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Based on observation, interview, and record review it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to post Emergency Medical Treatment and Active Labor Act (EMTALA) signs likely to be noticed by all individuals that visit the emergency department (ED); and the failure to obtain transfer consent explaining risks associated with transfer for two patients (#5 and #20) of two patients reviewed for transfer from a total sample of 20.

See A-2402: Failure to post EMTALA signs at the ambulance entry and in patient treatment rooms.

See A-2409: Failure to obtain transfer consent for explaining risks associated with transfer for two patients (#'s 5 and 20).

On 10/02/19 at 1050 during a tour of the Emergency Department it was observed that the facility failed to have EMTALA (Emergency Medical Treatment and Active Labor Act) signage at the entryway of the ambulance corridor, where traffic enters through the ambulance bay. At the time of observation, Staff A (Emergency Department Manager), was asked where patients entering the Emergency Department via ambulance would see the EMTALA information. Staff A stated, "I'm not sure, there are no EMTALA signs other than the one sign in the walk-in entrance." Staff A, further confirmed that patients arriving via ambulance do not enter the ambulatory/walk-in entrance and waiting area.

Based on record review and interview, the facility failed to obtain written consent for transfer for two patients (#5 and #20) of two patients reviewed for transfers of the risks associated with transferring to another facility resulting in the potential of those patients not being knowledgeable of possible adverse events occurring during transfer including physical decline or death. Findings include:

On 10/2/19 at 1400 review of patient #5's medical record revealed the patient was transferred from the facility's emergency department (ED) to another facility on 8/2/19. The transfer consent sheet for patient #5, failed to include the patient's or the legally responsible parties signature consenting to the transfer.

On 10/2/19 at 1430 review of patient #20's medical record revealed the patient was transferred from the facility's emergency department (ED) to another facility on 7/28/19. There was no consent for transfer documented in the medical record for patient #20.

On 10/3/19 at 1250 Staff A was queried regarding the missing transfer consent sheets for patient #5 and patient #20. Staff G stated, "we've looked in both charts for any additional documentation regarding consent, that's all that we have." He said, the unit clerks are responsible for making sure the transfer paperwork and forms are completed and sent to the receiving facility."

On 10/3/19 a review of the facility's "Emergency Medical Treatment and Active Labor Act (EMTALA)" policy, dated last revised on 3/2019 revealed the following: "Transfer of Individuals", page 10, "2. i. Patients may be transferred out of the ED when the ED physician who has personally examined the patient, determines that the patient requires a higher level of care/service than that available at (name of facility A) or that (name of facility A) does not have the capacity to treat the patient. The ED or on/call physician who has personally examined the patient is responsible for arranging the formal transfer with an appropriate facility/physician." The transfer must be in compliance with this policy and appropriate documentation must be completed in the patient's medical record. 'Medically Indicated Transfer and Physician's Certificate of Transfer...The consent of the patient should be obtained and documented."