED at Hospital # 1 stated that Patient # 28's family had requested transfer to Freeman but when Physician A contacted Freeman she was told that they "can't take care of any kind of pelvic fractures." The recorded call specified that the ED physician at Hospital # 2 accepted Physician A's request to transfer patient # 28.

Review of Hospital # 2's medical record revealed patient # 28 presented to the ED on 9/26/09 at 4:15 PM. Hospital # 2 admitted Patient # 28 to their intensive care unit for stabilizing treatment of his severely lacerated thigh wound. Review of Hospital # 2's services revealed it had capabilities equal to those provided at Freeman hospital.