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Based on record review and interview, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires that hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by:

1) Failure to ensure stabilizing treatment and/or an appropriate transfer was provided to a patient (Patient #1) who presented to the hospital's emergency department with a dislodged gastric tube. The hospital failed to provide an appropriate transfer to a receiving hospital for stabilization of an emergent medical condition when the transferring hospital did not have the capabilities to provide the stabilizing treatment. (See findings in A-2407)

Based on record review and interview, the hospital failed to ensure stabilizing treatment and/or an appropriate transfer was provided to 1 (Patient #1) of 1 patient who presented to the hospital's emergency department with a dislodged gastric tube out of a total sample of 20 patients. The hospital failed to provide an appropriate transfer to a receiving hospital for stabilization of an emergent medical condition when the transferring hospital did not have the capabilities to provide the stabilizing treatment.

Findings:

Patient #1
Review of the medical record for Patient #1 revealed a 12 week old infant with diagnosis of Trisomy 18 with VSD presented to the ED with his parents on 05/19/19 at 1:00 a.m. with a complaint of "G-tube came out 20 minutes ago." Further review revealed the patient was examined by S1MD and discharged home at 1:48 a.m. Disposition was documented as: Discharged to home, condition is good, follow up with private physician tomorrow to replace G-tube at Hospital B since tube not available at this facility.

Review of the medical record revealed no documented evidence that any treatment was provided to ensure the G-tube insertion site remained patent. Further review of the medical record revealed no documentation of any attempt to contact another facility to provide services the patient had been determined to need. Review revealed Patient #1 left the ED at 1:57 a.m. with his parents.

On 07/15/19 at 10:15 a.m., an interview with S3QualDir confirmed that the only gastric tube size the hospital keeps in stock is a 20 French and Patient #1 needed a smaller 12 French tube.

On 07/15/19 at 4:30 p.m., a telephone interview was conducted with S1MD, who was out of town. S1MD revealed she did not recall Patient #1 or the details of the event and was not able to answer questions.

On 07/16/19 at 12:00 p.m., an interview with S4MD, Medical Director of the ED revealed he had reviewed the record of Patient #1 and was familiar with him. Upon review of the medical record for the ED visit on 05/19/19 regarding the G-tube being dislodged, he confirmed that the documentation by the S1MD was lacking adequate detail related to the patency status of the gastric tube site (if it was closed up or if measures could have been taken to keep the site patent until transfer was facilitated to another facility for treatment). He also verified no documented communication attempts with another facility for transfer to address the treatment needed to replace the tube. S4MD agreed that without transfer arrangements to get the G-tube replaced within a reasonable time period, the patient would not be able to receive fluids, feeding and medications, which could lead to potential problems with dehydration, nutrition and medical issues related to his heart condition, and agreed the patient should have been transferred.