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Based on interview and record review, the receiving hospital failed to accept an appropriate transfer of Patient (P) #21 even though the receiving hospital had the specialized capabilities to provide treatment for P#21. This deficient practice delayed care for P#21 who was in need of a further examination to determine appropriate diagnosis and treatment. P#21 was subsequently transferred to another hospital where an evaluation was performed and treatment was provided.


The findings are:


A. P#21 presented to emergency department of the presenting hospital for dizziness and anemia due to an upper GI (Gastrointestinal) bleed. GI bleeding is any type of bleeding that starts in your GI tract. P#21 was triaged in the emergency department of the presenting hospital, received supportive care and a blood transfusion. P#21 was treated by the emergency department provider and required to be transferred for GI services that were unavailable at the presenting facility.


B. Record review of the recorded phone call from the presenting hospital agent and the receiving hospital's agent revealed the following:

"Receiving agent: Yeah, that's what we've been instructed to do. If they're calling from Fort Defiance, if their area code is from Arizona, they need to be transferred to Flagstaff or to Phoenix. But if they're from New Mexico, then we would transfer them into our rotation here.

Presenting agent: Oh, wow, okay. Well, he is from Fort Defiance. That's in Arizona.

Receiving agent: Okay, so then he would have to go to Phoenix or Flagstaff.

Presenting agent: Okay, well I'll go ahead and let our doctors know.

Receiving agent: Okay. Thank you."


C. Record review revealed, "The transfer was not accepted, and it appears the transfer center referred to the state algorithm (a process or set of rules to be followed) for not accepting the patient for transfer based on the patient's address. The hospital (in Albuquerque) was the closest hospital to meet the patient's emergency needs."


D. On 6/26/10 at 8:30am, during interview S#4 (Central Command Director) verified that the central command call center coordinators are not trained about EMTALA regulation but are instructed that EMTALA is based upon capacity.


E. On 6/26/20 at 9:30am, during interview S#11(Central Command Coordinator) verified that she received minimal training about EMTALA regulations.


F. On 6/26/20 at 10:00am during interview S#12 (Central Command Coordinator) verified that he was trained that EMTALA is about capacity but, was not trained on EMTALA regulations.