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Based on policy and procedure review, clinical record review and interview, it was determined the facility failed to inform five of five (#5, #9, #10, #15 and #16) patients the risks and benefits of being transferred to another facility specific to their diagnosis. The failed practice did not ensure the patients were aware of or accepted the risks or the benefits of the transfer specific to their diagnosis. The findings follow:

A. Review of Patient #5's clinical record on 11/07/13 revealed the patient's diagnosis was "head injury, subdural hematoma". Review of the Certificate of Transfer revealed the Risk of Transfer was "MVC (Motor Vehicle Crash)" and the Benefit of Transfer was "Pediatric Neurology".

B. Review of Patient #9's clinical record on 11/07/13 revealed the patient's diagnoses were "COPD (Chronic Obstructive Pulmonary Disease), Respiratory Failure and Myocardial Infarction - non ST Elevation". Review of the Certificate of Transfer revealed the Risk of Transfer was "Death" and the Benefit of the Transfer was "Higher level of care".

C. Review of Patient #10's clinical record on 11/07/13 revealed the patient's diagnosis was "CVA (Cerebral Vascular Accident) (Stroke) non-hemorrhagic". Review of the Certificate of Transfer revealed the Risk of Transfer was blank and the Benefit of the Transfer was "Neurology, Cardiology".

D. Review of Patient #15's clinical record on 11/07/13 revealed the patient's diagnosis was "Anterior Myocardial Infarction, STEMI (ST Elevation Myocardial Infarction)". Review of the Certificate of Transfer revealed the Risk of Transfer was blank and the Benefit of the Transfer was "Cardiology".

E. Review of Patient #16's clinical record on 11/07/13 revealed the patient's diagnoses were "Acute Coronary Syndrome, Elevated Troponin, Hypokalemia, Urinary Tract Infection (UTI)". Review of the Certificate of Transfer revealed the Risk of Transfer was "MVA (Motor Vehicle Accident)" and the Benefit of the Transfer was "pt (patient) primary physician".

F. Review of the policy "Emergency Medical Treatment and Active Labor Act (EMTALA) Policy" on 11/07/13 revealed, "The Emergency Department shall not transfer an individual who, as a result of a medical screening examination has been determined to have an emergency medical condition, without first stabilizing that condition, unless: a physician certifies in writing that the medical benefits reasonably expected to be derived from the transfer to another facility outweigh the increased risks to the individual and, in the case of labor, to the unborn child, from effecting the transfer".

G. The findings were confirmed in an interview with the Director of the Emergency Room on 11/07/13 at 1435.