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Based on review of clinical records, review of Hospital Bylaws, Rules and Regulations, Emergency Department (ED) logs, and staff interview, it was determined the Hospital failed to ensure an appropriate transfer process was followed for all patients that presented to the ED (refer to A-2409).

Based on clinical record review, review of Hospital Bylaws, Rules and Regulations, and staff interview, the facility failed to ensure that, at the time an individual is transferred, a qualified medical person (as determined by Hospital Bylaws, Rules and Regulations) has signed a certification after consulting with a physician, who agrees with the certification and subsequently countersigns the certification, for 1 of 10 patients (Patient #1). This could potentially affect all patients who are transferred with emergency medical conditions.

Findings include:

1) A review of the emergency department record for Patient #1 on 01/31/12 at 11:45 a.m. revealed that Pt. #1 was a 59-year-old male who was admitted to the emergency department on 01/30/12 at 1420 (2:20 p.m.) with chief complaint of chest pain and shortness of breath for 10 hours. A review of systems and relevant past medical history were conducted by the nurse practitioner (Provider #1) at 1445 (2:45 p.m.), who diagnosed the patient with atypical chest pain and pneumonia. A Request for Transfer/Consent for Transfer/Certification for Transfer was completed at 1625 (4:25 p.m.) by Provider #1. There was no certifying physician signature or name. There was no other documentation in the clinical record that a physician had been consulted regarding this patient's transfer. This finding was confirmed with the Acting ER supervisor on 01/31/12 at 11:45 a.m.

2) Review of the Physician or Qualified Medical Person's Certification for Transfer section of the Request for Transfer/Consent for Transfer/Certification for Transfer form on 01/31/12 at 11:45 a.m. revealed the statement, "If the certifying physician is not physically present at the time of transfer, I have discussed the transfer with the physician named below, who certified the transfer and I concur with the certification." There was no evidence that the transfer had been discussed with a physician. This finding was confirmed with the Acting ER supervisor on 01/31/12 at 11:45 a.m.

3) A review of Section 2: Emergency Department, H., of the "Bylaws of the Medical Staff of the USPHS Indian Hospital (Red Lake IHS Hospital), effective June 6, 2011, revealed the statement, "Transfer to a higher level of care, if warranted, shall be implemented and executed consistent with Federal and State regulatory requirements, and with IHS and Hospital policies and procedures." There was no evidence of either a determination of qualified medical person or procedures to accomplish a transfer in the absence of a physician. This finding was verified with the Clinical Director on 01/31/12 at 12:30 p.m.