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Based on record review and interview, the receiving Hospital B failed to enforce its policy to ensure compliance with the requirements of ?489.24 for 1 of 22 patients (Patient #22). Although Hospital B had specialty physician coverage for neurosurgical services and at least two administrative personnel (Personnel #5 and #9) were aware of a transferring Hospital A's request for an Emergency Department (ED) to ED transfer on 04/25/14, Patient #22 was not accepted as an ED referral by Hospital B after being contacted for a referral by Hospital A on 04/25/14. Hospital B had both capacity and capability to accept Patient #22 on 04/25/14.


Findings included:

Patient #22's admitting diagnoses dated 04/25/14 at 16:31 at Hospital A included Back Pain, Disc Herniation, Cauda Equine, and Chronic Back Pain.

Patient #22 was interviewed on 05/01/14 at 08:35 and stated Hospital B did not accept him due to lack of insurance. Patient #22 stated he had surgery for "three bulged discs" on 04/30/14.

The Hospital A Physician Report dated 04/25/14 at 16:31 reflected a Hospital A Emergency Department to Hospital B Emergency Department (ED to ED) transfer was requested due to availability of neurological surgery specialty services at Hospital B. Hospital B Personnel #5 declined the transfer because Patient #22 was to be a "direct admit."

Hospital A Personnel #12 was telephone interviewed on 05/07/14 at 10:02 and stated when Patient #22 was evaluated in Hospital A's ED on 04/25/14 the patient could not walk and was unable to urinate. Hospital A's ED staff initiated the transfer and faxed a face sheet with insurance information to Hospital B. When the surveyor asked Hospital A Personnel #12 whether he communicated Patient # 22's condition as an emergency to Hospital B Personnel #5, Hospital A Personnel #12 stated "yes." The patient transfer to Hospital B was denied. Hospital A Personnel #12 was telephone connected to Hospital B Personnel #5 who stated it was a direct admission and Hospital B did not have to accept an uninsured patient for inpatient services. When Hospital A Personnel #12 requested to send the patient to the ED, Hospital B Personnel #5 stated, "No, it's too late" and Hospital A Personnel #12 should send Patient #22 to a closer hospital if he was worried about the patient.

Hospital B Personal #9 was interviewed on 05/01/14 at 12:10. She stated Hospital B Personnel #11 had told her he would accept the patient and asked about bed availability. Hospital Personnel #9 stated she informed Hospital B Personnel #11 there were beds available.

Hospital B's call schedule dated 04/25/14 reflected neurosurgical physician coverage.

On 05/07/14 Hospital B faxed a document titled "chronological sequence of events that took place on April 25, 2014" to the surveyor. The document noted that on 04/25/14 at 13:56 Hospital B Personnel #9 retrieved an office voice mail from Hospital A's ED stating a request for an ED to ED transfer of a patient.

On 05/07/14 Hospital B faxed a written statement by Hospital B Personnel #9 to the surveyor. The document indicated that on 04/25/14,untimed, Hospital B Personnel #9 received a request from Hospital A ED staff to change the patient direct admission to an ED to ED transfer.

Review of Hospital B Personnel #11's credentialing file on 05/06/14 at 15:51 did not reflect evidence of EMTALA training.

Hospital B Personnel #7 agreed on 05/06/14 at 15:51 that there was no evidence Hospital B Personnel #11 completed EMTALA training.

Hospital B's Emergency Medical Treatment and Labor Act -EMTALA Policy dated 10/30/13 noted definitions including "Capacity encompasses such things as numbers and availability of qualified staff, beds, and equipment..." The policy noted that it was "...the policy of the Hospital to accept from a referring hospital within the boundaries of the United States the appropriate transfer of individuals who require the Hospital's specialized capabilities or facilities if the Hospital has the 'capacity' to treat the individual."

Cross refer to A 2411

Based on record review and interview, the receiving Hospital B failed to accept an appropriate transfer although the hospital had the capacity and capability at the time the request was made. Hospital A requested to transfer Patient #22 to Hospital B because of a neurosurgical emergency. Hospital B had specialty physician coverage for neurosurgical services and a bed at the ime of the transfer request. Further, at least two administrative personnel (Personnel #5 and #9) were aware of transferring Hospital A's request for the transfer on 04/25/14. Patient #22 was not accepted by Hospital B after being contacted for a by Hospital A on 04/25/14. Hospital had both capacity and capability to accept Patient #22 on 04/25/14.


