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Based on interview and record review, the receiving hospital (Hospital B) failed to report a suspected EMTALA (Emergency Medical Treatment and Labor Act) violation when Patient 1 was received from the sending hospital (Hospital A)'s Emergency Department (ED) without having had a Medical Screening Exam (MSE). This failure precluded the appropriate enforcement agency from investigating and preventing future patients from an unsafe transfer or delay in treatment.

Findings:

Review of the document received from county EMS titled, Base Report Form - Emergency Department, dated 7/2/18, disclosed the medics called the MICN at Hospital B. [Mobile Intensive Care Nurse - a Registered Nurse with specialized training and experience in pre-hospital care and authorized to operate base station phones for medical command]. The MICN documented the following:
- report from medics "Patient was taken to [Hospital A] ED and ejected from Ambulance Bay due to [PT] attempt to kick a staff member."
- "OK to bring to [Hospital B] for evaluation."
- "Call to [Hospital A], spoke to Charge RN [name]. Patient was brought to them because of intoxication ...but was refused/ejected from ED because of their zero tolerance policy for violence/abuse toward staff. Per [Charge RN] patient was ' never accepted into the ED ' and they called ...police to take the patient to jail."

A review of Patient 1's electronic medical record (eMR) from Hospital B, indicated Patient 1 was BIBA (brought in by ambulance) and was admitted to the ED with a diagnosis including acute alcohol intoxication.

Review of Hospital B ' s document for Patient 1 titled, Emergency Documentation, ED Note - Physician indicated the following:
- "Arrival Mode: Ambulance - ALS..."
- "History of Present Illness - 20 year old BIBA from [Hospital A] for alcohol intoxication... EMS took [patient] to [Hospital A] where [patient] threatened a nurse who then transferred [patient] here..."
- "Medical Decision Making, Differential Diagnosis: Alcohol intoxication, confusion, electrolyte abnormality. Rationale: 20 y/o [year old] [female] BIBA from [Hospital A] for AMS [altered mental status] & alcohol intoxication. EMS had taken initiallt [sic] to [Hospital A] and for unclear reason patient not seen or evaluated, instead paramedics have subsequently made base contact and patient brought to [Hospital B]"
During an interview with the Deputy Director of Standards and Compliance (DSC) on 4/25/19 at 2:25 p.m., the circumstances regarding Patient 1 ' s arrival to their ED (Hospital B) were discussed. When asked, by the Department, what their responsibility as the recipient hospital was regarding suspected EMTALA violations, the DSC stated they "are not required to report."

Review of the hospital provided document titled, [Facility Name] Emergency Department COBRA/EMTALA Provisions, dated 4/29/08, stipulated:
- " ...the Consolidated Omnibus Budget Reconciliation Act which includes EMTALA ...The avowed purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring the to ' county hospitals ' because they are unable to pay or are covered under the Medicare or Medicaid programs. This purpose, however, does not limit the coverage of its provisions ..."
- "COBRA/EMTALA requirements apply to all Medicare participating hospitals, regardless of accreditation status, for profit or not, corporate structure or ownership, location, state, county or other political boundaries. In practical terms, this means EMTALA applies to virtually all hospitals in the U.S. Its provisions apply to all patients; not just Medicare patients."
- "Enforcement - All hospitals and emergency departments are obligated to report any known violations of the EMTALA regulations ...Failure to report results in an EMTALA violation for the receiving facility. For example, if a member of our staff believes another hospital has transferred a patient to our facility without proper medical screening and/or without adhering to proper inter-facility transfer procedures, that staff member must report the incident to the department manager, or chief, or his/her designee immediately ...no patient can be sent anywhere else for care until the Medical Screening Exam is complete ..."

Review of the hospital document titled, Medical Staff Rules and Regulations, dated 3/12/13, stipulated "The medical staff of [Hospital Name] shall abide by the requirements of the EMTALA and California hospital licensing laws on the provision of emergency services and care ...All transfers of patients to this hospital and from this hospital shall be carried out in accordance with EMTALA and California state law."

Review of the hospital policy titled Compliance with EMTALA, dated 5/1/08, stipulated:
- "[Hospital Name], its physicians and staff will abide by the regulations of the Emergency Medical and Active Labor Act ...Violations of EMTALA may be reported to other federal agencies."
- "The California Department of Public Health [CDPH] is responsible for the enforcement of state hospital licensing law"
- "[Hospital Name] has determined that the Emergency Department and Family Maternity Center are dedicated emergency departments under the EMTALA definitions for ' Dedicated Emergency Department ' ."
- "The hospital will report to CMS [Centers for Medicare and Medicaid Services] or the Department ... [CDPH], within 72 hours if it has reason to believe that it has received an individual who has been transferred in an unstable emergency condition from another hospital."
- "Any hospital staff member who believes that an EMTALA violation has occurred shall report the violation to the Administrator on call, Deputy Director of Standards and Compliance and/or the Nursing Supervisor."