HospitalInspections.org

Based on record review, policy review and staff interview the hospital failed to follow their policy and did not accept an appropriate transfer request for one patient (patient #2) from Hospital A out of 21 sampled medical records selected from April - October 2011.

Findings include:

- Hospital policy titled "Emergency Medical Treatment and Labor Act (EMTALA) Screening, Treatment, Transfer and On-Call Roster Policy" reviewed on 10/25/11 at 3:00 PM
revealed on page 9 of 10, under H: Accepting Patient Transfers:

1. Mandatory Acceptance of Transfer. The hospital (including ED (emergency department) physicians and on-call physicians) shall not refuse to accept requests for transfers if the patient is in need of the specialized capabilities or facilities available at SVRHC (Stormont-Vail Regional Healthcare Center). The only exception to this prohibition is if the SVRHC lacks the capability or capacity to safely treat the individual.

2. Acceptance Procedure: a. Capability and capacity: When a request is made to accept the transfer of an individual from another facility, a physician in the appropriate speciality shall be contacted through Health Connections (transfer line) to determine whether acceptance of the transfer is appropriate based upon SVRHC's capability and capacity to treat the individual.

- SVW (Stormont Vail West, the Behavioral Health unit) policy titled "Admission Policy" reviewed on 10/25/11 at 3:30 PM revealed the following:

All requests for psychiatric services are triaged and assessed for the appropriate level of care. Inpatient Admissions: SVW accepts patients for admission who meet criteria and demonstrate the capacity to sign in as a voluntary patient. Adult Admission: 1. The Adult Unit accepts for admission, voluntary clients 18 years of age and older. 2. Imminent and/or potential danger to self and/or others with an inability to guarantee safety...If the patient meets admission criteria a QMP (Qualified Medical Personnel) may accept the patient...For patients who are accepted for inpatient, copy the intake...Attach a copy of the screen for self-pay and Medicaid.

- Review of a SVW "intake assessment" on 10/25/11 at 4:00 PM revealed ED physician D from Hospital A contacted SVW on 10/23/11 at 8:10 PM to request a transfer for patient #2 that required emergency psychiatric care admission. Patient #2 had presented to Hospital A with thoughts of hanging self. Registered Nurse A on 10/23/11 at 8:10 PM documented on the intake assessment form the request for transfer. Registered Nurse A documented she informed ED physician D that the patient required a MHC (Mental Health Center) screening because patient #2 received Kansas Medicaid benefits. Staff A gave ED physician D telephone numbers for MHCs to call and arrange a screening. Staff A told the ED physician D to call back if he had difficulty arranging the MHC screening.

Physician C, psychiatrist at SVW, interviewed by telephone on 10/25/11 at 10:03 AM explained he was the psychiatrist on-call/duty on 10/23/11. He received a telephone call from Registered Nurse A who conducted the intake assessments on 10/23/11 regarding the request for transfer from Hospital A for patient #2 who had thoughts of hanging himself.

Staff B, Administrative Director of Behavioral Health at SVW, interviewed on 10/25/11 at 11:22 AM verified they were aware of the request for transfer of patient #2. Staff B verified that what Registered Nurse A had told ED physician D was SVW's process for admitting a Medicaid patient. Staff B stated that if ED physician D had called back they would have probably admitted the patient and requested a MHC screening themselves. Staff B explained SVW does not take/admit violent or court ordered patients.

Patient #2's ED record from Hospital A reviewed on 10/27/11 at 2:28 PM revealed the following:

Patient #2 presented to their ED on 10/23/11 at 6:50 PM with complaints of suicidal ideation for the past six hours. Patient #2 planned to hang himself from a tree using a chain. ED physician D conducted the MSE (Medical Screening Examination) determined the patient was at risk for suicide with a credible plan. ED physician D called to SVW and requested the patient be transferred to SVW for admission to their psychiatric unit/facility. ED physician documented SVW told them the patient required a MHC screen because of financial policy. ED physician D documented SVW refused the transfer request for emergency psychiatric care for patient #2. Refer to Tag 2411 for further details.

