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Based on review of hospital documents, medical records and interviews with hospital staff, the hospital failed to enforce policies and procedures to ensure compliance with the requirements of 42 CFR 489.24. The hospital failed to enforce its policy and procedure concerning recipient hospital responsibilities.

Findings:

1. Review of a McAlester Regional Health Center (MRHC), policy and procedure, entitled, "Transfer of unstable Emergency and trauma Patients form(sic) other hospitals", documented, " ...A. Request from other health care providers to transfer patients who have an emergency medical condition as defined by EMTALA and require emergency and a higher level of medical care not available at that facility, should be immediately approved when services, space, facilities, and personnel are available to provide appropriate care...."

2. Review of a MRHC log, entitled, "Admissions/Transfer Log 2014", documented on 09/27/14 (critical access hospital name omitted) requested to transfer Patient A to MRHC with a referring diagnosis of "meth/bath salts OD. Agitation".

a. The request was denied by Staff Q. This was confirmed by Staff B during review of the log on the afternoon of 03/26/15.

b. The log documented the reason for declining the patient as, " Dr. __ (name omitted, at MRHC), spoke with Dr. __ (critical access hospital's physician's name omitted), and didn't accept pt because they were basically stable/and didn't need our hospitals intervention. Dr. __ (critical access hospital's physician's name omitted), stated he will do something else per Dr (name omitted, MRHC)."

Based on observation and interviews with hospital staff, the hospital failed to conspicuously post a sign (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor.

Findings:

On the morning 03/25/15 and 03/26/15 a tour was conducted of the McAlester Regional Health Center (MRHC) emergency department (ED).

MRHC ED did not have the required signage posted in a place or places likely to be noticed by all individuals waiting for examination and treatment.

Staff C stated on 03/26/2015 MRHC had recently removed the EMTALA signs and replaced the signs with decorative pictures.

Based on review of hospital documents, medical record review and interviews with hospital staff, the hospital failed to accept an appropriate transfer of an individual who required the specialized capabilities and facilities of the hospital.

Findings:

1. Review of a McAlester Regional Health Center (MRHC), policy and procedure, entitled, "Transfer of unstable Emergency and trauma Patients form(sic) other hospitals", documented, " ...A. Request from other health care providers to transfer patients who have an emergency medical condition as defined by EMTALA and require emergency and a higher level of medical care not available at that facility, should be immediately approved when services, space, facilities, and personnel are available to provide appropriate care...."

2. Review of a MRHC log, entitled, "Admissions/Transfer Log 2014", documented on 09/27/14 (name of critical access hospital omitted) requested to transfer Patient A to MRHC with a referring diagnosis of "meth/bath salts OD. Agitation".

a. The request was denied by Staff Q. This was confirmed by C on the afternoon of 03/26/15.

b. The log documented the reason for declining the patient as, " Dr. __ (name omitted, at MRHC), spoke with Dr. __ (critical access hospital's physician name omitted), and didn't accept pt because they were basically stable/and didn't need our hospitals intervention. Dr. __ (critical access hospital's physician's name omitted), stated he will do something else per Dr (name omitted, MRHC)."

3. Review of the medical record for Patient A, documented, on 09/27/14 at 5:32 a.m. Patient A a 30 year old female, arrived at the (critical access hospital name omitted) ED via ambulance for suspected drug overdose. The patient also complained of shortness of breath and chest pain. Patient A received the following in the ED: complete blood count (CBC), comprehensive metabolic profile (CMP), magnesium, creatine kinase (CK), troponin I, urine sample for analysis and toxin screen, chest x-ray and electrocardiogram (EKG). The urine toxin screen for Patient A tested positive for amphetamines. The patient was transferred via ambulance to the intensive care unit (ICU) at another acute care hospital. The transferring hospital (hospital that requested the transfer) was a 25-bed hospital without the capabilities the specialty care of intensive care/critical care nursing.