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Based on review of facility policies, review of the facility's Specialist On-Call Log, review of a digital audio recording, review of medical records, and interviews, the facility failed to accept the appropriate transfer of one patient (Patient #45) of 45 patients reviewed.

The findings included:

Patient #45 presented to the Emergency Department (ED) at Hospital C (a satellite of Hospital B) on 5/15/2022 at 10:10 PM with complaint of chest pain. Patient #45 was diagnosed with a STEMI (heart attack) and needed a Cardiac Catheterization (a small tube is inserted inside the heart to diagnose and treat cardiac disease) performed immediately. Hospital C did not have a Cath Lab (procedure room in which Cardiac Catheterizations are performed) and both the Cardiologist and Cath Lab at Hospital B (the main campus) were occupied with another STEMI patient. Hospital C's ED Physician attempted to transfer Patient #45 to Hospital A and contacted Hospital A by telephone on 5/15/2022 at 10:23 PM. Hospital C's ED Physician requested Cardiologist #1 at Hospital A accept transfer of Patient #45 to Hospital A to provide the Emergency Cardiac Catheterization Procedure, but Cardiologist #1 refused to accept the transfer. Hospital A on 5/15/2022 at 10:23 PM had a Cath Lab open and available, had a Cardiac Cath Procedure Team on hand, and Cardiologist #1 was on call and not performing any procedures at that time. Cardiologist #1 refused to accept the transfer after discussing the case with Hospital A's House Supervisor and the Administrator on Call. After Hospital A's refusal, Patient #45 was transferred by Hospital C to Hospital D on 5/15/2022 at 11:00 PM. Patient #45, upon arriving at Hospital D, was taken directly to the Cath Lab and a Heart Catheterization was initiated at 11:25 PM on 5/15/2022. Continued review revealed the patient was diagnosed with a STEMI and during the Heart Catheterization three stents (tubes inserted in arteries of the heart) were inserted. The patient was discharged home in stable condition on 5/18/2022.

Refer to A-2411

Based on review of facility policies, review of the facility's Specialist On-Call Log, review of a digital audio recording, review of medical records, and interviews, the facility failed to accept the appropriate transfer of one patient (Patient #45) of 45 patients reviewed.

The findings included:

Review of facility policy titled "EMTALA [Emergency Medical Treatment and Active Labor Act] GUIDELINES - TREATMENT OF INDIVIDUALS IN NEED OF EMERGENCY MEDICAL SERVICES" dated May 2021 revealed, "...To the extent that the Hospital has specialized capabilities or facilities...that are not available at a facility that has asked the Hospital to accept the transfer of an individual with an EMC [Emergency Medical Condition] requiring the specialized capabilities or facilities, the Hospital will accept the Appropriate Transfer of such individual if the Hospital has the capacity to treat the individual..."

Review of the facility's log of On-Call Specialist revealed on 5/15/2022 Hospital A had Cardiologist #1 on call for the treatment of patients with STEMI (heart attacks/ST Elevated Myocardial Infarctions).

On 5/15/2022 at 9:00 AM, a digital audio recording was reviewed in the Administrative Conference Room. This digital audio recording was identified by Hospital A's Quality Director as a recording of conversations on 5/15/2022 between Intake Staff, Hospital C's Emergency Department (ED) Physician, Hospital A's On-Call Cardiologist (Cardiologist #1), Hospital A's House Supervisor, and Hospital A's Administrator on Call. There were no time stamps on the audio recording. The audio recording revealed Hospital C's ED Physician notified Hospital A's on-call Cardiologist of the need to transfer Patient #45 with a STEMI (heart attack) to Hospital A for treatment. Hospital C's ED Physician stated Hospital B (Hospital C is a satellite of Hospital B) had another STEMI patient requiring their cardiologist and Cath Lab (a procedure room where cardiac catheterizations are performed) and needed to transfer Patient #45 to Hospital A for immediate treatment. The recording revealed Hospital A's Cardiologist (Cardiologist #1) refused to accept the transfer and stated Hospital B had enough cardiologists to call a second one in to treat the patient. The recording revealed Cardiologist #1 called back to Hospital C's ED Physician and stated Hospital A was not obligated to accept Patient #45's transfer. The ED Physician told Cardiologist #1 the patient was being transferred to Hospital D for treatment. Hospital A's House Supervisor called Cardiologist #1 to discuss Patient #45's transfer and he again refused to accept the transfer. Hospital A's Administrator on Call then had a long discussion with Cardiologist #1 regarding his refusal to accept Patient #45's transfer from Hospital C and Cardiologist #1 repeatedly refused to accept the transfer.