Based on record review and interviews the hospital failed to accept patient #2, when the hospital had the capabilities and qualified staff to provide the necessary care and treatment for one out of 21 sampled medical records selected from April - October 2011.
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Findings include:

- SVW (Stormont Vail West, the Behavioral Health unit) policy titled "Admission Policy" reviewed on 10/25/11 at 3:30 PM revealed the following:

All requests for psychiatric services are triaged and assessed for the appropriate level of care. Inpatient Admissions: SVW accepts patients for admission who meet criteria and demonstrate the capacity to sign in as a voluntary patient. Adult Admission: 1. The Adult Unit accepts for admission, voluntary clients 18 years of age and older. 2. Imminent and/or potential danger to self and/or others with an inability to guarantee safety...If the patient meets admission criteria a QMP (Qualified Medical Personnel) may accept the patient...For patients who are accepted for inpatient, copy the intake...Attach a copy of the screen for self-pay and Medicaid.

- Review of a SVW "intake assessment" on 10/25/11 at 4:00 PM revealed ED physician D from Hospital A contacted SVW on 10/23/11 at 8:10 PM to request a transfer for patient #2 that required emergency psychiatric care admission. Patient #2 had presented to Hospital A with thoughts of hanging self. Registered Nurse A on 10/23/11 at 8:10 PM documented on the intake assessment form the request for transfer. Registered Nurse A documented they informed ED physician D that the patient required a MHC (Mental Health Center) screening because patient #2 received Kansas Medicaid benefits. Staff A gave ED physician D telephone numbers for MHCs to call and arranged a screening. Staff A told the ED physician to call back if they had difficulty getting the MHC screening.

- Staff B, Administrative Director of Behavioral Health at SVW, interviewed on 10/25/11 at 11:22 AM verified they were aware of the request for transfer of patient #2. Staff B verified that what Registered Nurse A had told ED physician D was SVW's process for admitting a Medicaid patient. Staff B stated that if ED physician D had called back they would have probably admitted the patient and requested a MHC screening themselves. Staff B cnfirmed that a bed was available on the psychiatric unit on 10/23/11 when Registered Nurse A received the call from ED physician D. Staff B stated that the SVW psychiatric unit is locked and secured, the windows are made of safety glass, and all patient beds are bolted to the floor. Staff B also stated that 2 seclusions rooms are present on the psychiatric unit and restraints are available if needed. Staff B explained that if a patient is placed in the seclusion room, the patient is placed on one-to-one observation. Staff B confirmed that Medicaid patients are normally screened by a MHC prior to admission.

- Patient #2's ED record from Hospital A reviewed on 10/27/11 at 2:28 PM revealed the following:

Patient #2 presented to the ED on 10/23/11 at 6:50 PM with complaints of suicidal ideation. Patient #2 planned to hang himself from a tree using a chain. ED physician D conducted the MSE (Medical Screening Examination) and determined the patient was at risk for suicide with a credible plan. ED physician D called SVW and requested the patient be transferred to SVW for admission to their psychiatric unit/facility. ED physician documented SVW told him the patient required a MHC screen because of a financial policy. ED physician D documented SVW refused the transfer request for emergency psychiatric care for patient #2.

- ED physician D from Hospital A, interviewed by telephone on 10/27/11 at 8:40 AM confirmed that patient #2 presented to the ED after threatening to kill himself. ED physician D stated the patient had a credible plan/threat to kill himself by hanging. ED physician D confirmed he called SVW and requested a transfer for patient #2 due to suicidal ideation because Hospital A was not capable of meeting the patient's psychiatric needs. ED physician D stated the intake staff at SVW told him the patient needed to be screened by a MHC because he received Medicaid benefits. ED physician D stated he felt like SVW "flat-out" denied the transfer. ED physician D confirmed he arranged to transfer patient # 2 to another hospital with a psychiatric care unit.