HospitalInspections.org

Based on document review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to have a patient/guardian sign consent to transfer to another medical facility and acknowledging the risks and benefits of a transfer, See A 2409.

Based on document review and interview the facility failed to have the patient/guardian sign the transfer form that explained the risks and benefits of a transfer for 2 out of 3 transfer patients (#4, #15) reviewed. Findings include:

On 8/4/15 at approximately 1400 during review of the policy titled, "Screening, Stabilization and Transfer of Emergency Patients (EMTALA)" dated 1/27/2015 it was documented "1) The request must be in writing, and indicate that the individual is aware of the risks and benefits of the transfer. Use Borgess' 'Patient Transfer form Emergency Department' form." The patient transfer form documents the risks and benefits and has a section for the patient/legally responsible person to sign indicating consent and understanding of the risks and benefits.

On 8/4/15 at approximately 1330 during review of patient #4 and #15 it was revealed that the patient transfer form was not signed by the legally responsible person. Both patients were minors.

On 8/4/15 at approximately 1330 during an interview with staff B regarding the medical records for Patient #4 and #15, it was stated, "No, the transfer form is not signed by the guardians."