HospitalInspections.org

Based upon record review and interview, the facility failed to accept an appropriate transfer of 1 of 25 (Patient ID #25) patients reviewed.

Review of medical record for patient #25 from the transferring facility revealed on 4/10/22 at 10:11 am, patient arrived from private vehicle with complaints "sore throat and difficulty swallowing." He had been on oral augmentin antibiotic and Medrol dose pack and his 'symptoms continue to worsen'." He stated he "is now unable to swallow any pills." Physical exam revealed "vital signs: Temp 98.7, HR 58, BP 100/65, Pulse ox 97%." The Staff ED physician ID #65 documented on exam "positive bilateral parotid swelling, sone mild swelling underneath the jaw, no exudates, positive ulcerations noted posterior pharynx, uvula midline, ..." CT Neck with Contrast impression documented "mild soft tissue swelling including the oropharynx circumferentially. No phlegmom or focal abscess collection. 11 mm nodule in left thyroid." The ED medical decision making by Staff ED physician #65 includes "However at this time he is maintain airway, discussed with patient and wife that we do not have ENT here at this hospital so we need to transfer him, since he cannot go home since he cannot swallow any medications." The record further stated "Dr XXX (Physician ID #55, ENT at facility XXX refused to accept transfer for higher level of care. 1220." (Facility AOC), Staff ID 63 "was on recorded line as well."

HealthOne Transfer Center Transfer Center written record reviewed 6/28/22 at 3:30 p.m. for Patient ID #25 record 4/10/22 at 12:09 stated "Diagnosis #1 Pharyngitis. Diagnosis #2 Unable to Take PO. Reason for Transfer: Service NA". Staff ED physician ID #65 MD stated "hoping to transfer for higher level of care. We don't have ENT here."

Review of HCA Healthcare Northwest facility policy titled "EMTALA - Texas Transfer Policy", last revised 10/2021, stated "A hospital with specialized capabilities or facilities ( ....) shall accept from transferring hospital an appropriate transfer of an individual with an EMC (emergency medical condition) who requires specialized capabilities, if the receiving hospital has the capacity to treat the individual."

Voice recording of the telephone conversations were reviewed on 6/28/22 @ 4:25 p.m. between the transferring ED physician (Staff ID #65) and Recipient facility ENT surgeon on call (Staff ID #55) regarding Patient ID #25 was reviewed for content. The voice recordings confirmed that Physician #65 explained to Physician #55 why she felt patient needed transfer for higher level of care/specialty care : "sore throat wk ago, to MD couple of times, on augmentin, got worse, can't swallow pills or food ... can't swallow anything at all. We don't have ENT here."

A telephone interview was conducted with the recipient hospital ENT surgeon Staff ID #55 on 6/28/22 at 4:00 pm. He confirmed that he considered transfers based on "diagnosis and severity of disease." He stated he "remembered this case/call very well" and stated the ED physician ID # 65 told him she was reporting him for an EMTALA violation. He stated that he refused the transfer via transfer center recorded call on 4/10/22 because Patient ID #25 did not require ENT intervention or surgery" and he "believed the facility the patient was being seen was capable of providing IV antibiotics and steroids."

Interview with facility CEO Staff ID #54 on 6/28/22 at 5:00 p.m. revealed the facility administrator on call (AOC) was designated administrator for transfer center calls. He stated that regional corporate leadership for Houston Metropolitan area reviewed all transfer denials and stated he was not aware of any specific service-line limitations precluding transfer acceptance.

Interview with facility CNO Staff ID #51 on 6/28/22 at 3:45 p.m. revealed the facility was not on capacity/divert status on the date of 04/10/2022. The facility transfer acceptance report for April 2022 was reviewed and the facility accepted 8 patients on the date of service, 04/10/2022 through transfer center process.