HospitalInspections.org

Based on a review of documentation and an interview with staff, the hospital transferred the individual without the receiving hospital agreeing to acceptance of the patient.

Findings were:

A review of the clinical record (at WJ Mangold Memorial Hospital/aka WJMMH) for patient #1 revealed that [pt #1] an 11-year-old female, was struck by a vehicle while riding her bicycle on 9-3-21. The history of present illness stated the following:
"[Pt #1] is an 11-year-old female who presents to the ED via ground EMS after MVA versus bicycle accident. Patient [#1] was hit by an SUV going approximately 30-40 mph, we are unsure if she was hit from the side or behind. Patient [#1] was riding a bicycle. Unsure if car ran her over. EMS called aero care to the scene but they were still greater than 15 minutes out and all we have is basic EMS who cannot even start an IV or administer fluids or pain medications so they transported her to ER instead. Patient arrived on a backboard with rigid c-collar in place. She had no IV in place as all we have is basic EMS. 2 large bore IVs were started and 1L NS bolus started. Patient's vital signs were stable, 123 systolic, heart rate around 110, O2 was about 88% on room air but improved to the 90s on 2 L. Patient complaining of pain all over, grimace with pain on palpation of abdomen, cried out in pain with palpation of right thigh and pelvic rock, attempted to put a pelvic binder on her but unfortunately it was too large so we were able to stabilize pelvis with blankets and taping to the backboard. Had a 3-4 in gaping laceration to her left lower quadrant with obvious subcutaneous fat but it did not appear to penetrate the muscle and into the peritoneal cavity, not bleeding. Did have a large bruise surrounding this laceration and basically encompassing her left upper and lower quadrants. Abrasion to left outer shin and right shoulder. Attempted Foley placement but was unsuccessful. Patient did have blood in her mouth, after suction was noted that she was missing a lower front tooth on the right, the lower right canine was very loose but I was unable to extract it with gentle traction, and a lower posterior capped molar was also very loose but there were no other obvious lacerations. X-ray of pelvis/femurs were obtained and patient does have a midshaft femur fracture to the right and what appears to be a stable pelvic fracture. EMS arrived while we were in the midst of x-ray. Patient was transported to helicopter for transport to trauma center."

The patient was flown via Aerocare (air ambulance) from WJMMH to United Medical Center (UMC) Lubbock.

Additional physician documentation from WJMMH stated the following:
"MVA versus bicycle/right femur fracture/right pelvic fracture/possible abdominal injury - Helicopter arrived approximately 20 minutes after patient arrived to our hospital as we were obtaining a pelvic x-ray, they did help us secure patient's pelvis with blankets and taping her to the EMS board, at that time patient was stable and was transported to the helicopter. Patient's vital signs were stable but patient is still in critical condition, concern for pelvic fracture and also intra-abdominal injuries due to significant bruising and laceration. As EMS had originally paged out the helicopter and requested transfer/transport from the scene and Aerocare was already in route and had already notified UMC of the incoming trauma, due to unavailability of any extra staff available to initiate transfer prior to patient leaving without compromising patient's care, patient did leave facility without official transfer being in place. ER RN, [name redacted], did attempt to call report immediately after patient left facility but transferring hospital refused to take report because no official transfer from our facility had been completed."

Once at UMC, pt #1 was examined immediately and her history of present illness stated the following:
"By EMS report the patient was riding her bike this afternoon when she was struck and ran over by a suburban. Patient was taken emergently to an outside hospital where x-rays were obtained of the pelvis and femur and noted to have fractures of both. Patient also noted to have multiple lacerations of the body. Patient has received approximately 700 cc of fluid as well as 70 mcg of fentanyl. Reportedly to have normal neurologic status during this time. Mainly complains of abdominal pain, and leg pain. No other history of the incident reported at this time."

Pt #1's physical exam revealed the following:
* Large lacerations of the left lateral abdomen, and multiple of the right leg including open wounds.
* Acute, displaced, medial right clavicle fracture
* Acute, proximal right femoral shaft open spiral fracture
* Comminuted fracture of right body & symphysis of mandible
* Comminuted fracture of left superior iliac wing

Following a 13-day stay, the patient was discharged home from UMC.

In an interview with (WJMMH) staff #2 on 10-25-21, staff #2 was asked if she could remember a situation in early September where a pediatric patient may have been transferred from their ER to a higher level of care without securing proper transfer and acceptance prior to transfer. Staff #2 stated that she did and was asked to tell the surveyor what she could remember about the incident.

Staff #2 stated that an 11 year old female (pt #1) had been struck by an automobile while riding her bicycle in downtown Lockney on the evening of 9-3-21. She stated that 911 had been called and the Lockney ambulance service responded. She stated that the Lockney ambulance is made up of volunteers who can only provide basic services and cannot transport a patient anywhere but to Lockney hospital (WJMMH). She stated that the ambulance service had seen the extent of the patient's injuries and had called an air ambulance service to transport the patient to UMC, as they were the nearest Level I Trauma Center and had a pediatric hospital. Staff #2 said that the air ambulance told the paramedics that it would take them 20 minutes to get to the scene. Staff #2 stated that the helicopters were based out of Lubbock (approximately 60 miles away) or Plainview (approximately 18 miles away) and that WHMMH does not own an ambulance service. She stated that the patient (pt #1) continued to bleed and the paramedics decided to take the patient to WJMMH for evaluation and stabilization. Staff #2 stated that the patient was seen by the ER doctor, x-rays were done and that the helicopter landed within 15 minutes on the hospital's helipad. She stated that the doctor and staff were working on the patient the entire time and no one thought to call UMC and secure transfer and give report, as the ambulance had already called for transport to UMC from the scene of the accident. She stated that when hospital staff tried to call report to UMC (after the helicopter had departed), UMC stated that WJMMH should have gone through the transfer center and followed the proper procedures. Staff #2 stated that UMC staff told the WJMMH nurse that WJMMH should cancel the helicopter and start the process all over, but staff #2 said that the helicopter was already en route to UMC with the patient by the time the call took place.

A review of the Emergency Department Policy & Procedure Manual revealed the following policies:

Facility policy titled "Emergency Medical Treatment and Labor Act" states, in part:
" ...
Procedure:
...
10. When transfer is indicated, documentation must include doctor to doctor contact between the transferring physician and the receiving physician as well as hospital to hospital contact indicating proper consent from the receiving hospital to accept the patient was obtained."

The above was confirmed in an interview with staff #2 on 10-25-21.