HospitalInspections.org

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Based on interview and record review, the hospital failed to adhere to the provider's agreement that required a hospital to be compliant with §42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases.
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Based on record review and interview, the Facility failed to provide an appropriate transfer when the Memorandum of Transfer (MOT) for nine of nine patients (Patient #2, #4, #5, #7, #10, #11, #12, #16, and #20) whose records were reviewed failed to contain completed or signed physician certifications that listed the medical benefits or potential risks to the individual upon transfer.
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Cross reference to Tag A2409 CFR §489.24(a) and §489.24(c).

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Based on record review and interview, the Facility failed to provide an appropriate transfer when the Memorandum of Transfer (MOT) for nine of nine patients (Patient #2, #4, #5, #7, #10, #11, #12, #16, and #20) whose records were reviewed failed to contain completed or signed physician certifications that listed the medical benefits or potential risks to the individual upon transfer.
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Findings:
There were 20 randomly selected patient records chosen from the ED and Transfer Logs, to include nine transferred patient records. The MOTs for each were reviewed. It was noted that for nine of nine patients (Patient #2, #4, #5, #7, #10, #11, #12, #16, and #20) whose records were reviewed the MOTs failed to contain signed physician certifications that listed the medical benefits or potential risks to the individual upon transfer. One of nine (Patient #4) did not contain a signed consent to transfer. Three of nine (Patient #10, #16, and #20) transferred via private vehicle and did contain a signed transfer refusal. Three of nine (Patient #2, #5, and #11) were transferred with advanced life support. Three of nine (Patient #4, #7, and #12) were transferred with basic life support. The detailed findings are as follows:
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Patient #2: Date of ED admission 06/17/2024 at 2143 PM with chief complaints of snake bite; triage began at 2150 PM; medical screening exam began at 2150 PM; treatments: vital signs monitored, Zofran was given, history reviewed, exam; diagnosis at disposition: snake bite; transferred for a higher level of care at 2207 PM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via EMS with advanced life support in place.
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Patient #4: Date of ED admission 02/12/2024 at 1204 PM with chief complaints of abdominal pain; triage began at 1205 PM; medical screening exam began at 1206 PM; treatments: vital signs monitored, labs obtained, CT of the abdomen and pelvis - acute appendicitis, uncomplicated, no abscess; diagnosis at disposition: acute appendicitis; transferred at 1638 PM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did not contain a signed consent for transfer. A "Patient Condition for Transfer" statement was signed by a physician, but no reason was indicated, and it did not explain risks and benefits of the transfer. The transfer was completed via EMS with basic life support in place.
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Patient #5: Date of ED admission 02/12/2024 at 1418 PM with chief complaints of abdominal pain; triage began at 1446 PM; medical screening exam began at 1447 PM; treatments: vital signs monitored, labs obtained, CT abdomen and pelvis - no acute findings, moderate stool, meds given, indwelling foley placed; diagnosis at disposition: stercoral colitis; transferred to a higher level of care on 02/13/2024 at 0607 AM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via EMS with advanced life support in place.
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Patient #7: Date of ED admission 02/13/2024 at 1906 PM with chief complaints of throat pain; triage began at 1929 PM; medical screening exam began at 1938 PM; treatments: vital signs monitored, CT soft tissue neck - showed several bilateral tonsilitis with left peritonsillar abscess, meds given; diagnosis at disposition: left peritonsillar abscess; transferred on 02/14/2024 at 0201 AM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via EMS with basic life support in place.
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Patient #10: Date of ED admission 02/15/2024 at 1317 PM with chief complaints of a fast heartbeat and chest pressure; triage began at 1318 PM; medical screening exam began at 1324 PM; treatments: vital signs monitored, labs obtained, EKG obtained, exam; diagnosis at disposition: light headedness, heart palpitations; transferred at 1539 PM. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via private vehicle as the patient refused to consent to transfer. The refusal is signed.
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Patient #11: Date of ED admission 02/15/2024 at 2018 PM with chief complaints of feeling like he had a stroke; triage began at 2034 PM; medical screening exam began at 2056 PM; treatments: vital signs monitored, CT of head, neck, and brain - shows atherosclerotic plaque, no acute herniation or hemorrhage; diagnosis at disposition: transient ischemic attack (TIA); transferred on 02/16/2024 at 0231 AM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via EMS with advanced life support in place.
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Patient #12: Date of ED admission 02/16/2024 at 1317 PM with chief complaints of nausea, vomiting and diarrhea; triage began at 1326 PM; medical screening exam began at 1335 PM; treatments: vital signs monitored, labs obtained, x-ray abdomen- shows bilateral clear lungs, mild to moderate stool burden, flu positive; diagnosis at disposition: influenza, myositis, rhabdomyolysis; transferred at 1655 PM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via EMS with basic life support in place.
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Patient #16: Date of ED admission 02/19/2024 at 0946 AM with chief complaints of abdominal pain; triage began at 1114 AM; medical screening exam began at 1120 AM; treatments: vital signs monitored, labs obtained, CT abdomen and pelvis - active GIB arising from diverticula and aortic aneurysm, admitted observation at 1838 PM; diagnosis at disposition: abdominal pain, alcohol use; transferred at 1719 PM. MOT reviewed and found to contain an explanation of risks and benefits and physician's signed certification. The MOT did contain a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. A signed consent for transfer was completed. The transfer was completed via private vehicle for patient's refusal of ambulance transportation. The refusal of transfer form was signed.
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Patient #20: Date of ED admission 04/01/2024 at 2040 PM with chief complaints of shortness of breath; triage began at 2042 PM; medical screening exam began at 2044 PM; treatments: vital signs monitored, labs obtained, CT of the chest, rule out pulmonary embolus (PE) - PE was seen, CT abdomen - showed right sided pleural effusion with atelectasis, US of the abdomen - negative, meds given, antibiotics given; diagnosis at disposition: pulmonary embolism; transferred on 04/02/2024 at 0213 AM. MOT reviewed and found to not contain an explanation of risks or benefits or a physician's signed certification. The MOT did contain a signed consent for transfer and a "Patient Condition for Transfer" statement signed by a physician, which did not explain risks and benefits of the transfer. The transfer was completed via private vehicle for the patient's refusal of ambulance transportation. The refusal of transfer form was signed.
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In interviews on June 18, 2024, and the morning of June 19, 2024, Staff #1 (Nurse Manager) & Staff #2 the staff members were asked, "Are all of your MOTs like these nine (referring to the MOTs reviewed during patient record reviews) and void of a physicians certification, risks and benefits?"
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Staff #2 replied, "Yes, they have a patient signature stating that the risks and benefits of the transfer were explained to them. The certification is no longer needed as the patient was stabilized prior to transfer."
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