HospitalInspections.org

Based on medical record review, staff interviews and document reviews, it was determined the facility failed to comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases by refusing to accept a patient from a referring hospital that was an appropriate transfer.This failure has the potential to negatively affect all patients receiving care from the facility.

Cross reference - 489.24 (f) A participating hospital that has specialized capabilities or facilities may not refuse to accept from a referring hospital an appropriate transfer of an individual who requires such specialized capabilities or facilities.

Based on medical record review, staff interviews and document reviews, it was determined the facility failed to accept a patient from a referring hospital an appropriate transfer of an individual who required specialized care of one (1) out of twenty (20) patients, patient #1. This failure has the potential to negatively affect all patients receiving care from the facility.

Findings include:

A review of the facilities Emergency Departments (ED) Central Log revealed Patient #1 was not listed in the log.

A review was conducted of a document titled "Patient Name (Last, First Middle)" time: 9:43pm, date: 8/5/24. The document contains a section titled "Comments: 8/5/24" which states, in part, "Patient was brought in by [significant other] as a walk in for assessment. [Significant other] reports that (Patient #1) has consumed an unknown amount of Ethyl Alcohol (ETOH) and sedatives (Xanax) ...Tried to call report to SMMC ED, the nurse (EMP #8) said (Patient #1) has a no trespassing there so is not allowed to go there. Report called to [other facility RN] at [other facility] at 9:35p.m.; also advised that SMMC unable to take [Patient #1] due to no trespassing order (concerned that patient may be violent and wanted them to be wary of that)."

A review was conducted of a policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," last reviewed 06/20. The policy states in part, "Policy: as required under the emergency medical treatment and labor act 42 USC section 1395 and all federal regulations and interpretive guidelines promulgated thereunder any patient who comes to St. Mary's Medical Center requesting emergency services, regardless of diagnosis or financial status, is entitled to and will receive a medical screening examination within the capabilities of the hospital 's emergency department, performed by individuals qualified to perform such examination, to determine whether an emergency medical condition exists."

An interview was conducted on 8/8/24 at 9:00a.m. with Emp #8. Emp #8 was asked about the phone call they received from [Psychiatric Hospital]. Emp #8 stated, "They called me about wanting to send a patient here. The patient was drunk and had hit their head. I told them this patient had just been 'no trespassed' so they can go to [other local acute facility]." Emp #8 was asked about receiving calls from [Psychiatric Hospital]. Emp #8 stated, "If it is their admitted patient, they give us the complaint and tell us they are sending. I clarified that [Patient #2] showed up at their door with their significant other, was intoxicated and had fallen in their lobby. [Psychiatric Hospital caller] said the patient's name is [Patient #2] and I said [Patient #2] been no trespassed and can go to [other facility]." Emp #8 was asked the name that she was given and Emp #8 states in part, I heard [Patient #2's name] but I know now it was [Patient #1's] name. It should be noted that Patient #1 did not have a no trespassing order against them.

A telephone interview was conducted on 8/8/24 at 9:35a.m. with [Psychiatric Hospital] Staff #1. [Psychiatric Hospital] Staff #1 was asked about the events of 8/5/24 that occurred at their facility. [Psychiatric Hospital] Staff #1 stated, "A person showed up in our lobby and was heavily intoxicated and fell in our lobby, striking their head. [Psychiatric Hospital Staff #2] contacted our physician, and they advised sending the patient to the ER. [Psychiatric Hospital Staff #2] called St. Mary's and told them about the patient. The person at St. Mary's said that the patient had a no trespassing order on them, and they could not take the patient. That person advised them to go to [other local acute facility]. [Psychiatric Hospital Staff #2] contacted [other local acute facility] and they took report on the patient." [Psychiatric Hospital] Staff #1 was asked if there was documentation as to who was contacted at St. Mary's. [Psychiatric Hospital] Staff #1 stated, "I am attempting to contact [Psychiatric Hospital Staff #2] to see if they remember the name because it is not in the documentation."

A second telephone interview was conducted on 8/8/24 at 1:25p.m. with [Psychiatric Hospital] Staff #1. [Psychiatric Hospital] Staff #1 states in part, [Emp #8] was the person that was contacted and told them to take the patient to [other local acute facility]. [Psychiatric Hospital] Staff #1 was asked if they were told St, Mary's was on diversion at the time. [Psychiatric Hospital] Staff #1 stated, "There was no diversion that we were aware of."

An interview was conducted on 8/8/24 at 1:30p.m. with Emp #4. Emp #4 was asked about the events of 8/5/24. Emp #4 stated, 'I agree one hundred percent (100%) there needs to be additional education. I'm not sure what [Emp #8] was thinking in terms of this being a transfer versus a non-patient being sent to us."