HospitalInspections.org

Based on interview and record review, the receiving hospital, H#2, failed to accept and provide care for Patient (P) #1 even though the receiving H#2 had the specialized capabilities to provide treatment for P#1. This failed practice delayed care for P#1 who was in pain and needed an evaluation to determine appropriate diagnosis and treatment. P#1 was transferred to another hospital, H#3 where an evaluation was performed and treatment was provided. The findings are:

A. Record review of the Emergency Department (ED) Note from hospital H#1 revealed P#1 presented to the emergency department on 06/17/18 at 19:15 (7:15 pm) "with a complaint of right lower quadrant abdominal pain (Dull pain near the navel or the upper or lower abdomen). P#1 was treated with Morphine (pain medication) and Zofran (medications to prevent nausea and vomiting) for discomfort." The ED note further revealed P#1 improved but needed a CT/CAT (computerized axial tomography makes use of computer-processed combinations of many X-ray measurements taken from different angles to produce cross-sectional images of specific areas of a scanned object, allowing the user to see inside the object without cutting is used for a visual image of soft issue inside body) scan and "we unfortunately do not have a CT/ CAT scan that is working."

B. Record review of Patient Transfer Summary from H#2 revealed the following:
1) A call was initiated for transfer of P#1 on 06/17/18 at 07:46 pm.

2) At 7:50 pm, staff S#4 from H#2 "advised Med/Surg (medical/surgical) beds are available".

3) At 8:00 pm, S#6 "denied the pt [sic]".

4) "Disposition: No physician Capacity, Status: Denied, Notes: None"

C. Record review of an undated and unsigned "Missed Admissions" form from H#2 revealed in comment section, "[Name of S#6] declined patient."

D. Record review of P#1's medical chart from H#3 revealed the following:
1) P#1 was transferred from H#1 to H#3 via ambulance.
2) History and Physical dated 06/17/18 revealed P#1 was admitted to H#3 at 12:00 am as "a direct transfer from [name of town] with acute RLQ (right lower quadrant) pain for the past 4 hours.
3) Consult Note dated 06/17/18 revealed P#1 "who presented to an outside ER [sic] yesterday evening with complaint of RLQ. Patient was transferred here for further evaluation. CT performed here demonstrated no appendicitis (a medical emergency that almost always requires prompt surgery to remove the appendix)."
4) An Addendum dated 06/18/18 revealed, "No surgical intervention recommended." P#1 was discharged on 06/19/18 diagnosed with "Enteritis (inflammation of the intestine) most likely of viral origin".

E. On 07/05/18 at 11:00 am during interview, ER physician (Dr) from H#1 stated P#1 required a CT scan and the scanner (at H#1) had "hardware problems".

F. On 07/05/18 at 1:35 pm during interview, S#3 from H#2 stated, "If we have the capacity and ability to treat, we will".

G. On 07/06/18 at 8:25 am during interview, S#2 from H#2 stated, "I was the administrator on call" on 06/17/18. S#2 revealed S#6 denied the transfer of P#1 as H#1 had the capability to care for the patient.

H. On 07/06/18 at 8:40 am during interview, ER attending from H#1 stated, "I talked to ER physician (at H#2), he wasn't helpful, he was rude. I wanted a CT scan and was told I could do an ultrasound. In my experience a ultrasound is not helpful. I was told you can surgically explore. No I said, never mind we'll handle it".