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Based on medical record review, staff interview, policy and procedure review, and facility document review it was determined the facility:

Failed to comply with the requirements for recipient hospital responsibility that had the capability and capacity to accept an appropriate transfer of a patient from a referring hospital requiring specialized services. (Refer to A2411).

Patient #21 required transfer from facility #1 to receiving facility #2 that had the capability and capacity for urology services on 8/10/13. The Emergency Room physician from facility #2 accepted the patient. The on-call urologist refused the patient after the patient had been accepted by the ER physician. This may have led to a delay in access to urology services for patient #21 requiring transfer to facility #3.

Based on medical record review, staff interview and review of policy and procedures it was determined the facility failed to accept a transfer in need of urology services that was within the facility's capability and capacity for one (#21) of twenty-one patients sampled.

Findings include:

An interview was conducted with the CEO (Chief Executive Officer) on 9/10/2013 at 11:05 a.m. He stated an ER (Emergency Room) physician to ER physician communication, via the transfer center, was done on 8/10/2013 for the transfer of a patient (#21) from facility #1 (transferring facility) to facility #2 (receiving facility). It was disclosed the transfer center is a shared service by multiple facilities including both facility #1 and #2. The patient was accepted for transfer by the ER physician of facility #2.

Review of the medical record from facility #1 for patient #21 revealed the patient presented to facility #1's ED (Emergency Department) on 8/10/2013 for complaints of right sided flank, abdominal and pelvic pain. The patient reported a history of kidney stones and that she had just finished an antibiotic for a UTI (Urinary Tract Infection). Review of the ER physician's documentation revealed following assessment, laboratory testing, ultrasound and a CT scan the physician's impression was acute pyelonephritis with hydronephrosis and staghorn calculus and the patient required urology services. Review of the form "EMTALA Memorandum of Transfer" revealed patient #21 required care unavailable at the transferring facility.

Interview with the Director of Risk Management on 9/10/2013 at 10:50 a.m. revealed at the time of the ER physician to ER physician communication the transfer center was unable to reach the urologist to conference him into the communication call. Following acceptance of the patient transfer by the ER physician from facility #2 the transfer center ended the call. The transfer center contacted the urologist following the acceptance by facility #2 to communicate to him the transfer of the patient from facility #1 to facility #2. At that time the urologist refused to accept the patient. The transfer center then contacted facility #3 and the patient was accepted and transferred. The Director of Risk Management stated the transfer center did not contact facility #2's CEO or Administrator on Call to notify them of the urologist refusal to accept the patient.

Review of the facility policy, "EMTALA-FL Patient Transfers", last revised 3/2013, states (3) Authority to Accept a Transfer: the emergency physician and the hospital CEO or designee are the only individuals authorized to accept or refuse the transfer of an individual from another facility on behalf of the receiving hospital. The policy states (5) Transfer Center Use: hospitals may utilize a transfer center to facilitate the transfer of any individual from or to the ED of the transferring facility to the receiving facility. The transferring ER physician determines the appropriate receiving facility with the capability and capacity for providing the care necessary to stabilize and treat the individual's emergent condition. Transfer centers do not make independent decisions as to where the individual will be transferred. The policy states the on-call physician does not have the authority to refuse an appropriate transfer on behalf of the facility.

Review of the facility policy, "EMTALA-Definitions and General Requirements", effective 9/01/2012, states (A) EMTALA requires the hospital to do the following: (4) accept appropriate transfers of individuals with EMCs (Emergency Medical Condition) if the hospital has the specialized capabilities not available at the transferring hospital and has the capacity to treat the individuals.

Review of the medical record for patient #21 and interview with the CEO revealed patient #21 met the criteria for an individual with an EMC that required specialized care and the patient was accepted for transfer by the ER physician of facility #2. Review of facility #2's on-call physician specialists log for August 2013 revealed the urologist was on-call on 8/10/2013, the date of transfer but refused to accept the patient.

The refusal to accept the patient after initially accepting the patient may have caused a delay in obtaining urology services for patient #21.