HospitalInspections.org

Based on review of facility documents and medical records (MR), and staff interviews (EMP), it was determined that the facility failed to accept from a referring hospital an appropriate transfer of an individual (PT1).

Findings include:

Review of facility policy "Emergency Medical Treatment and Labor Act", issued 12-08, revealed "PURPOSE: To develop a means to remain in compliance with all rules and regulations relating to the Emergency Treatment and Labor Act(EMTALA) which ensures access to emergency medical care, appropriate stabilization and transfer for all individuals presenting to Highlands Hospital for care."

Review of facility policy, "Medical Screening Exam ... 12-05-08 Date of Review" revealed "Policy: The medical screening exam consists of a physician evaluation and if deemed necessary diagnostic testing and therapeutic intervention ... All patients are stabilized within the capabilities of the hospital prior to disposition."

1) Review of MR22 (PT1's medical record from another hospital) revealed that the patient presented to [other hospital] ED on March 03, 2010. Further review of MR22 "ED History and Physical" revealed "[PT1] was reevaluated by me prior to transfer to Highland's Hospital. [EMP6] was the accepting physician. The patient was stable at the time of my evaluation. [PT1] was alert and oriented, protecting [their] own airway and able to sit up independently. ... [PT1] is agreeable with transfer. Addendum: Time: 9:34 PM [PT1] was returned ... from Highland's Hospital because they felt that the patient's blood pressure was too low for them to handle on a psychiatric floor. ... reexamined the patient on arrival. [PT1] is unchanged from when [PT1] was transferred. [PT1] is alert, oriented and stable neurologically."

Continued review of MR22 (PT1's medical record from another hospital) "Trip" sheet from Fayette EMS (Emergency Medical Service) dated March 3, 2010, revealed " History of Present Illnesses PT Being TX to Highlands Hospital after being treated and evaluated at [Other Hospital] for OD. PT medically released by ED MD to be TX (transferred) to Highlands 1 West for Psych Evaluation, PT Rejected by receiving facility, they stated PT not stable, requested pt be TX back to [Other Hospital] ED.

2) Review of MR1 revealed "Mental Health Clinical Interview Form" dated 3-3-10, revealed " ... Clinical Information Presenting Problems: ... medically cleared ... last B/P 86/49 - Told [staff at other hospital] that patient was lethargic/unstable and would not be acceptable on the MH unit. [They] reported that patient [had already] left [other hospital]. [They] were informed to call ambulance and tell them not to bring [pt] back to the unit. Patient arrived at HH-MH unit via Fayette EMS. Fayette EMS was told that patient not accepted at this time."

2) A telephone interview with EMP7 on March 22, 2010, at 10:35 AM confirmed the above findings that patient was sent back to transferring facility and further stated "Initially, I did accept the patient. ... I saw the patient at the door, and that was all. It looked like [pt] was crashing ... I told them [EMS] [the transferring hospital] should have called them and sent patient back. I told them [EMS] that [the transferring hospital] was expecting [pt] back."