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Based on record review and interview, it was determined the facility failed to accept an appropriate transfer for one of one (#1) patient requiring possible surgical intervention not offered by the transferring facility. By not accepting Patient #1 the facility delayed the specialized treatment needed for Patient #1. The failed practice had the likelihood to affect any patient needing the surgical services provided by the facility for acute surgical intervention. Findings follow:

A. On 01/10/24, review of Baptist Health Fort Smith "Patient Care Policy, EMTALA (Emergency Medical Treatment and Labor Act) Guidelines," showed "The receiving facility should accept appropriate transfer of individuals with an emergency medical condition if the hospital has specialized capabilities or facilities and has the capacity to treat those individuals."

B. On 01/10/24, review of Baptist Health Fort Smith Transfer log for November 2023 showed Patient #1 was placed on the Intake Activity Log as cancelled after the initial referral denial on 11/13/23 at 10:34 PM.

C. On 01/10/24, review of Patient #1's clinical record from the Referring Facility dated 11/13/23 to 11/14/23 showed the following:
1) On 11/13/24 at 6:17 PM, Patient #1 was admitted to the Referring Facility's Emergency Department (ED) with sudden onset of RUQ (right upper quadrant pain). Had a known ventral hernia and pain was located at the hernia site. Hernia did not reduce and mildly tender after medication. Review of the Radiology Impression showed "Relative collapse of the large bowel leaving the hernia sac concerning for partial obstruction." Patient # 1 was given morphine 4 mg (milligram) and Zofran 4 mg. NG (nasogastric tube) placed while in ED due to partial SBO (small bowel obstruction) findings.
2) On 11/13/23 at 10:08 PM, Patient #1 requested transfer to Baptist Health Fort Smith. Baptist Health Fort Smith Access Center was called by the referring Physician. The Baptist Health Fort Smight Access Ccenter paged the surgeon and would call back.
3) On 11/13/23 at 10:24 PM, Baptist Health Fort Smith Access Center returned the call and said the on call surgeon refused to accept Patient #1 as other local hospital (Receiving Hospital #2) had multiple surgeons. The Access Center for Baptist Health Fort Smith was notified that the other Facility (Receiving Facility # 2) was on MedSurg (Medical, surgical) divert and Patient #1 had requested Baptist Health Fort Smith for transfer as he was due to see a surgeon there on 11/15/23 to discuss the same concern.
4) On 11/13/23 at 10:36 PM Receiving Hospital # 2 Transfer Center was contacted by referring Physician to explain situation regarding Baptist Health Fort Smith refusal to accept Patient #1 and need for general surgical evaluation. Patient #1 was accepted for ED to ED transfer to Receiving Facility #2 on 11/13/23 at 10:40 PM.

D. On 01/11/23 at 11:00 AM review of Baptist Health Fort Smith Call Center audio during teleconference confirmed findings in C.1 and C.2.

E. On 01/11/24 at 11:00 AM during a teleconference interview with Director of Patient Command Center at Baptist Health Medical Center - Little Rock (Central Access Command Center for Baptist Health Facilities), he stated, "Before 11/13/23 capability and capacity was the basis for acceptance of transfers. There was a meeting on the 11/13/23 and a new policy was put in place on the 14th (11/14/23). Before that there was no escalation process. Now Hospital Administration must be contacted before a Patient transfer is declined. Patient #1 should have been accepted. I will send the new and the old policy."

F. Review of the Policy, "EMTALA" with effective date of November 14, 2023 and updated December 27, 2023 showed, "When coordinating an Emergency Department to Emergency Department transfer (to include observation patients) and you encounter a physician refusing to accept the transfer, and the following apply: 1. The receiving Emergency Department is not on diversion. 2. The facility physician has the capability and capacity to care for the patient, and we are on no other diversion status that would impact capability and capacity then we should contact the Command Center Supervisor or Director and discuss the issue. It is important to ensure that this is a potential EMTALA violation based on physician refusal when there is adequate capability and capacity."