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Based on record reviews and interviews, the hospital failed to meet the requirement of §489.24 as evidenced by:

The hospital failed in its responsibility as a recipient hospital by accepting a transfer psychiatric PEC (Physician Emergency Certificate) patient(s) and not having available capacity/bed to admit and treat the transferred patient(s) at the time of acceptance by basing the accepted transfer on anticipated capacity/bed availability for 2 (#3, #5) of 2 patients reviewed for accepted transfers to the (recipient) hospital, who were later transferred to another hospital, out of 9 accepted transferred patients who were transferred to the recipient hospital out of a sample of 20. (See A-2411)

Based on record reviews and interviews the hospital failed in its responsibility as a recipient hospital by accepting a transfer of a psychiatric PEC (Physician Emergency Certificate) patient(s) and not having available capacity/bed to admit and treat the transferred patient(s) at the time of acceptance by basing the accepted transfer on anticipated capacity/bed availability for 2 (#3, #5) of 2 patients reviewed for accepted transfers to the (recipient) hospital, who were later transferred to another hospital, out of 9 accepted transferred patients to the recipient hospital out of a sample of 20.

Findings:
A review of the hospital policy titled, "Receiving Transfers of Emergency Cases from Other Hospitals", as provided by S2DON as the most current, revealed in part: The hospital will accept any appropriate EMC (Emergency Medical Condition) who requires specialized capabilities, provided the hospital has the capacity and the capability to treat the individual. Capacity and Capability means the ability of the hospital to accommodate the treatment of the transferred individual. If the hospital does not have the capacity to accommodate treatment of the individual, the proposed transfer must be refused.

Patient #3
A review of the patient's medical record from the transferring hospital (as per faxed information from the transferring hospital) revealed in part: The patient was admitted to the Emergency Room of the transferring hospital on 05/13/16 with a chief complaint of Manic Reaction. The patient received a MSE (Medical Screening Examination) by the transferring hospital's ER (Emergency Room) physician and was PEC (Physician Emergency Certificate) by the ER physician. The patient had been stabilized and was transferred to a Psychiatric hospital for further treatment. The receiving (recipient) Psychiatric hospital had agreed to accept the transfer of the patient and had confirmed the availability of adequate space and qualified personnel necessary for the treatment of the patient. The patient was transported to the receiving (recipient) Psychiatric hospital by ambulance on 05/13/16.

A review of the (recipient) Psychiatric hospital's EMTALA log on 05/13/16 revealed: Patient #3 was transferred to the Admission Intake area of the recipient Psychiatric hospital by ambulance transport and was later transferred to another Psychiatric hospital on 05/13/16. The recipient Psychiatric hospital had requested a transfer of the patient to another Psychiatric hospital and the patient was accepted as a transfer to the other Psychiatric hospital and was transferred by secured transport to another Psychiatric hospital on 05/13/16.

Patient #5
A review of the patient's medical record from the transferring hospital (as per faxed information from the transferring hospital) revealed in part: The patient was admitted to the Emergency Room of the transferring hospital on 04/13/16 with a chief complaint of Bizarre Behavior. The patient received a MSE (Medical Screening Examination) by the transferring hospital's ER (Emergency Room) physician and was PEC (Physician Emergency Certificate) by the ER physician. The patient had been stabilized and was transferred to a Psychiatric hospital for further treatment. The receiving (recipient) Psychiatric hospital had agreed to accept the transfer and to provide appropriate medical treatment. The patient was transported to the receiving (recipient) Psychiatric hospital by ambulance on 04/13/16.

A review of the (recipient) Psychiatric hospital's EMTALA log on 04/13/16 revealed: Patient #5 was transferred to the Admission Intake area of the recipient Psychiatric hospital by ambulance transport and was later transferred to another Psychiatric hospital on 04/13/16. The recipient Psychiatric hospital had requested a transfer of the patient to another Psychiatric hospital and the patient was accepted as a transfer to the other Psychiatric hospital and was transferred by secured transport to another Psychiatric hospital on 05/13/16.


In an interview on 06/02/16 at 12:00 p.m. with S7MD/Psych, Medical Director, he indicated that many patients (approximately 100 a month) are accepted as transfers to the Psychiatric hospital and then admitted to the hospital. He indicated that the hospital will take into consideration discharged patients with written discharge orders or a patient who was discharged and who was awaiting medicaid transportation, as an available bed when accepting transfers from other facilities. He indicated that infrequently the bed does not become available in a timely manner, usually due to medicaid transportation not picking up a discharged patient in a timely manner or as scheduled. The accepted transferred patient would then be transferred to another Psychiatric hospital.