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Based on interview and record review, the hospital failed to abide by the provider's agreement that required a hospital to comply with §42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases. Hospital A was not in compliance with the EMTALA (Emergency Medical Treatment and Labor Act) requirements, in that, 1 of 1 patient (Patient #4) who was under police custody was not appropriately transferred on 09/23/18.

Cross Refer to Tag A409 - §489.24(e)(1) and (2) Appropriate Transfer/Discharge

Based on interview and record review, the hospital did not appropriately transfer 1 of 1 patient (Patient #4) who was under police custody on 09/23/18.

Patient #4 presented in the ED (emergency department) on 09/23/18 at 4:01 PM. Patient #4's chief complaint was "Overdose, intentional. (Boyfriend brought patient in and states that she took a handful of Xanax and was drinking wine. Patient reports she took 1 mg Xanax then 3 halves of Xanax. Patient yelling, cursing. Wants to leave. Reports she took medication to feel better.)"

4:29 PM Attending physician (Physician #11) saw the patient and ordered multiple lab work and a crisis clinician consultation.

4:45 PM a nurse reassessed Patient #4's pain. "Patient/family was educated on pain. Level of Consciousness: slurred speech...Coping. Observed Emotional State: frustrated, uncooperative..."

4:53 PM Crisis Clinician Personnel #6 was in the ED and at 5:38 PM conducted an intake assessment.

5:44 PM Personnel #6 noted Patient #4's "Primary Diagnosis: Major depressive disorder recurrent episode. Major depressive disorder with anxious distress. Current severity: severe. Secondary diagnosis: Generalized anxiety disorders. Recommendations. Factors affecting treatment. Level of care: involuntary. Anticipated length of stay 4-6 days. Treatment Recommended: inpatient. Patient response to recommendation: declined. Treatment disposition: inpatient."

5:55 PM Personnel #6 called the transfer center and talked to Personnel #13. Personnel #6 told Personnel #13 patient information needed for the transfer. Personnel #13 was told Patient #4 was on warrant detention. The patient was medically cleared. The patient was uncooperative. The patient had no psych history. Patient #4 stated she has hallucinations all the time. The patient was now calm, guarded, not aggressive, and not cooperative. The primary care nurse was Personnel #12.

6:01 PM Personnel #13 called Hospital B charge nurse. Personnel #13 informed the charge nurse that Patient #4's blood alcohol was 248 and about Patient #4's current condition and history. Hospital B charge nurse told Personnel #13 that she would call back.

6:04 PM Urine drug screen result: Positive for Benzodiazepines and Cannabinoids.

6:20 PM Hospital B charge nurse called back Personnel #13. The charge nurse told Personnel #13 that Patient #4 would go to bed 22B and would be needing more lab work.

After this call, there was no evidence that Hospital A's ED was informed that Patient #4 was accepted in Hospital B and had an assigned bed (22B), and/or there was no evidence that Hospital A's ED called the transfer center to ask for the status of Patient #4's transfer.

7:00 PM Personnel #12 documented "ED Nurse Discharge Documentation: Other flowsheet entries: Discharge destination: Transferred (JPS); Patient has ride home: Yes (Bedford PD)."

7:07 PM RN Personnel #12 noted "Patient left ED."

7:12 PM Physician #11 recorded "ED Disposition set to Discharge to Court/Law Enforcement."

8:01 PM Personnel #13 called Hospital A's ED and asked if Patient #4 was still in the emergency room. An ED staff replied the police took her. Personnel #13 replied I will cancel her then.

During an interview on 10/01/18 at 3:25 PM, Personnel #3 informed the surveyor that no one in the emergency department had any knowledge that Patient #4 was accepted in Hospital B and that a bed was already assigned.

Policy "Medical Screening Examinations and Patient Transfers" last reviewed: 08/09/2016 required "4.3.4 Routing requests for transfer. The THR Patient Logistics Center should be used to assist transfer request...4.3.5 Response time for answering requests to transfer...no longer than 1 hour if there are extenuating circumstances for the delay...4.3.6 Confirming acceptance for patient transfer. The Nursing Administrative Supervisor will confirm with the ED that a Hospital medical staff member has accepted the patient...The Nursing Administrative Supervisor is responsible for accepting or declining the transfer."