Review of a Teletracking Timeline of an audio recording dated 5/15/2022 revealed:
1. At 10:23 PM, "...CODE STEMI PAGED OUT TO TEAM...CODE STEMI [HOSPITAL C]...[HOSPITAL B] IS AT CAPACITY AND REQUESTED [HOSPITAL A] TO TAKE...[HOSPITAL B] HAS TWO STEMIS AT THE SAME TIME AND MAIN IS AT CAPACITY...[CARDIOLOGIST #1] DECLINED TO ACCEPT THE PATIENT...[CARDIOLOGIST #1] ADVISED [HOSPITAL C] ER TO CALL 2ND CARDIOLOGY TEAM IF THERE ARE 2 STEMIS GOING ON..."
2. At 10:26 PM, "...[CARDIOLOGIST #1] CALLED BACK AND CONFERENCED [HOSPITAL C's ED PHYSICIAN] AGAIN...[HOSPITAL A] IS NOT OBLIGATED TO ACCEPT THE PATIENT...[HOSPITAL B] NEEDS TO TAKE CARE OF THEIR OWN PATIENTS...[HOSPITAL C's ED PHYSICIAN] WILL CALL [HOSPITAL D]..."
3. At 10:31 PM, "...H/A [SUPERVISOR] NOTIFIED OF THIS CASE. HE WILL CALL ADMIN ON CALL AND [MEDICAL DIRECTOR]..."
4. At 10:44 PM, "...H/A CONFERENCED WITH [CARDIOLOGIST #1]...[HOSPITAL B] HAS TO TAKE CARE OF THEIR OWN PATIENT...[CARDIOLOGIST #1] REFUSED TO ACCEPT THE PATIENT..."
5. At 10:54 PM, "...ADMIN ON CALL CONFERENCED WITH [CARDIOLOGIST #1], CASE DISCUSSED..."
6. At 11:15 PM...ADMIN CONFERENCED WITH [HOSPITAL C]...PATIENT ACCEPTED IN [HOSPITAL D] MAIN..."

Review of Patient #45's medical record from Hospital C revealed he had presented to the ED there on 5/15/2022 at 10:10 PM with complaint of chest pain. Patient #45 was diagnosed with ST Elevated Myocardial Infarction (Heart Attack/STEMI). A physician's untimed note dated 5/15/2022 revealed, "...Called transfer center to activate cath [Cardiac Catheterization, a procedure in which a flexible tube is inserted into the chambers of the heart for diagnostic tests and treatment] lab for Stemi...[Hospital B] Cath lab occupied with stemi currently...[Hospital A's Cardiologist #1] did not accept the patient...[Hospital D] interventional cardiologist...he will take directly to [Hospital D] cath lab..." Continued review revealed Patient #45 was transferred to Hospital D on 5/15/2022 at 11:00 PM.

Review of Patient #45's medical records from Hospital D revealed the patient was admitted there on 5/15/2022 at 11:05 PM. Patient #45 was taken directly to the Cath Lab at Hospital D and a Heart Catheterization was initiated at 11:25 PM on 5/15/2022. Patient #45 was diagnosed with a STEMI and during the Heart Catheterization three stents (tubes inserted in arteries of the heart) were inserted. Patient #45 was discharged home in stable condition on 5/18/2022.

Cardiologist #1 was interviewed in the Cardiology Office Conference Room on 6/14/2022 at 1:00 PM. Cardiologist #1 stated he was on call at Hospital A for interventional cardiology on 5/15/2022. Cardiologist #1 stated he was available to perform procedures and treatments including Heart Catheterizations on 5/15/2022 after 7:00 PM. Cardiologist #1 stated he remembered Patient #45 transfer request on 5/15/2022, and stated he was available to perform the needed procedures and treatment, but he refused to accept the transfer. Cardiologist #1 stated he refused to accept the transfer because he believed Hospital B was able to perform the procedure and the patient was Hospital B's responsibility.

The Cath Lab Manager was interviewed in the Administration Conference room on 6/15/2022 at 10:07 AM. The manager stated the facility has 8 procedure rooms with 4 of these rooms equipped for Heart Catheterizations. The manager stated the facility has one procedure team on call constantly and the ability to call a second team if needed. Continued interview revealed on 5/15/2022, there were no heart catheterizations performed after 8:00 PM. The manager stated the procedure rooms were open and available when Hospital C requested the transfer of Patient #45 on 5/15/2022 at 10:23 PM. The manager stated the procedure team was called in as soon as the call came in and they were on their way to Hospital A when Cardiologist #1 refused the transfer. The manager stated the procedure team was available and on their way to the hospital and a procedure room was available. The manager stated there was no reason for Hospital A to refuse Patient #45's transfer on 5/15/2022.