Findings included:

Patient #22's admitting diagnoses dated 04/25/14 at 16:31 at Hospital A included Back Pain, Disc Herniation, Cauda Equine, and Chronic Back Pain.

Patient #22 was interviewed on 05/01/14 at 08:35 and stated Hospital B did not accept him due to lack of insurance. Patient #22 stated he had surgery for "three bulged discs" on 04/30/14.

The Hospital A Physician Report dated 04/25/14 at 16:31 reflected a Hospital A Emergency Department to Hospital B Emergency Department (ED to ED) transfer was requested due to availability of neurological surgery specialty services at Hospital B. Hospital B Personnel #5 declined the transfer because Patient #22 was to be a "direct admit."

Hospital A Personnel #12 was telephone interviewed on 05/07/14 at 10:02 and stated when Patient #22 was evaluated in Hospital A's ED on 04/25/14 the patient could not walk and was unable to urinate. Hospital A's ED staff initiated the transfer and faxed a face sheet with insurance information to Hospital B. When the surveyor asked Hospital A Personnel #12 whether he communicated Patient # 22's condition as an emergency to Hospital B Personnel #5, Hospital A Personnel #12 stated "yes." The patient transfer to Hospital B was denied. Hospital A Personnel #12 was telephone connected to Hospital B Personnel #5 who stated it was a direct admission and Hospital B did not have to accept an uninsured patient for inpatient services. When Hospital A Personnel #12 requested to send the patient to the ED, Hospital B Personnel #5 stated, "No, it's too late" and Hospital A Personnel #12 should send Patient #22 to a closer hospital if he was worried about the patient.

Hospital B's call schedule dated 04/25/14 reflected neurosurgical physician coverage.

On 05/07/14 Hospital B faxed a document titled "chronological sequence of events that took place on April 25, 2014" to the surveyor. The document noted that on 04/25/14 at 13:56 Hospital B Personnel #9 retrieved an office voice mail from Hospital A's ED stating a request for an ED to ED transfer of a patient.

On 05/07/14 Hospital B faxed a written statement by Hospital B Personnel #9 to the surveyor. The document indicated on 04/25/14,untimed, Hospital B Personnel #9 received a request from Hospital A ED staff to change the patient direct admission to an ED to ED transfer.

Hospital B Personal #9 was interviewed on 05/01/14 at 12:10. She stated Hospital B Personnel #11 had told her he would accept the patient and asked about bed availability. Hospital Personnel #9 stated she informed Hospital B Personnel #11 there were beds available.

On 05/07/14 Hospital B faxed a written statement by Hospital B Personnel #10 to the surveyor. The document stated that "...no records of...[Hospital B Personnel #5's] completing EMTALA training were found in his credentials file."

Review of Hospital B Personnel #11's credentialing file on 05/06/14 at 15:51 did not reflect evidence of EMTALA training.

Hospital B Personnel #7 agreed on 05/06/14 at 15:51 that there was no evidence Hospital B Personnel #11 completed EMTALA training.

Hospital Policy COMP-RCC 4.57 dated 04/24/14 reflected the purpose to "...provide patients with a Cash Pay Rate payment option for certain services." The policy noted implementation of "...Cash Pay Rates for certain approved services in order to provide patients a payment option where the patient pays for the service in full at or before the time of service...At all times, the policy shall be implemented and applied with sensitivity to the patient's health, privacy, and dignity."

Hospital B's Emergency Medical Treatment and Labor Act -EMTALA Policy dated 10/30/13 noted definitions including "Capacity encompasses such things as numbers and availability of qualified staff, beds, and equipment..." The policy noted that it was "...the policy of the Hospital to accept from a referring hospital within the boundaries of the United States the appropriate transfer of individuals who require the Hospital's specialized capabilities or facilities if the Hospital has the 'capacity' to treat the individual."